receive dental services each year, and a large part of them are ...

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DENTAL RESEARCH AND DENTAL CARE 151

receive dental services each year, and a large part of them are of very high quality. For these services the American people spend each year between one-third and one-half a billion dollars-most of it in direct out-of-pocket expenditures on a fee-for-service ba~is, ome of it through taxation ( Federal, State, and local), and a small fraction of it through insurance payments of one kind or another. The total amount has varierl, within thi range, according to the level of our economy. Our population is not receiving mo1·e than a fraction of the dental services needed and it is not spending enough to pay for them.

Dental ervices of substantial nature, quantity, and quality have been largely limited to people who are in income brackets above the lowe. t levels. People on the lower rung of the economic ladder have been receiving much less service than those who are better off, getting along largely with emergency care, extractions, and relief of pain. The best available evidence suggests that not over 25 percent of the population receives anything like the needed, adequate, or regular dental care. About 75 percent 1·eccives very limited care, and this mostly for emergency services, or no care at all. The volume of accumulated dental neglect is therefore so large that several times the total annual dental manpower would be required to clear it up within a year. Indeed, the total dental manpower may not even be sufficient to take care of maintenance needs.

'l'here may be some differences among the experts about the precise figures that I have summarized in these generalizations; hut I believe those differences are minor and that the generalizations are valid. Any program for comprehensive and adequate dental care for the entire population, or for most of it, would involve not only an effective method of paying for the service, hut also a□ evolving program adapted to the capacity of the facilities for the training of enlarged dental personnel.

Dental diseases are the most prevalent of all disea es that affiict man. They are also the most neglected. The neglect is more prevalent among the poor than the rich; it is greater in rural areas than in the cities.

The5e deficiencies in dental ervices, with their deep roots in economic factors, are reflected in the numbers of dentists and in their distribution. You are aware, I as ume, that before the war the 70,000 dentists in the United States were heavily concentrated in the cities and more particularly, in the cities of the richer States. Six States, with less than a third of the population, had one-half of the dentists. A program for more adequate dental care will have to face the problem of distribution as well as the problem of enlargement of personnel.

Viewed in terms of total or average costs of dental care, the economic gradient in the distribution of dental services has no ready economic interpretation. Total national expenditures for dental care equal only about $3 or $4 per person. Assuming that the services are received by the equivalent of one-third of the population, these figures might be multiplied by 3, so that they are equivalent to only $9 to $12 per person receiving some dental care. These are not large figures. But the fallacy of such an average becomes plain if you take into account that one person who is served may spend only a few dollars on a dental ca e or in the course of a year, while another has to spend hundreds of dollars. When you take account of variations in cost, you have the hard core of the financial problem in dentistry .

IV It is generally agreed that the root causes of the present dental health needs

are fear of the dental chair, neglect of health, ignorance of the importance of dental care, and inability to pay the costs. There are some difference of opinion as to the relative weights to be given to these factors. It may be agreed, however, that a dental health program must deal with all four of them.

To deal with fear, neglect, and ignorance we must rely on education. There can be no disputing the need for greatly strengthened and enlarged programspublic and private-to educate the public on dental hygiene, the value of pe1·iodic examinations and prophylactic services, and on the receipt of needed treatment .and dental rehabilitation. An educational program is of the first moment in any plan for positive and preventive dental health.

In this connection and still emphasizing prevention, an obvious need is support-technical and financial-of a more adequate proirrnm than we now have for research on the causes of dental diseases, on methods of prevention, and on methods of diagnosis and treatment for dental diseases and defects that cannot be or are not, prevented. Nor are these sufficient in planning research. There is ~lso great need for experiments and careful observations on methods of dental

152 DE TAL RESEARCH AND DENTAL CARE

practice that may increas(' the effective use of manpowN' and the volume of so•yice, while reducing costs and safeguarding quality. I shall refer to these kind of research again later. But at this point I want to emphasize the importance of a program of research to enlarge the r ientiflc basis of dental services, vreyentiv and curative. There can be no doubt that what we are spending now for these purposes is rnueh less than is warranted by the prevalence of dental diSl'llSf>S and by the lack of ba ic kn0\\'ledge as to cau e · and methods of prevention.

Th<' dental profession has frequently pointed out that dental per onnel must be increased if needed services are to be furnished. Their stuclie show that the number of dental Rtuclents must be increased even to maintain the Nation's prewar number of dentists, to say nothing of augmenting that number. I gather this will involve enlargement of existing dental schools and also the establishment of ndditional schools. These various increases will have to be very large if the total number of dentists should be encouraged to increase by sometbing like 50 or 100 percent. In addition, there no longer appears to be any <loubt that the number of dental hygieni ts trained and pructicing under the direction of de11tistR should be ,er:v greatly increa ed. What de,·elopment is neeclf'd in the education and training of dental as istant is, I gathet·, still controversial.

These remarks on expansion of clentnl personnel must be interpreted with caution. New method for the pre,ention of caries or other dental diseases, and improved methods of dental treatment, may greatly reduce the future volume of nfed('d services or the manpower to furnish tlwm. Personnel estimates for years nheacl must take account of these possibilities.

Moreover, the various elements in a program for expansion of personnel must be C'Onsidered together. And this whole subject must be inspected simultaneously with a consideration of (a) the specific programs that are to be undertaken for service to various group in the population, ( b) the assurance of stable financing to pay for the augmented volume of services that can be furnished by the larger personnel, and (c) the methods (financial, recruitment, and supervisory) designed to insure the rational geographical distribution of the personnel. Obviously. no good cause would be served by encouraging expansion in personnel unless means were assured to enable the- public to utilize the enlarged resourcesand to pay for the services. l\Ioreover, the need to make efiectiv(', efficlont use of auxiliary personnel under the direction of qualified dentists should be accompanied by a11propriate aff'guards, in order that persons who were trained forlimitecl functions shall not hold themselves out to furnish unlimited erviees. But caution on this point should not mean negation. We should keep in mind the unfortunate mistake made in other countries where, largely for lack of a concerted program, two or more clns es of independent dental practitioners. de,('lop('(). or in our own country where the ame thing happened in respect to otber medical snvices.

IIavinp; touched upon the problems of personnel and their utilization, it is not inappropriate to mention the controversial question of organized practice. Dlfference>s of opinion about the use of group practice are, I know, especially large with rc-spert to office against clinic practice, and a between "generalized" and "specialized" group prnctice. I am impre , eel by the conRtructive way in which d('ntists are exploring thi: imbject, are (''{11erim1>nting with various techniques.. and are ])Janning actnal trials of new ideas. Because of needs that are very largf', costs that arc- inhe>rf'ntly high, and personnel shortages that will be incrPn~ingly a<·ute, there will be mounting pressur('S to find the most e>ffective and the mo. t economical mt>thocls of utilizing personnel in supplying <lental servi('e,:. De>spite understandable relucrnnces to change from traditional methods of praelice, we may assume that <lentif,tr:v will su1,ply the leadership for careful an<l ,igorons exp<'l·im('ntation ·n this field of fundamental importance.

The problems of costs can be dealt with in various ways: Direct individual payment. by the patient, ocial in. urance contributions, tax payments, andof course--various combinations of thesC' rnethrdc;. To what 1>xtent one method or another will he coupled with one type of service or another, or with services for one population group or another. I cannot say and, I believe, no one can conficlt>ntly prcclict at this time. We should be aware of the diverse possibilities.

Every comprehensive exploration of this snbject must start by taking nccount of the huge volume of acrumulated neglect. But from this initial point, opinions at once diverge. Some think that there would be an overwhelming demand forservicl' if payment wt>re assured in advance; and that, accordingly, a service promise that cannot be fulfilled should not be made by the financial plan. Others..

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think that some increase in demand would appear, but that it need not be expected to exceed the capacity of available personne1, especially if the capacity to serve is increased by such methods as can be introduced rapidly-use of multiple chairs, auxiliary personnel, organized clinics, etc. 'l'bis basic que tion needs much more careful evaluation than it has received.

Some who believe that the YOlmue of accumulated uPglect is insurmountable, urge that a beginning be made toward prpventing a similat· accumulation for the future, by concPntratin~ on J)reveutiYe and remedial services for children. Proposal;: to provide adequate services for children baYe obvious merit, and will U1l{l0ubtPdly have strong support. I hope tliey will be examined carefully, especially to be sure that they are extended to all children, that they are freed from any eonsideration of a means test, and that they are kept clear of any stigma of indigency or so-called dental indigency. Should a program of dentistry for children be financed out of general tax funds or by the method of social insu1·ance? The answer to this question will, I suspect, be greatly influenced by what Rinmltaneous provisions are made for adults.

Apart from the program for children, therP are alternatives as to sen-ice programs for adults-ranging fron. nothing up to comprehensive provisions for them . with many possible intermediates. I assume that any financial program for adult dental care will probably be financed by social in urance rather than by general tax funds, or will be financed by combinations of insurance, taxatio1~, and individual payment -but with substantial insurance participation in the finances.

You know that the ·wagner-Murray-Dingell bill, proposing an expanded system of social insurance coverage and benefits, included comprehensive provisions for medical, bospit'al, and laboratory services. It did not include dental ervices. In tead it provided for a study and a report of this subject within 2 years after the medical and related benefits become availablP. 'l'be sponsors of the bill in Congress have explained that they were not ready to d cide just what dental benefits should be included, and how they should be fin'anced as between the social insurance sysMm {that is, all potential beneficiaries) and the persons served {that is, the actual beneficiaries).

I single out the Wagner-Murray-Dingell bill for mention in this connection because it has been receiving widespread attention and it is a good illustr'ation of the importance of the subjects I have been briefly reviewing.

V

Fortunately, the outlook for dealing with the problems of dental health is not as bleak as might appear from emphasis on problems. Programs-many of them-h'ave been advanced from many quarters. The principles recently adopted by the .American Dental As ociation obviously deserve main attention. The new association statement on dental health fo1· the American people r ts on fom· points-adequate provision for research; stronger provisions for dental health education; dental cm·e for all, reg'ardless of income or geographic location; and participation by the representatives of the association in the planning of dental programs. The association and the denti ts of America are to be congratul'ated on a progressive declaration of policy.

I have already expres eel my agreement with proposals for re earch and dental health education. I can add equally unequivocal agreement with any proposal to pt·ovide adequate c'are for children. I am somewhat uncertain, however, how to correlate the proposition that "all available resources shoulcl first be usPd to provide adequate dental treatment for children ancl to el'iminate pain and infection for adults" with the other proposition that "d ntal care should be available to all regardless of income or geographic location." [Italics added.]

If the proper meaning of these proposals is that-insofar as there are limitations of resources for servic~hildren should be given priority, but that the most acute needs of adult should 'also be met, then there is only room fo1· such differences of opinion as may reasonably result from the closer study of important details and of ways and means. If these proposals are intended to indicate support for the comprehen ive care of children but only for limited and emergency care of adults, they will-I expect-be criticized as being too re trictivP.

This recently 'adopted program of the American Dental Association differs, as you know, from proposals which were common during the la t few years. Some groups and individuals who subscribed to proposal for children's care, disregarded or neglected the needs of adults. It bas not seemed to me that such an extreme partiality between one fraction of the population an(! another was a

154 DENTAL RESEARCH AND DENTAL CARE

necessary consequence of a careful auditing of needs as against re ources. Moreover, it has seemed improbable to me that the adult public who would haave to pay for any dental service program-whether by one method of financing or another-would be ready to accept such a completely negative attitude toward their own needs. It is therefore e pecially gratifying that the principles 'adopted this year by the American Dental Association take some account of adult, as well as of children's, needs.

I proceed on the assumption that the American Dental Association statement of principles offers a sound and useful basis for joint study :111(1 planning by all who are actively intere ted in dental health for all the people.

VI

It seems to me that a comprehensive and adequate program for dental health may be summarized in the following eight points:

1. Financial and technic'al aid for dental research. 2. A greatly enlarg,ed and strengthened program for dental health education. 3. Provision of comprehensive care for children. 4. Provision of as comprehensive care as may be practical for adults. 5. Expan ion of service personnel ( dentists and 'auxiliaries) through enlarge

ment of educational and training facilities. 6. Financial provision to assure--(a) Effective and adequate support of professional personnel and facilities,

rationally distributed geographic'ally. (b) R eady acce s of all persons to needed and available dental services. (cl 8tability and adequacy of funds to pay for service . 7. Profe sioual participation with the public in planning and in administration

of a dental-care program, and professional direction to safeguard the quality of the services furnished.

8. Economical provision of service, without sacrifice of essential qualitative standards.

Such a li ting of elements is, of course, vague and non pecific, in part because it doe not repeat all of the detail which it entails and in part becau e I do not profess to have specific answers to all of the questions that are involved.

It may interest you to know that we have recently initiated technical studies of these subjt?cts a a joint undertaking of the Bure'au of Research and Statistics in the Social Security Board and of various divisions of the United States Public Health Service. Other agencies of the Government that have an active interest in these studies are also collaborating. We plan to explore both the social insurance and the public health approaches to the prnblems. We expect to have the technical aid and the advice of dental consultants who have been actively engaged in studying various asp cts of the problems. If these studies are productive, it is planned to make the results available to the dental associations for study 'and discussion.

VII

I do not want to encl on a note that might seem merely to imply new studies for old. We cannot afford to forget that while one group or anothe1· is studying dental health problem , millions and tens of millions of people in the United States are developing dental diseases, are accumulating dental neglect, are uffering-needlessly-pain and damage to health. This is no plea for reckl '· s haste in formulating, adopting and implementing a com11rehensive dental health pro• gram for the 1·ation. But it is a plea that we get on with studies and experimentation, and move on to practical and realistic program planning an<l toward actual program operations.

Public interest in national health is widespread. It is fair to assume that provisions will be made in the near future for the strengthening of preventive and curative services. If pro,·ision is to be made for dental heulth, it is important and urgent that all who have useful contributions to mnke shall engage actively in the formulation of policies ancl plans. The progressive discussions being carried on by dental associations-National, State, an<l local-are groun1ls for encourag ment and high hopes.

These sentimt?nts are especially appropriate he1·e--before the Penrn:;ylvania As ociation of Dental Surgeons. In the century rf its life, the as,;ociation ha,; seen the whole march of modem dentistry, from the humble beginnings of the profession to the present high levels of attainment. What is past, is only prologue. With

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the great opportunities that plainly lie ahead, you can, I believe, proudly subscribe to the ancient prophecy: Your old men shall dream dreams, your young men shall see visions.

Hon. CLAUDE PEPPER,

ExnIBIT 21

THE UNIVERSITY OF ROCHESTER, SC'IIOOL OF MEDICINE AND DEN l"lBTRY,

Rochester 7, N. Y., June ZS, 1945.

Subcommittee on lVartime Health anct JMucation, United States Senate, Washington, D. a.

DE.\.R l\ln. PEPPER: 0

1\fay I express my appreciation for your invitation to appear before the health subcommittee of the Senate Committee on Education an<l Labor which will hold its meetings next week. I am, of course, deeply interested in the two bills, the dental research bill, S. 100, introduced by Senator l\lurray and the dental c:11·e bill, S. 1099, int1·oduced by Senator Aiken and yourself.

I have withheld an answer to your telegram and lette1· in the hopes that I could find my way clear to attend the hearings. Unfortunately, clue to the extreme pressure of urgent war work I cannot be present. I am sorry to miss this opportunity to talk with you and of preirnnting my earnest recommendation that the dental research bill, S. 100. be acted on favorably.

I wish to place before you one or two comments on the dental research bill, S. 190. First of all, dental research has been largely run in the past on a shoestring. This bill would represent an enormous increase in money available for dent,ll research. I am sure that many important advances in our knowledge of dental health problems would be derived from such an institute.

In section 4, parngraph ( c), may I pass along a suggestion concerning the grants-in-aid for research projects relating to dental diseases. I would recommend that gr::ints be nmde on a long-term basis, for example, 5 years wherever feasible. The practice of 1-year grants-in-aid for research has proved to be unsatisfactory.

I have no comments to m::ike on the dental care b·n, S. 1099. '.!.'hank you again for the invitation, and I trust that ::it . ome later date I may

have the pleasure of discussing these important matters with you. Very truly yours,

IIAROLD C. HODGE, Associate Professor of Biochemistry and Pharmacology.

EXHIBIT 22

INTERll\I REPORT OF TIIE INTERDEPARTMEN'.J.'AL COl\1l\1ITTEE ON DE TISTRY

Presented by the Minister of Health and the Secretary of State for Scotland to Parliament by Command of Ilis Majesty, November l!H4

I. INTRODUCTION

1. We were appointed on 8th April 1943, with the followinir terms of reference: "To consider and report upon-" (a) the progressive stages by which, having regard to the number of prac

tising dentists, provision fot· an adequate and satisfactory dental service should be made available for the population;

" ( b) the measures to be taken to S<'cure an adequate number of entrants to the dental profession ;

"(c) existiug legi~lation dealing with the practice of dentistry and the government of the dental profession;

"(d,) measures for the ncouragement and coordination of research into the causation, prevention, ancl treatment of dental disease."'

2. ,ve ha Ye already made a fairly wicle . uryey of our field of investigation. We have held fourteen two-clay meeting of the committee, b ,;ides subcommittee meetings, and we have received oral evidence from thirty-four bodies or personsseven of them on two occasions. We have also examined the written evidence

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of these and many other bodies. given either as a result of ~r>e<'iflc invitation or in response to a more general invitation which we Issued through the Press.

3. We are still engaged in our enquiry, and we are not yet ready to submit our full report upon the wide fiel(l of inyestigation which we have undertaken. We must therefore explain why we are submitting this interim report now, and what is its nature and purpose.

4. During our enquiry so far, we have taken note of the publi<'aticm of any Government proposals and the reports of any other committees which are relevant to our own subject. In particular, we have studied the proposals in the Government's White Paper on a Tational Health Service, und Rubseqnent pronouncements on those proposals, because they seem to us to be intimately related to our enquiry.

5. We note that the two IIealth Ministers are at present engaged in that period of di:;;cussion which the White Paper cont!'mplated must be followed by the submis~ion of legislative proposals for setting up the broad structure of the new h!'alth service. We understand that the lllinisters feel that they would be helped, both in their discussion and in their legislati,e preparations, if-pending the submis:;;ion of our full report-we cffPrecl to th!'m some int!'rim guidance as to the general principles on which we think they should be working, so far as the dental aspects of any new health service are concerned.

6. That is what we are endeavoring to do in Part III of this interim report. which attempts to set out shortly the main general considerations which we feel should be present in Mini,;ters' minds when they discuss, and later formulate, the main structure of the proposed i::ervic!'.

7. Bnt first, in part II, we take this opportunity of presenting a brief account of the present situation as we fincl it-an arcount of the cl!'ntal profession in this country, its history, government, education, and numbers present ancl prospectiYe; nlso on account of the main publicly organizec1 dental :;;ervices as they exist at present, their salient feature , and the public attitude to them, with our comments on the present state of dental health of the people and its relation to their general state of health.

8. \Ve hould like at once to a ·knowledge the great help we hav!' received from so many sources in conducting our difficult task so far, and to misure all who ha,e furnished us with information and ,;uggestions that without them we could never have obtained the detailed picture on which we are able to ba e our recomIUendations.

II. THE PRESENT SITUATION

9. In the pages which follow much is said which is already very familiar to those acquainted with the practice of denti try and much is omitted which it would have been interesting to include; our aim, however, bas been to give a succinct account of so much of the present position as will form an adequate background for our recommendations as to the future.

(I) THE DENTAL PROFESSION

10. It was the Denti~tR Act, ]878, which fir t made the profession of dentistry subject to statutory regulation and provided for the formation of a register of "persons specially qualified to practice as dentists." The act prohibited unregister!'d practitioners from acfopting the title "dentist" or "dental practitioner," hut it did not effectively prevent th!'m from practicing, and the evils of such practice are vividly described in the report of the Departmrntal Committee set up to investigate them. This Committee, whos!' Chairman was th!' Rt. Hon. F. D. Acland, l\f. P., afterwards Sir Franc!,; Arland, reported in 1019, and one part of its recommendations was given legislative effect in the Dentists Act of 1021.

11. This act restrict!'d the practice of dentistry to registered dentists, registered medical practitioners, and, to a very limited extent, registered pharmacists: the performance by any person of minor dental work in rrny public dental :;;ervire was permitted under certain conditlon11. At the same time the act provided for the admission to the register, subject to rert11in conditions, of bona fide practicing dentist of some years standing, and some other,; without qualification under the act, if they applied within a time limit. Under this act, too, companies carrying on the business of dentistry must confine themselves to d!'ntistry or some ancillary brn,iness, and a majority of the directors, together with all the operating staff, must be registered dentists. (There was some saving for existing companies.)

12. Dentists have formed themselves into three professional associations-the British Dental Association (incorporated in 1880), the Incorporated Dental

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Society (dating back under another name to 1892 and representing particularly the dentists admitted to the register by the 1921 Act), and the Public Dental Service Association (instituted in 1922 to represent particularly dentists giving service to insured persons).

Government of the dental profession 13. The 1878 act placed the government of the profession in the bands of the

General Medical Council. The 1921 act provided for the establishment of the Dental Board and brought in the present arrangements which are descril~ed below. It will be seen how the functions of governing the profession have been divided between the Council and the Board.

14. When acting under the Dentists Acts, the General Medical Council includes three additional members selected by the PriYy Council from those members of the Board who are registered as graduates or licentiates in dentistry. The Board itself includes a Chairman appointed by the Privy Council, three lay members appointed one each by the Minister of Health, the Secretary of State for Scotland and the Goyernor of Northern Ireland, three members appointed by the General Medical Council and six elected registered dentists.

15. The General Medical Council ha,e certain duties laid on them with a view to securing a proper standard in the examinations conducted by licensing bodies and in the curriculum of dental schools. The Dental Board have no such duties but they have a duty, after paying certain prior charges, to allocate any money received by them to purposes connected with dental education and research or any public purposes connected with the profession of dentistry in such manner as they-with the approval of the Council-may decide. The Board are respon ·ible for the registration of dentists, but the regulations made by them for this purpose requirf' the Council's approval. It is for the Council to "re<'O"'nize" the certificate produced by any dentist coming from abroad and desiring to be registered in this country.

16. In matters of di~cipline, it is the Board who in,estigate the case and report to the Council and the erasure of a name from the Register or its restoration thereto requires the Council's decision. The Couneil control the registration of "additional qualifications." The accounts of the Board must be submitted to the C'ouncil.

17. The Board's chief source of revenue is the fee paid annually by dentists registered since 1921 for the retention of their names on the registe1·. This fee has varied between £2 and £5 (the maximum) from time to time and the income of the noarcl has C'orre;;pondingly varied from about £20.000 to about £50,000. In the years 1923-42 the Board has in round figures made grants to students totalling £217,000, grants to dental schools totalling £155,000 (£78,000 for buildings and £77,000 in aid of salaries), £73,000 in aid of J"(' eurC'h and £60,500 in aid of dental h('alth education. The e subsidies are worthy of special comment, coming as they do out of the pockets of dentists themselves.

Undergraduate education 18. There are fiye dPntal schools in London (at Guy's Hospital, King's College

Hospital, the Loudon Hospital, the Royal Dental Ilospital of London and University College Hospital), seven in English proYincial cities (Birmingham, Bristol, Leeds, Liverpool, l\Ianchester, Newcastle, Sheffield) three in Scotland (Dundee, Edinburgh, Glasgow), one in Nortliern Ireland (Belfast) and four in Eire.

19. Their total student cavacity before the war was b('tween 2,000 and 2,500. Apart from perhaps one professor and one or two other senior whole-time teachers, most schools were staffed largely on a part-time basis paid or honorary. Before the war close on 400 students entered the dental schools annually, of whom about 10 percent were women; roughly one-third of them came from beyond daily traveling distance. From certain schools women students ·are excluded.

20. After passing an examination in chemistry, physics, and biology, students proceed to the study of other subjects common to medicine and dentistry, and dental subjects. To a varying extent, dental studrnts receive instructions in the former alongside medical students with whom they share the available facilities. A high proportion of time is spent during the first 2 years on practical dental mechanics.

21. Students may study either for the degree (B. D. S.) or the licence (L. D. S.) ; in the former case the educational standard for entry is the same as for other degree courses; in the latter, it is in most cases somewhat lower. The length of the course leading to the license is on average about 5 y('ar ' ( including the year spent on "premedical" subjects) ; the <l('gree course is rather longer, except in London. The majority of students take the license.


22. The dental licensing bodies are, in England, the Universities of Biriningham, Bristol, Durham, Leeds, Liverpool, London, l\fanchrster and Sheffield and the Royal College of Surgeons of England; in Scotland, the University of St. Andrew's, the Royal College of Surgeons of Edinburgh and the R:>yal Faculty of Physicians and urgeons of Glasgow; iu Ireland, the Queen·R Univen,ity of Belfast, the Univer~ity of Dublin, the National University of Ireland and the Royal College of Surgeons in Ireland.

23. 'l'he cost of the whole course leading to the license varies between schools from about £230 to about £::!5::>; that for the degree eon1•sp varies fnpn about £270 to about £300. These figures ex<'lude the cost of books and in truments which may be put at about £75, and the <·ost of living, which at a conservative estimate could not be less than £100 p '.'r awmm. 'l'hus the total expense of training and qualification could nowhere be less than about £ 00, and it would usually be much higher.

24. At most schools dental students enjoy good social and athletic facilities; at some, limitrd hol'<tel accomodation is available.

25. Since 1921, no fewer than 1,358 students have received grants or loans from the Dental Board. Though of the greatest value, tlleSf' grants, which were discontinued at the beginning of the war, did not pnrport to meet more than a prcportion of the total expem:es. Very few grants from other sources are held by tudents, though some are a sisted by local education authorities, or from benefactions.

26. So far as the United Kingdom dl'ntal schools are concerned, the English provincial schools, and those in Dundee and Belfast are integral parts of Universities; in three of the~e rnses the Unh·ersity managrs or shares in the management of the a sociatecl d"ntal hospital, in the remaining six cases the dental hospital is under separate authority, on which the educational authorities may, or may not, b:> represented. The London dental schools are affiliate<l to the University but their clo est link is with the associated dental hospital which (with the exception of the Royal Dental Ilospital) is itself part of a general teaching hospital. The Edinburgh and Ghffgow clental schools are extra-mural and the management of the school and hospital is one. ThuR, some dental schools are more closely associated with Universities, other with hospitals, while in some the management of all three is very closely integrated.

27. l\Iost schools have c-crtain fnc'lities for drntal research but the time of the staff i o fully occupied with teaching and administrative duties that little re earch is pof'sible.

2 . The dental hospitals were established to give treatment to the poor, and provide facilities for the clinical training of dental stuclent . Under existing conditions the treatment given necessarily consists of extractions and the provision of dentures to a greater extent than is desirable from the educational standpoint. Contributions from patients account for the bulk of the hospital revenues. Neither the ho~pita!s nor the schools are in a financial position to exprnd or improve their faciliti 'S in any marked degree without considerable assistance. Post-grad1wte education

20. Post-graduate instruction is prQvided for newly qualified dentists through a limited number of "house'' posts available at the dental hospital..

3'). For general dental practitio11ers, refrei;;;her courses dealing with various aspects of general practice have bPen promoted and mssisted by the Dental Board since 10'.:'3. The e courses have been a1Tangl'fl in various cities either by the dental sthools ancl hospitals or by the local brandies of the dental associations; hut in general, the demand for the courses has not been large.

31. Little provision has been made for specialist post-gracluate training. A number of dental practitioners have, however, rc•ceived post-g1·aduate experience in the Eastman Dental Clinic, particularly in dentistry foi: children.

Dental manpower 32. The Government Actuary bas furnished us with valuable advice on the man

power poi,;ition ancl we reprodlH:e in AppPnclix A a Table (I) in which he shows the distribi1tion of dentists on the Dentists R 'gistel' at the f'll(l of 19-!2 according to age, acldre. s, and natul'e of qualifications; it will be seen from thi Table that on 31st DeC'embn-, l!H2, the names of 13,lH~ dentists were include<! 011 the Register, of whom 12,812 were estimatE>d to be engaged for some pa rt of theil' time in private practice or in the service of local authorities. This Allpendix also repl'oduces another Table (II) in which the Government Actuary shows the estimated num-


ber of dentists available in the future, on the basis of stated numbers of new entrants (re ident in Great Britain) to the register immediately after the 31st December, 1942. These estimates have been based on the experience of the past as to (a) the proportion of those on the Register who take an active part in, private or public dental practice (these have been retkoned as devoting their whole time to dentistry ancl this may be a slight exaggeration, though no other reliable assumption could have been adopted), ( b) the probable wastage by death and other causes in various age groups, {c) the age clistribution of the dentists added each year to the Regist<>r. Ile has also assumed that of the dentists serving with the Armecl Forces the proportions appropriate to their ages will be available for a general dental service after the termination.of hostilities. The number of entrants to the profession until 1047 can be estimated with accuracy, since they

" are already undergoing training in the dental schools; thereafter the position becomes progressively more conj ctural. There is ome practice of dentistry under a medical qualification and without dental registration, but the numbers concerned are small.

33. There are two salient features in this position to which special attention should be paid. 'l'he first is that the bulk of those dentists who were admitted to the Register under the special provisions of the 19:.!l Act (see paragraph 11 above) are now in the age-groups above 4~. with the result that the total number of names on the R "gister i heavily weighted in these higher ap;e groups; and in the next few years there will be a cun-esponclingly ra1id loss of names from the Register by retirement. 'l'he second feature is on the recruitment sicle. The average annual entry rate to the Register (of those resicling in Great Britain) in recent pre\Var years wns about 310. A compared with this, in the war years the annual student-entry ratt' has fallen to below 300, and it mu, t be remembered that something like 10 pen:P11t of these who brcome $tudents do not (for one reason or another) het•ome dentists. This wartime student entry rate has thus fallen to about 100 below the c·orrrspo11cling prrwar nveragr rate and to about 150 below the wartime quota permitt<>d by the Ministry of L'tbour and Nationnl Service.

31. 'l'hr~e figures are not nearly sufficient to maintain the Register even at its present Rtrengtb. It will be seen from Table (II) in Appendix A that if the numher entering the profession annually were to rise to 400 in the years 1048-52 and to 423 tbN·eafter, it would !:itill be about 30 years before the present effective total of the proft>ssion would be incr<.>ased. This is an alarming forecast and we have no reason to think it will be substantially falsified unless vigorous measures are taken. Ancillm·y dental ivot·ke1·s

35. Dental drrsscrs: Under the Dentist Acts, provision was made for the performance rf minor dental work in any public dental srrvice by person not register<.><l undt>r the actR, provided that sueb work was carried out under the personal supen-is;on <1f a regiRt<>recl dentist in a<'cortlance with conclitions approved by the l\1inister qf Ilralth after consultation with the Dental Boarcl.

3G. 'Ihe conditions thus approved rl'quired that a rrgistere<l denfo;t should be present when operative work was being carried out and that be must not supervi e more than two persons at one time if operating himself, or more than six persons at one time if not operating himself; be must also prescribe the treatment, inspect every case afte1· treatment, and take respom;ibility for the efficient ca1 n·ing oilt of treatment. Dri>~sers were at first permitted to insert or remove dre,:sing!'I or temporary fillings but their work was subsequently limited to cleaning and polishin!( and cel'taiu clerical functions.

37. Little use of <leutal dn'ssers has bern made by local education authorities, ancl it is nnclerstootl that at the present time there is none emplored in the public dectal services.

38. Thr Royal Air For<'e have during the presi>nt war employed selected pe1·~0111wl known as di>ntal hygienists on the cleaning and polishinp; of teeth aocl the maintenance of oral hygiene. At present 32 in all are so employed at 14 :stations and 12 are under training.

39. Dental attendantR: The majority of dentists have surgery assistants who inclnd<> in thc>ir cluties the prP-operative and subsequent care of patil'nts, Rterilization of instruments. preparation of materials, aml maintenance of apparatus; they are not permitted to carry out any work in the mouth. They may also make appointments for patients, keep recor<ls of treatments, and di charge other cle1·ical duties. Very few of them are registered nurses, and with the exception of oceasiorrnl short courses, no training has been available to them other

160 DENTAL RESEARCH A D DENTAL CARE

than that given by the dentists employing them. Recently two organizations of dental attendunts have been formed.

40. Dental mechanics: The dental mechanic is an essential part of any dental service; he constructs dentures and other appliances to the design and under the supervision of the dentist, who takPs the ''impressions" of the mouth and carries out all subsequent chairside procedures. At present the arrangements for the proper training of dental mechanics are inadequate. Formerly it was the- practke to serve a formal apprenticeship, but for economic and other reasons this practice has been largely discontinued in recent years and systematic instruc· tion in dental mechanics is not widely available. There are understood to be some 8,000 or so dental mechanics in the country. They have lately begun to m·ganize themselves through the medium of two 'l'rades Unions and a Joint Council of repres,mtatives of the dental profeRsion and mechanics has been established.

'l'he carce1· of dentistry 41. It will hardly be conte ted that at the present time the career of dentistry

is relatively unattractive to boys and girls iu e01upa1•isou with other professional careers, especially medicine. We have b,·en told that not a few who take it up do so becuu:,,e there is no room for tliem in the rnc-dical schools. The work itself i apt to appear unplea ant and of restricted scope until its scientific interest begins to be appreciated; and there i , of neces~ity, little scope for specialisation. Prnctisi11g dentists feel that th<>ir work has not an important pnough place in the mind of the public, and in the local authority clental services they complain in many cases of lnck of access to the responsible comtl'ittee of tlte authol'ity. l\lany local authorities have no chief dental officer responsible for the org,lBisation and working of their dental sen·ices. 'l'be opportunitiPs wltic)l do exist in the career are not, it is generally felt, macle as widely known as they might be, either to parents or to boys and girls when C'honsing their future vocation. Finally, the training is long a'ncl expensive and many parents cannot afford it for their children.

42. We have given a brief account of the prof,,ssion of dentistry-a profession in an early stage of its evolution, partly govern1>cl by the meclical authorities, with a prospective shortage of rnPmbers, an<l at present without great powers of attrac.tion as a career for the nrnjority of young pen1)l<'; a 1m,fession on the other hand which has, we are convinced, a gTPat future before it if it is <'nabled and encouraged to progress on the 1·ight lines, and a profession whose expanded services m1rnt be fully utilised in any rneasures for the improvement of the national health.

(Il) THE ExISTINO PUBLIC DEN'l'a\L SERVICES Arffl THI,; PUBf,IC ATTI1UDE ' TO THEM

The school dcntai service 43. In England and Wales there were, on 31st l\Ia1·ch 1938, 5,0!lU)75 C'hildren

on the r<'gisters of publlc elementary schools ancl -l70,003 J>upils on the rl'gisters of grant-aided secondary schools. At that date local education authorities were, by the effect of the Education Act and the Board .of Education's Grant Regulations, under an obligation to provide dental treatment for public elementary school-children; they were empowered but not obliged to provide it .for pupils attending secondary schools ancl other institutions for higher eclueation.1 At the E'ml of 1938 the school dental staff, consisting of whole-time and part-time office-rs, was equal to 783 whole-time dentists-an average of one dentist to each 5,780 public elementary school-children in average attendance. In 1928 the corre~ponding fig11re was 1 to 11.300 children-a fact not irrelevant to the dental ill-health of the population, as described in paragraphs 50, u2, and 63 below. Progress towar<ls a sati~factory ~taffing standard bas bpen fairly steady but very slow and it was not until after the commencement of this war that it was pos:-<ible to rf'cord that every local education authority hncl a school dental scheme.

44. In 1938 about 3% million elementary school-children were dentally iui-peC'ted; some 216 million ,n-re recorded as rPquiring treatment and about 1.600,COO recei vefl treatment, though not all the treatment given was complete. Exprcssecl in another form, 70 percent of the 5 million children were inspected: 50 percent were r<'corded as ref[uiring treatmc-nt, arnl 33 percent received treatment. 'l'he acceptance rate (i. e., the proportion of those requiring treat-

1 The effect of the Education Act, 1944, Is referred to In paragraph 85.

,.


ment who received it) was 65.5 percent and each dentist treated on average 2,137 children.

45. In Scotland, the total school population of all ages (i. e., from under 5 to 18 plu ') in grant-aided schools at June 1944 was 751,000. Education authorities are by the effect of the Education Acts and the 8ecretary of State's Grant Regulations, under an obligation to provide dental inspection for pupils attending school in their areas, but the provision of treatment becomes a legal obligation only where the child is unable, through lack of it, to take full advantage of the education provided. Prior to the war the school dental seTTice was improving very slowly in staffing standards; since 1939 the quickened desfre of local authorities to increase their staffs is shown by an increase of <i3 percent in the numher of whole-time posts. The difficulty of filling all the new posts in wartime has proved insurmountable, but a wartime increase of 35 percent in the posts actually filled is shown at June 194.4, the number of dentists then employad whole time or part time being equivalent in aggregate to 02 whole-time dental officers. '.rhere is good reason to believe that throughout Scotland local authorities generally will much improve the staffing of their school dental serYice when normal times return. The number of children inspected annually at present is believed to be rather over 50 percent of the total school population, and of those found to require treatment the prnportion accepting it varies from below 50 percent to about 90 percent between localities.

46. Our evidence is conclusive that a keen local education authority, employing adequate staff and nlisting the cooperation of school teachers and parents, can stimulate a very high acceptance rate witllout any recourse to compulsory methods.

47. In Cambridge Borough the staffing ratio in recent years has been approximately one dC'ntist to each 2,000 public elementary' school children; the service is exceptionally complete and it is therefore instructive to note the statistics. All the children pre,sent are inspected each year, about 75 percent annually require treatment, and practically lCO percent of those requiring treatment accept it. There are other areas in England and Scotland with good records. In residential schools administered by some authorities, a satisfactory service has been developed and the children regard the treatment as part of the normal routine of their lives.

Maternity and child welfare services 48. In England and Wales, 407 local authorities of various types have a power

but not a duty to make arrangements, with the approval of the Ministry of Ilealth, for the care of expectant and nursing mothers and of chilrtren under school age. The majority of these authorities make some provision for dental attention as part of their arrangements. This provision, however, according to the incomplete evi(]ence aYailable to us, is in most places extremely meagre. Fo1· example, a routine inspection of either women or children by a dental officer was the exception. Few authorities arrnnged for "follow-up" inspections. A considerable proportion of those requiring attention did not attend for treatment and the tre'ltmrnt where given consisted, perbans of neces ity, largely of Pxtractions.

49. The 55 Scottish welfare authoritie1;; have similar powers. About half of them have made arrangement1;; for dental treatment bnt the actual nmonnt of treatment given in moi-t places is small. Even where ample facilities exist, advantage is not taken of them.

50. There are 1;:igns, we are told, that the younger mothers are beginning to appr<'ciate the valu 0 of conservative dentistry to an increasing extent, but this trend hns a very long way to go "l'Pt be"or0 the nosition can be called satisfactor:v.

51. The service for JwPsrhool children nired 2-;, who arP not at nursery schools presents some of the greateRt difficulties, as the mother is usually too busy with domestic dutiPS to bring the child for treatment. At nursery schools, however, a high rate of ncceptance is often found.

Dental benefit ttnder National Health Insurance 52. Those aporovPd societies; which are found at thPlr quinquennial valua

tion to have disnoRable surplus funds may, subject to Ministerial sanction, give certain statutory "additional benefits" to their members. Dental benefit is one of thPSP benefits, and it consists of the whole or nart paymPnt of the cost of approYPd dPntal treatment gi,Pn to members bv dPntists of their choice under nresrribecl conditions. A dentist is nnd<'r no obli1rntion to pro"l'ide trPntmPnt for insured persons. but if he does ia:o. he mn<:t providP all the treatment that is necessary to render the patient dentally fit. When treatment has been com-


pleted in accordance with the conditions the approved society pays not less than 50 percent of the cost. A few societies pay more than this. Payment is made on the basis of an itemised scale of fees.

53. Roughly two-thirds of the insured population, that is between 13 and 14 million people, are entitled to dental benefit, but only 800,000 (le · than 7 percent) of these claim it on average ea<:h year. (This percentage is commonly known as the demand rate.) The qualifi.:ation for dental benefit is a prescribed period of membership of a Society which works out at about 2½ years on average and can be completed, at the earliest at the age of about 17. Thus the boy or girl who leaves school at 14 has usually no assistance in obtaining dental treatment for those three important years. Approved societies can refer to regional dental officers of the Health D:>partments any case of proposed or completed dental treatment on which they desire further advice, and dentists themselves have a similar right.

(H. It i the common experience in insurance dentistry that people do not resort to treatment until a stage when the teeth are uusaveable and often there is gross oral sepsis.

Other services 55. D:.>ntal-teaching hospital or hospital departments, of which there are

fifteen in England and Scotland, and one in Jorthern Ireland, provide treatment for the poorer sections of the community, and many general hospitals arrange for some dental treatment to be given to patients. Rome authorities (such as the London County Council) make full provision for the necessary dental treatment for all patients in certain of their hospitals. Dwtal treatnwnt is also given as rart of the Emergenc-y l\Ieclical Rcheme of the Health Departmfints. Dental treatment i~ a particular feature of the arrangements made for the care of tubercnlou persons by the responsible authorities. 'l'he metropolitan boroughs of B rmonclsey, Finsbury, and Shoreclil<'h proYide treatment for their general population in municipal dental clinics at small chargrs. I~xtraction ancl the provi ion of dentures is often found to be the only possible form of treatment.

56. A large number of drntists are now serYing with the Armed Forces; we are, of course, precluded from giYing a <lei ailed account of the evicleuce we have been given on these services. bnt we have been impressed by the results obtainable and the willing service given under good organisation.

57. Broadly, then, the picture is of II number of public dental servicrs not clooely correlated and each with sborh'omings, and of a public ill-educated and apathetic in regard to the carC' of the te<'lh. This attitude ;;pring,-, w<' think, mainly from a natural fear of pain an<l la<"k of an~• real nn<lerstancling of the importance of dental health. Eronomic fadon, nrnst also contribute, but we are inclined to think that thry are of lrs effe<:t in this connexion than lac:k of education.

(ill) THE STATI; OF DF.NT.\L IIEAT.'fH OF THE POPULATION AND ITS RELATION ·ro GENElL\L JJE.\L'fH

58. The state of the clf'ntal health of our population il'I bad and its effect on thrir g!'neral health is bad.

rm. 'l'his view is ba, eel upon a mass of rviclenre whiC'h cannot all be reduced to the form of statistic,-, but as a i::amvle we give in Appendix Il table-· showing the dental condition of male and !Prnnlf' rec•ruit to the Army in the present war. This is Yaluablr as being concPmrcl with a lnrge and n•presentntiYe sample of the youn~rr age groups of the population, nnd ii will he seen that on average 90 percent of the men and l:-6 percent of the women requirPcl clC'ntal trt>atment on enlistment; 13.4 percent of thP men were in possession of essential artificial dentures and a fnrther 10 percent rpqnired them. r.rhrse fignrr::; are brnadly co1Toborated by the r'a\'y. They show both that the incidence of dental clii-:rn~r was high and that prior to enlif;tment the teeth of recruits had been much nrglected. Other figures tell the $Hille story.

GO. In Cambridge, it wn,; found in rn:~8 that only n.1 percent of the 5-year-old chilclrt>n examined had natnrnlly sound teeth; on ayerage each child had over four cl('cayecl teeth.

61. Of a group of 10,000 Scottish 5-year-old children exnminP<l betwC'en 1941 and 19-13, 1,000 only were found free from caries noel 70,000 teeth ,vere decayed or missing-7 out of each child's 20 teeth on average, nbout :. of these 7 being molar!:'. These figure refer to the temuorary teeth. Of R.700 G--to-13-year-olcl Scottish children examint>d in the 1,ame period it was found that the percentage of sound "first permanent molars" dropped steadily from 82 percent at age 6

, DENTAL RESEARCH AND DENTAL CARE 163

to 20 percent at 13, at which age 27 percent of these molars were carious but saveable, 20 percent carious and unsaveable, 25 percent lost, and only 8 percent filled.

62. One approved society in its experience, during one year, of the dental treatment of the young people betw~en the ages of 16 and 19, found that no less than 12.2 percent of those who applied for treatment had needed full upper and lower dentures.

63. At three large ordnance facto1·ies a representative sample of the workers was examined and it was found that only about 1 percent were dentally fit without the aid of artificial dentures.

64. It has indeed not been seriously ,disputed in any quarter that though there are signs of improvement among the younger sections of the community yet the generalization with which we began is amply justified.

65. There is evidence to show that the health of the teeth aud jaws are associated with systemic well-being, and that diseases of the mouth bring about morbid processes in the body. Since the onset of dental decay and inflammatory conditions of the gums, such as pyorrhea, is insidious, serious and even irreparable consequences may occur before treatment is sought. No useful purpose would be served by giving here an account of the many conditions which have been attributed to dental causes, but it suffices to say that dental neglect is responsible directly, or indirectly by lowering body resistance, for much avoidable suffering and ill hearth. Special reference may be made, however, to the fact that a diseased mouth may offer a portal of entry to infection and, by preventing response to treatment, prolong incapacity. Improvement in general health in children and industrial workers after the eradication of dental disease has been reported by several authorities. Where, as a result of neglect, extraction is the only possible treatment, masticatory efficiency may be impaired, and proper nutrition impeded, to say nothing of possible aesthetic and psychological effects.

66. Dental health is in a word an integral part of general health, and dental clisease contributes in no small measure to much general disease.

Ill. INTERIM RECOMMENDATIONS

An adeqiiate and satisfactory service 67. So much for the present state of affairs; it is a far cry to the ideal at which

we must aim and we have not deceived ourselves into thinking that a dental millennium will come any sooner than any other kind of millennium. Nevertheless we should like to put a brief statement of the ideal to be airn'ed at in the forefront of our recommendations. In doing so we shall make clear what we mean by an adequate and satisfactory service.

68. The ideal is that people should value the health of their mouths as of great importance in the maintenance of tl1eir general health and should seek by every means to preserve it. One of those means will be regular inspection and the treatment of any incipient defects, the treatment to include all that a constantly evolving science of dentistry finds efficacious and to be applied with all the skill that training can bestow. This treatment should be conveniently and promptly available when demanded, with the minimum of formalities and the maximum of personal freedom; and it should be paid for by the people not as patients but as members of the commtmity.

69. This very brief sketch of the ideal is perhaps sufficient when contrasted with the present state of affairs, to bring out the point that progress must be made concurrently on two sides: first, the stimulation of a demand more truly representative of the need for treatment; secondly, the supply of an ever more adequate service, including -preeminently an adequate number o:t; dentists.

70. On this last point we must be clear at the outset. We use such words as "shortage" and "supply" here, not in a theoretical sense as measured against the need for treatment, but in a practical sense as measured against the demand for treatment, present or prospective. There was before the war (accorc1ing to the evidence given to us by responsible and well-informed witnesses) no lack of dentists, over the country as a whole, to meet the actual demand for treatment. If the demand for treatment rose, in the future, to somewhere near equality with the real need for treatment, then there would be a shortage of dentists unless the numbers of the profession had increased pari passtt. It must be an object of policy to increase demand in this way; but the whole question of a shortage of dentists turns upon the probable pace of increase in demand and supply respectively. If, for example, a total annual demand rate


of the order of 10 percent to 20 percent were the experience in the next few years, and if vigorous measures were taken to make the career of dentistry attractive, we foresee no substantial shortage. If, on the other band, the annual demand rate rose rapidly to 40 percent or 50 percent and the numbers of t:tie profession showed no rapid increase, the shortage would be very serious.

71. It may seem ironical that the too great success of one object of policy should he a matter of anxiety with regard te the other; but it is not really so, if viewed realistically. A man who drives two horses in a race must drive them approximately at the same rate if he is not to be up et; but subject to this, he must drh·e them both as fast as he can. That is our object-to keep demand and supply in a rough equality, but still to make the quickest possible progre s in both. And the analogy will ~o a little further still; for just as one horse helps the other forward, so, we hope, will a greater demand for dental treatment encourage recruitment to the profession, and con,ersely a well-staffed ser.ice will undoubtedly stimulate the demand.

A comprehe,1,~i1:e sei-vice 72. The greatest single step forward which in om· view could be made at the

present juncture is the acceptance of the principle of a comprehensive ser,ice; that is to say a service which, while perhaps not yet wholly ndequate, will be equally available to all who demand it, and which will be paid for by the community as a whole. Let us consider some of the advantages of taking such a step now.

73. First of all, as we ha,e said before, there are two factors depressing the public demand for regular dental care, and of these the greater is, in om· view, lack of appreciation of the importance of dental health and the lesser is lack of menns. It is idle to seek to remove the first until the second has been removed; therefore, a a beginning we want to "divorce dental health care from questions of means" and thus begin to build up the demancl ; then can come the teadier and longer process of increasing public enlightenment about dental health.

74. Secondly, the Gowrument is proposing, as we are glad to note, to introduce a comprehensive health sen-ice. \Ve have shown that dentistry is not an adjunct but an organic part of health; therefore, it is important to the success of the health sen-ice as a whole that dentistry should, if possible, form an integral part of it on a comprehensive ha sis.

75. 'l'hirdly, the 'ational Health Ser ·ice proposals haYe now be~n followed by general propo,;als for social insmran<'e, which contemplate a comprehensiYe system of contributions., 'l'hesc- proposals, bC'tweC'n them, will supersede th<! pre ent framewo1·k of' National HPalth Insuran!'e in which dental benefit hns its place. If anything less than a comprPhensive scheme of dentistry is introduced it will be very hard, administratively, to st-cure that those now entitled to dental benefit arc not left with a justifiable sc-nse of grieYanc:e.

76. L:istly, we belien, that a comprehPnsive scheme, if it is framed and administered in a satisfactory way, will offc-r to the dental profession itself the best opportunity of attaining its rig-htful place in the public estimation. This is not the justification of the proposal: but it is an important consideration because it involYes the rc-asonable expectation, if true, that young men and women will adopt the career of dentistry in sufficient number to make the scheme a success. Plenty of work, adequate remuneration, goorl conclitions of service and the knowledge that dentistry is making an pssential contribution to national hPalth, will be, in our view, the best ways of encouraging recruitment to the profession, and securing that ready cooperation which must be the foundation of any satisfactory dental service.

77. So much for the reasons in favour. On the other side of the medal there is, of course, the question, can it be done'/ \Vill there be at any time such a demancl for treatment that the service available at that time will be hopelessly inadequate, and the scheme be thus disrredited?

7 . On a careful review of thP prooabilities we recommend the institution of a comprehensive dental senice from the outset. \Ve confe-.:s that we cannot rega1·d some temporary pxcess of dPmand over supply with any undue anxietyfor what would it mean? It would mPan that demand was coming closer to an equality with the true need; it would mean that much more was being done for the dental health of the pC'ople than ever before; and it would, we believe, soon bring an expansion in supply

79. Finally, we have already quoted the GoYernment's words that health care should be divorced from questions of personal means; to this we sub~cribe and we cannot see that if there were a certain shortage of d<'ntists those words would become untrue. If there should he a shortage, let it be shared b:v all

,,


80. We therefore recommend that when the National Health Service is Inaugurated, a comprehensive dental service should form an essential part of it. The possibility of temporary and local shortages should be frankly a<'cepted and stated; the position would, we think, be willingly accepted by the public for the sake of a scheme of comprehensive scope.

81. We are not in a position at this juncture to give our recommendations on a question which we have already consiclerecl deeply as bearing on the possibility of a shortage of dentists and on the future of th~ whole dental profession; namely, the question whether any dental work should be delegated to ancillary workers. We shall give our recommendations on this point as well as on the other topics remitted to us as early as possible.

Speciai classes 82. There are certain classes of the community who stand particularly in need

of dental care and who can benefit in a special way from it. Steps must be taken to see that that care is made aYailable to them and also that, so far as education and persuasion can go, they accept it. _

83. We have received a great deal of evidence in favor of a concentration of effort on the dental care of (a) expectant and nursing mothers, (b) children, and (c) adolescents. There are already, as we have shown, public services organised by local authorities which go some way towards rneetin~ the needs of these classes; namely, the S<'hool dental service and dental arrangements made by maternity and child-welfare authorities. Our concern is not to dispense with these services, nor to regard a genernl serYice as a substitute for them. but rather to strengthen and improve them by all practicable means; they must form 11s it were the sharpest point of attack of the dental force of the country upon dental disease.

84. The claims of these classes need hardly be argued. In the case of the expectant and nursing mother, the harm that oral disease can cause both to mother anrt child is well known. As regarrls the young it is not only that their health and de,elopment benefit in a special degree from dental care: a point ultimatE,ly of even greater significance is that if they come to a true valuation of dental health, our major problrm is solved not only for them in their adult lives, but also for future generations.

85. The way of advance in these services is already showing itself. The recent Education Act provides in Section 48 that local education authorities shall have the duty of securing the provision of medical (including dental) care for those who come within their province, and of encouraging and facilitating accrptance of treatment. vVe regard a big expansion of the dental services available to school children as one of the essential foundations of a comprehrnsive service.

BG. The Government is proposing further to create a new responsibility for providing all necessary health cai·e for the people and we hope that the Health Ministers will regard the provision of dental care for expectant and nursing mothers and young children as an important feature of any local health plans submitted to them for approval, and that they will make the progressive implemrntation of these plans a matter of continuing interest to their Departments.

87. Further, and more :renrrally, it will be in the special and immediate Interest of the health service to secure the eradication of dental disease in thoi:;e cases where it is seen to be contributing to general disease; whether this is to be done by referring the patient to the "general" service or by making special arrangements, e. g., for the treatment of hospital patients, will depend on the circumstances.

88. There are difficulties, too, however, in regard to the special classes-the adolescent at work, for instance. We express as strongly as we can the hope that employers will give their workers, and particularly the adolescents, time ofI without los of pay for dental treatment. An increasing number of employers have found it p0ssible to do this, and it makes all the difference at a crucial period of life. The provisions of the Education Act will result we trust lo more and more adole cents coming within part-time contact with education authorities. ,ve would stress that In their case too, the authorities should take their responsibilities in respect of dental care very seriously; otherwi!:'e rnuch pre,·ious expenditure of time and money may be thrown to the winds. The adolescent must not be left (to quote the Public Dental Ser,ice Association) in a "dental no man's land."

80. We have already referred to the difficult problem of the preschool child whose mother is too busy with household duties to bring him to a clinic or

166 DENTAL RESEARCH A D DENTAL CARE

centre for dental treatment. Nursery schools have prornd a great asset from this point of view; ancl possibly omething might be clone by the health visitor collecting children for visits to the dentist. It is a matte1· for the consideration and ingenuity of the local authority.

90. Before we leave this part of om· topic we woulcl record with satisfaction the attitude of respousible local government associations to the future of the public dental services which are the concern of the authorities whom they represent. The Association of l\1uni_cipal Corporations recognise that "the present p1·ovision of dental treatment in the local authority health , ·ervices is inadequate in all its branches." The Metropolitan Boroughs' Stan<ling Joint Committee infom1ed us that "the wicle extension of local authority dental services is in our view desirable." The County Councils Association recommended a statutory duty on local authorities "to provide for at least an annual or preferably biannual inspection and treatment for each child." '.l'he cottish local authorities, the teache1·s, and the medical officers of health took up a similar attitude. One local authority told us it had recently decided to quadruple the number of dentists in its services. The position of tile dentist in the viiblic dental service

91. It is of very great importance that dentists working in the public dental services should ha,·e cause for satisfaction and pricle in their work. The detailed couditions of service are a matter for negotiation between the Government and the profession; there are certain principles, howe1·er, which we think are fundamental. In the first place, there should be no compulsion on any clenti,;t to enter the public se1•vice; if he does so, it must be of his own free will, and he must be at liberty to leave it at any time shoulcl he so desire. Secondly. any dentist should be free to engage eitbPr whole time or part time in the public dental service, and in any brnnch of the servil'e in which there is opportunit~· to sel'l'e. 'l'hirdly, the patient must have free choice of denti t and the liberty to alter his choice if he so desires. In particula1·, we would emphasize that om· proposals are not designed or intended to interfere with the free right of everybody to seek his dental advice and care through private arrangements and by private fee, if he for any reason wishes to do so, or with the free right-which is necessarily complPmPntarv to thi,;--of any dentist to elect to practi. e privately for the whole or part of his time, if he so prefers. Our object is a service equally available to all, but not compulsorily imposed upon any.

General dental vmctitioner service 02. We e1wisage the iclPa of a gPnPral clPntal praetitioner Sl'l'Yire as b<'ing

broadly analogous in principle and structure to that of a general medical practilionf'r sen·i<'e althou/.(h the special fraturps and problems of dental practice will also need to be borne in mind. 'l'his "general service," as we have ealled it, should bf' available to an who wish to use it. The detailed a<lministrntive a1TangPmPnts will, of conrsl:', bf' 111atte1·s for discue;;sion br-tw<'Pn the Government and the dental profeHsion, but there is a point of principle whiC'h we wish to emphasize here. "'e are in full agreement with the Brifo,h Dental Assol'iation' view, as given in their memorandum of Pvicle1we to us, that "anr schpmes for a comprehensiYe d~ntal serviee must have aH it!, foundation tlw family." We recognize of course that a great part of the population today have no such relation with a d<'nlal praetitionP1· as i,; <·onvPyP<l by thf' term "family dentist"; but it must be an object of policy to encourage the llevelopment and growth of such a conception by all pos ible means.

Health centres !)3. The use of Health Centres as a medium for the provil,ion of dental treat

ment is a matter to which we have given careful consideration. Dental Ilealth Centrps will undoubtedly provide fa<:ilities for team work, and it may well be that in cl•rtain lol'alities thf'y will eITect economies in dental man-power and equipment.

!l. \Y\' note in connexion with the Go,·e1·n111Pnt'. prnpo,;als for a National Health Service tliat the fut111·e develot)mPnt of the "I!Palth Centre·• idea will clepen<l upon the result;; of a full trial of this mpthocl of or/.(anizing prnctice. We 1•pcommend thnt during the expe1·imental stage tlental I1ealth Centres should be established in suitable areas. We are of opinion that there should be local con~nltation with the profession not only as to the deYelopment, siting and ize of these Centres, but also as to their internal arrangement, design


and equipment. They may be either sPparate or (preferably) a part of the general llealth Centre where other kinds of care are received. We share the desire of the Incorporated Dental Society to see the services of dentitsts included wherever possible in IIealth Centres set up for the purpose of providing medical and surgical treatment. We see no reason why the dentists employed by local authorities should not operate in these Centres; on the other band we contemplate that they will mainly be staffed by those who elect to come into the ''general" service. Many denti ts may wish to work for only a part of their time in such a Centre, whether or not their whole time is devoted to public dental service; such a wish should be in our view be respected wherever it is practicable to do so. It is our considered view that there should be no kind of compulsion either upon dental practioners to work in these Centres, or upon patients to receive their dental treatment in them. It will in many cases no doubt be found convenient for a dental laboratory to be associated with the dental Health Centre.

Specialist services 9. We note in connexion with the Government' proposals for a National

dentistry, ·ucb subjects as oral surgery, orthodontics ( the regulation of cbil!lren·s teeth) and, to a lesser extPnt, radiology have come to be regarded as special branches of practice. It should be the aim of a comprehensiYe dental service to make available to those who need them, all necessary facilities for special diagnosis and treatment.

Oo-opemtion and co-ordination of the services 96. The comprehensive dental se1•vice as we see it will be made up of several

elements-the general service and the service for special classes, the separate p1·actice and the group practice in dental Health <'entres-and it is impo1·tant that these several <'lcments shouW be a source of strength and not of weakness to one another. Moreover it is in our view essential that full use should be made of the expert guidance of dentists in the planning and admini tration of the service, both centrally and locally. Further, the body with whom practitioners in any general dental pracititione1· service are in contract should be a dental body.

97. We cannot in present circumstances usefully comment on all the administrative details which will have to be settled; but we would urge in view of the limited dental man-power available that eYery possible step be taken to secure co-ordination and co-operation between the various parts of the service at all levels. To give but a single instance: in many places-those for instance in which dental Health Centres are established-it may be desirable tha the general ervice should assist the local education authority in regard to t e school dental service, that is, that the local education authority might ask some of the dentists practising in the Centre, without actually coming into their employment, to treat school children under the "general service" during certain se sions, the school authorities making all the arrangements for attendance, etc. In other places it may be that certain dentists will undertake part-time employment with ecl,ucation authorities devoting another part of their time to public general practice or private practice. Elsewhere, again, there will be whole-time clental officers of the local education authority, though we hope that any such whole-time employment will not prevent a dentist from enjoying a variety of work or binder those, for example, who leave school from continuing to visit a dentist whom they know. Our main point here, however, is that all such variant arrangements, suited to local circumstanceR, require close, friendly and continuing consultations between the various authorities concernrd and the representatives of the denti ts themselves.

98. We woulcl make one further point. Although the general ervice will beand clearly must be-available to member of the s1)ecial classes as well as others, this will not exonerate the appropriate- authorities from their special duties in re pect of these classe!s. In the case of local education authorities, for instance, we envisage that at the beginning of school life they will seek from the parent a general consent to the treatmeut of his children under arrangements made by them. If this is given it will be for the chool authorities to provide the treatment or-if they make use of the general service for the purpose--to make all the arrangements for attendance, and so forth. It will be for them, too, to encourage acceptance, and if they find on insvection that a child, whoi::e parent did not consent to his "school" treatment. has a neglected mouth, it will be for them to pres;;

-


again for this consent. The authorities for the special services are to take the initiative. The existence of the general service abrogates nothing from their responsibility, and their keenness will be vital to succes . The same is true of the welfare ervice. EYery expectant mother coming to a clinic shoul(l be dentally examined by a dental officer who should then (after consultation with the medical officer in 1·egard to the patient's general condition) decide on the treatment which is necesi;ary. Every authority on whom a duty for the provision of a dental scheme is placed should appoint a chief dental officer responsible to them for the organization and operation of the service, and thi · officer shoultl ha,e direct access to the appropriate committees of the authority. Such an arrangement does occur today, but it should be the general rule.

Dental-health education 99. We have shown already how far the genE>ral public is from appreciating

the need for regular inspection and treatment of the teeth, let alone any more po itiye or preventive attitude to oral health. The undoubtedly great efforts that haYe been made by the Dental Board, by indi,iduals, and by indh'idual authorities ha,e not yet produced the general state of mind we wish to see. Nor do we belie,e that any short-term publicity methods would do o. Our view is that the following elements should all be combined in a teady policy rather than a "campaign."

100. First, and by far the most important, will be the quality of treatment given to the public.

101. econdly, the health center offers (e.g., by means of lectures, films) great opportunities for dental-health education.

102. Local education authorities will ha,e the duty of encouraging children to accept treatment, and this duty can more easily be fulfill d if lessons include a rational teaching of the need for regular dental care. This is not to suggest that the encouragement should be delayed until the age when the explanation can be fully understood. We consider that dental hygiene should form part of school routine.

103. D ntal-health education should be one of the essential parts of the advice given at maternity and child-welfare clinics.

104. Material for publicity (e.g., films, posters) should be supplied from central sources, but they can never achieve success without the upport of local and personal effort. We agree with the Central Council for Health Education that valuable assistance can be given in dental-health education by a central organization, and also that "dental-health education and general-health education must be the concern of the authorities responsible for the dental and general health of the various sections of the public." Dental-health education should deal with questio of diet and dental hygiene as well as stressing the need for regular inspection and treatment.

105. We do not wish to separate dental from general health education; the one is a sentence on the page of the other. But we are anxious that that sentence should not be crowded out; rather than that, we would have it given a page to itself.

106. We recommend, therefore, that whatever central consultative body of dental experts may be set up should have a standing duty to keep under review the state of public enlightenment in dental matters and the measures to be taken from time to time to increase it. We have spoken before of "the two horses," demancl and supply. It is for dental-health education to keep demand well up to supply, and eYen a little ahead. Additional recommendations

107. There are certain further matters to which we take the opportunity of drawing attention now in the hope that the war may shortly be coming to an end and in antici1mtion of the situation which will then ari e.

10 . E,ery pos ible step should be taken to encournge suitable ex-servicemen and women to take up the profession of dentistry. We have had brought to our notice the further education and training scheme for helping ex-servicemen and women, and others in a similar position, and the Ministry of Labour and National Service is, we believe, aware of the need for dentists. We would urge, however, that this scheme should be interpreted liberally in the case of intending dentists, so that, for instance, an ex- erviceman or woman who 11<.d not begun a <lental training or who had even pursued some other vocation before the war shuold, if he or she is a willing and suitable candidate for the profession, receive the maximum assistance in seeking entrance to it.


109. It is imperative that dental teachers should be recalled from service with the Arme<l Forces to their peace-time callings at the earlies t possible moment compatible with general national policy. The public dental services will demand a greatly increased entry to the profession, and our final report will contain our recommendatious on this and kindred topics. The immediate point, howeve1·, is that the first need in order of time is for the adequate staffing of dental schools so as to cope with the anticipated postwar student-entry. 'l.'he schools are understaffed at the present moment to a serious degree: if they remain so after the war, the situation as regarcls dental maupower will deteriorate progressiYely. .

110. Much valuable dental equipment will, we expect, be disposable from the Dental Sen-ices of the Armed Forces after the war. ,ve cousicler that steps Ehould be taken by the Government at the proper time to make the best use of this equipment in the interests of the public dental services.

Conclusion 111. These are our interim recommendations; we know that their brevity will

not be taken as implying on our part either a superficial scrutiny of the facts or a hastily formed judgment of the requirements. ,ve have giYen to these problems the most earnest and careful consideration. Our conclusions deal with broad outlines rather than with administrative details. They are put forward with unanimity and with a whole-hearted conviction of their importance to natioual health.

We have the honour to be, Sirs, Your obedient Servants,

(Signed) : 'l.'eviot (chairman), L. C. Attkins, Freclk J. Ballard, E. G. Bearn, Robert Brndlaw, R. J. Brockelhurst, Thos. II. J. Douglas, W. Kelsey Fry, J. P. Helliwell, James F. Henderson, A. C. W. Hutchinson, H. T. A. McKeag, Thomas Rankin, W. L. Raynes, Andrew Rhearer, John Stewart," Gwendoline Trubshaw, Robert Weaver, Bryan J. Wood, Chad Woodward.

OCTOBER 19, 1944.

IV. SUMllARY OF RECOMMENDATIONS

1. A comprehensi,e dental service should be instituted as an integral part of the National Health Sen·ice at its inception. (Paragraphs 72 to 80.)

2. There should be a general dental practitioner service broadly analogous in structure to the proposed general medical practitioner service. (Paragraph 92.)

3. D ental Hea 1th Centres should be d ,veloped in conjunction with general Health Centres where suitable. (Paragraph 94.)

4. There should be freedom for both dentist and patient to participate in the servic<' are in contract should be a dental bocly. (Paragraph 96.)

5. Full use should be made of dental expert opinion in the planning and administration of the sen-ice, both centrally and locally. (Paragraph 96.)

6. The body with whom practitioners in any general dental practitioner service are in contact should be a dental body. (Paragraph 96.)

7. The appropriate authorities should pm, ide dental treatment for e."pectant and nursing mothers, children, and adolescents, anti should encourage acceptance of treatment. (Paragraph 98. )

8. An authority on whom a duty for the provh,ion of a dental scheme rests should appoint a chief clental officer to be responsible for the organization and operation of the ser,·ice. and to have access to appropriate committees of the authority. (Paragraph 98.)

9. There should be the maximum amount of cooperation nt all levels between the general sen·ice an<l the service for special clm,ses. (Paragraph 97.)

10. The hope is expres~ed that employers of labour will give their employees, especially adolescents, time off without loss of pay for dental treatment. (Paragraph 8, . )

11. Some of the menns by whir-h dental health education may be furthered are suggested. (Parr grarhs 99 to 10-l.)

12. Certain action to be taken when hostilities cease is indicated. (Paragraphs 107 to 110.)


APPE DIX A

TABLE I.-Distrib1dion of 15,192 dentists on the register Deo. 31, 1942, by late.~t address

Great Britain Elsewhere Total on register Great Britain

Dentists en• gaged at least part•lime in

Age last private practice Den• Den• Den• or service of birthday tists lists 0th• To· tists Others local authorities Acts Others Total Acts ers tal Acts Total

1921-3 1921-3 1821-3 Est!• Est!·

mated mated pro• num-

portion bcr -----------

Percmt 20 to 24 ..•.•... -------- 417 417 -------- 23 23 -------- 440 440 100 417 25 to 29 ..••.... -------- 1,387 1,387 -------- 50 50 -------- 1,437 1,437 100 1,387 30 to 34 ...••••• -------- 1,234 1,234 -------- 61 61 -------- 1,295 1,295 95 1,172 35 to 30 ........ -------- 1,162 1,162 -------- 43 43 -------- ), 205 1,205 95 1, 104 40 to 44 .••••••• 228 1,190 1,418 7 62 59 235 1,242 1,477 95 1,347 45 to 49 ........ 1,265 1,053 2,318 29 73 102 1,294 1,126 2,420 90 2,086 50 to 54 ..•.... 1,358 922 2,280 28 05 123 1,386 1,017 2,403 90 2,052 65 to 69 ....•... 902 583 1, 4 6 33 73 106 935 666 1,591 85 1,262 60 to 64 ..•.•••. 711 548 1,250 24 60 84 735 608 1,343 80 1,007 ------

651 I 4,585 ------------

Under 65 .•.... 4,464 8,496 12,000 121 5.'IO 9,026 13,611 (91.3) 11,834 65 to 69 ..•••.•. 445 467 912 10 33 43 455 500 955 75 684 70 to 74 ..•.•••. 205 187 392 6 17 23 211 204 415 65 255 75 to 79 ........ 61 68 129 -------- 6 6 61 74 135 30 39 80 and over .•.. 15 51 66 -------- 10 10 15 61 76 -------- --------

5,1901 9, 269 ---

Total.. .• 14,459 137 500173315,327 9,865 15,192 css. 6) I 12. 812

TABLE IL-Estimated number of denists in f1ittwe years resident in Great Britain

On dentists' register Dentists available for a general dental service

s ~ s .. - 8'2~ Survivors from Survivors from OOl

.t 0 ~~ -::,c,

~~ ... ""Cl a~~~ _,,

"' _., _., _.,

"' _., _,,, _.,

~'O e a:s-- c:d "'~ .,~ .,~ .,~ ... ""- .,--: .,~ .,~ .,~ ... ::, - ., Dec. 31 ""' ::, Cl ::, " ::,i::l~ §~ ""' "" "" ::li::1~ .,- f .... ~z 0~ """" Clo, <N =.,- 0~ c.,,-. ".,.,. =.,- I>°'" :,.- " ... r c ._; C .... ~ 1>- ~L~I C "-? i:I ... :B cc,~-:::? OCJ C:.c:I

·-"' °'="' .,~ .,~ ... ... __ .,, °'-;;~ .,~ ... .t:5 E~ I> =cl: " =l :§ I> AcJ: ~~5

- "I> ~.E§~ ;; ... .5 C) ~ ~~r-4 gor-4 ~~- 0 ::l :e Or-4 ~C)r-4 O"""'

"' "' .... ... 8 "' "' ... 8 "' (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (Jl)

------------ ------1942 ---- -- 14,459 ··i;:i52· -------- -------- 14,459 12,812 ··i;:i4:i. -------- -------- 12, 12 --------1947 ------ 12,843 -------- -------- 14, ms 11,013 ·"i;g53· -------- 12,356 ·····488 1952 11,089 1,301 1,967 -------- 14,357 9,140 1,254 -------- 12,347 1957 .::::: 9,259 1, 246 l,8P3 2,oro 14,4 7,306 I, 181 1,824 2,075 12,386 944 1962 ...... 7,434 1,185 1,812 4,101 14,532 5,578 l, 117 1, 717 4,013 12,425 1,374 1967 5,710 1,115 1,724 6,027 14,576 4,011 1,017 1,624 5,837 12,489 1,780 1972 . :·::::: 4,174 1,030 1,621 7,858 14,683 2,699 918 1, 4 0 7,563 12,660 2,150 1977 ..•...• 2,891 92 1,499 0, 581 14, 99 1,745 795 1,336 9,135 13,011 2,484 1982 ..•••• 1,889 802 1,350 11,173 15,214 1,063 647 1,156 10,555 13,421 2,773 1987 •. ...•• 1,146 653 1,167 12,607 15,573 542 492 941 11, 784 13, 759 3,008

..

DENTAL RESEARCH AND DENTAL CARE 171 .APPENDIX B

Table showing the dental condition of male recruits to the Army

.Age group PercPnt• age re• quiriog

treatment

Average conserva

tions required per man

Average extrac• tions

required per man

Percent• age In posses• sion of

essential dentures

Percent• age re•

quiring essential dentures

Oral hygiene percentage Avera11:e !----,------missing

teeth per man Good Fair Neg•

lccted

-·-----1----1•----------------------------18.......... . . . .. 98. 5 19-... ... ... ..... 95.4 20... ......... . .. 92. 5 21...... . ..... ... 91. 8 22........... . . .. 89.4 23.............. . 88. 6 24............... 85.4 25.... 82. 3 26............... 80. 0 'Zl ............ .. 92.0 28.. ........... 90. 0 29......... ...... 88. 0 30............... 87. 0

f-----1 Summary 18-30 90. O \

2.9 3.1 3.4 3.9 2. 7 3. 3 2.6 2.0 2.0 1.9 2. 0 1.8 1.6

2.5

I. 1 1.5 1. 6 .8

I. 5 I. 5 I. 1 I. I 1.0 1.8 2.0 2.6 2.1

3. 5 3. 4 3. 2 44 45 11 3. 6 3. 4 3. 5 32 00 8 8. 2 4. 9 3. 9 33 52 15

10.3 8.0 3.4 28 62 10 12.5 8.1 4.8 25 65 10 13. 4 8. 2 4. 8 30 60 10 15. 1 8. 3 · 5. 2 33 52 15 17.6 8.1 5.3 24 64 12 20. 0 7. 2 5. 4 29 57 14 18.1 10.0 6.0 17 53 30 17.2 14.4 7.1 17 75 8 17. 1 14. 0 7. 4 21 60 19 18. 0 14. 0 7. 8 'Zl 59 14

13. 4 1------io.oi---5-.1-1~ 58.7 ~

Table showing the dental condition of female recruits to tlte Auxilia1·y Territorial Serrice

Age group

17 -·············· 18 ........••••.. 19 .......••..•.•. 20 ......•. •.. .... 21. •••••••••••••• 22 ....••.••••... 23 .•... ....... •.. 24 ........... ... . 25 ...•....•.••...

Summary 17-25 ···•·•

Percent• age

requiring treatment

94 90 87 82 87 82 82 83 81

Hon. CLAUDE PEPPER,

A veragc Average Perce_nt• I Percent• Oral hygiene percentage conserva- extrac- age '':1 age Average

lions tions posscsswn requiring missing required required of rsJn• 1 essential teeth per Neg-per per uaxiliary Good Fair auxiliary auxiliary dcn~ures dentures Iected

------2. 5 .8 Til i\Til 2. 2 50 42 8 2.4 1.0 1.8 2. 2 2. 7 38 55 7 2.4 1.0 2.0 2.5 3.0 60 30 10 2. 7 I. 3 3.0 5.0 5.1 40 45 15 2.6 I. 2 2.0 5. 5 5.0 35 50 6 2.3 . 95 3.0 5.3 4.9 50 40 10 2.0 I. 5 4.0 7.3 5.0 66 26 8 2.1 1.1 6.1 6. 2 6.0 33 58 9 2. 0 I. 3 8. 5 7. 9 7.0 46 47 7

I. 06 ,--3-. 4-,--4-. 6-,--4-. 5-,--46_1 __ 45- ---9

EXHIBIT 23

DEPARTMENT" OF AGRlotJLTURE, Washington, July 31, 1945-

Chairman, S11bc-0111mittee on Wartime Health and Education of the Oo111mittec on Education and Labor, United States Senatr.

DE.\R SENATCR PEPPER: In accordance with your recent request to Dr. Mott, I am glad to suhmit comments on S. 100, the l\1urray National Institute of Dental Rf>!,earch Act, and S. 1009, the amendment to the Public Ilealth Service Act prnposed by Senator Aiken and yourself "to provide assistance to States in developing and maintainipg dental health programs and fo1• other purpose ."

In its C'IIorts to rehabilitate low.income farm families and to assiRt them to increase their production of food and fiber, the Farm Security Administration has rec-oi?nized since the eal"ly days of its program the vital importance of good ht>alth. ReprC'sentatives of the Department are familiar with the eriously adverse e1Iect on farm operations and on family life of chronic illness ancl handi• cavping conditions, including dental disease. On the other hnnd, the Yery beneficial effects of prompt and allequate medical an(! dental care, particularly pretentin• sen·ices, ban:? been i:=:een.

75979-45--12


In their effor.ts to help FSA borrower families get needed dental services, FSA county supervisors and other field workers have become acutely aware of the serious deficiencies in dental care resources in rural communitie . If anything, the shortage of dentists is even more marked in widespread areas than the better-recognized shortage of physicians. There are practically no dental clinics available to serve disadvantaged farm families such as those found in urban communities. It is only rarely that one finds either preventive or restorative dental care made available to children through school health programs or through programs of local health deparlments. It is no surprise, therefore, to find evidence of extreme dental neglect among thousands of families who have recei,ed loans from this agency.

In JD40 the Farm Security Administration made a survey to ascertain the health status of its borrower families. Physical examinations of 11,497 persons were made in 21 rural counties in 17 States. Of the individuals examined, 96 percent had significant physical defects, with an average of about 3 1/~ defects pet· person examined. 'l'he" most prevalent defect found was dental caries. A final analysis of the data collected has not yet been completed by the United Stales Public Health Service, but according to preliminary reports, 65 percent of the white persons and 73 percent of the colored were found to have carious teeth. Among individuals from 15 to 29 years of age, 85 percent of the white and 79 percent of the colored had dental caries.

Since the preventive aspect of dental care is very important, the status of the children's teeth as revealed in this survey should lie noted. Fifty-two percent of the white children from G to 15 years of age ancl GO percent of the colored children already had carious pet·manent teeth. So far as the care of the deciduons teeth is con<'erned, the examining denti!lt in one of the counties reported: "Of marked significance is the observation that of those clients exam. ined not one filling was found in the deciduous teeth surfaces. This in spite of the fact that there were found 2,303 deciduous surfaces definitely needing filling." After discussing the whole problem of caries, fillings, and missing teeth in bis report, this same dentist aptly summarized the problem as follows: "In other words, the implications are for these clients, teeth become carious, remain untreated, and finally are extracted."

As in the case of medical, surgical, and hospital care, the FSA bas attempted to help its borrowers get needed dental services and has sponsored a number of dental-care plans on a prepayment basis, either in combination with medical services or a separate plans. This program has been developed through understandings with State dental associations and through agreements with local dental societies. Under the program the families have been able to secure at least limited dental care at a cost which they can afford to pay.

The experience of the FSA in this field has been rather varied. In the great majority of plans, care has been rendered in the offices of private dentists. In a few cases, however, it bas been possible to help borrowet· families get the ad• vantage of a full-time dentist and a well-equipped mobile dental unit, particularly in i!':olated communities where care would otherwise have been virtnally unol:>tainable. Again, the great majority of plans have been financed entirely by the families themselves, often with the assistance of loans, whereas in a few cases the FSA has been able to extend direct financial aicl to health associations compo~ed of these families to enable them to enjoy more complete services. Experience has been gained, too, with respect to different method of payment for dental care. Most of the plans have been on a fee-for-service basis, but a considerable number have been on a capitation basis aud in some the local dentists have J)('C'n paicl on a pC'r hour basis or have been employed on a full-lime salary.

Largely because of the even more drastic shortage of dentists in rural communities due to the war, a considerable number of our dental-care plans have had to be discontinued. As of December 31, 1044, however, there was a total of 20,500 families, or lO;i,000 individuals, receiving at least limited dental care on a prepa~•ment basis in 304 counties in 23 States and Puerto Rico.

It would be difficult to estimate the amount of goocl that bas been accomplished through this program. Needed cat·e bas been ma(le available to thousands of families, many of whom had gone virtually without care previously. Many of them, too, have doubtless come to recognize the value in proper care of the teeth for themselves and their children. The program, however, bas been characterized by serious deficiencies which stem partly from the nature of the program and partly from the lack of rural dental resources. FSA borrowers simply <'annot afford to pay sufficient sums to purchase adequate dental services on a prepay-

..

•


ment or any other basis. The services in the program have accordingly had to be limited rather sharply, reducing their potential value to participants in the program. Another serious deficiency has been the lack of dental health education in rural communities through health departments, schools, or otherwise, which would result in recognition of the need and desire for preventive and restorative tlental serYices. There has been a lack, too, of modern dental facilities, whether in health centers, clinics, schools, or mobile dental units, together with a lack of young and well-trained dentists, particularly men interested in children's dentistry, not to mention the almost total lack of auxiliary dental personnel.

These deficiencies in rural dental services seem to stem from basic economic causes, notably the sheer lack of sufficient purchasing power am,)ng many rural people and also the geographic factors associated with a sparsely settled population. There are also what we might term educa ionrtl and psychological factors which I believe could be overcome quite rapidly through dental health education and through the actual experience of gettiug scientific dental care in up-to-date facilities. There is, of com·se, another vitally important factor, namely, the la.ck of knowledge as to how to prevent dental disease. The treatment of disease conditions, for the most part after they have occurred, seems extremely wasteful in terms of money, time, and effort.

Although I am not in a position to comment on the details of the proposed legislation. lam glad that consideration is being given to the problem of dental disease and availability of dental services. Rural and urban people alike benefit from active dental research and preventive work amorg children.

In view of the time element, there has been no opportunity to obtain a clearance from the Bureau of the Budget and we are, therefore, unable to say whether or not enactment of either or both of these bills will be in accord with the program of the President.

Sincerely, CLINTON P. ANDERSON, Secretary.

EXHIBIT 24

FARM SECURITY .ADMINISTRATION DENTAL Ca\RE PROGRAMS

(Prepared by subcommittee staff)

THE PTIOBLEM:

The Farm Security Administration has found that the problem of providing dental care of e,en a limited nature for FSA families with their stringent financial resources is a staggering one. The accumulation of dental diseases and neglect of dental care are virtually universal among the low-income farm families.

The job of furni bing dental care to farm families differs from that of proYidlng even limited medical care. Even if the accumulated dental defects could be immediately corrected, an expensive procedure at best; there would be a steady, almost mathematical, incidence of decayed teeth year by year. Gradually, the limited dental plans of FSA now in effect are at least making a beginning in the control of the vast amount of accumulated oral defects. One ba~ic objective is to establish programs which will be ready to keep up with defects as they occm: each year.

A further problem is to be found in the shortage nnd ma)(]istribution of dental manpower. E,en to a greater extent than ph. •sicinns, dl'ntists have settled in the larger towns and urban areas during the past few years, and at great rlistances from the farmers' homes . . Not only were there too few dentists in rural areas before the war, but the problem has become more acute as dentists have been drawn into the armed forces.

POLICIES OF THE DENTAL PROGRAM

In order to permit flexibility no set rules have been laid down in the organization of the dental programs. Plans are adapted to local neecls. The high cost of restoration dentistry (such as dentures and crowns) and the very limited funds of the borrower farm families have brought about the orl!'anization of necessarily very limited dental programs. Because of the vast amount of dental

174 DEN'l'AL RESEARCH AND DENTAL CARE

care needed and because of the lack of funds for adequate dental care, the Farm Security Administration dental programs are often designed to furnish protectirn dental care for children and only emergency work for adults. The desimbility of organizing more complete dental-care plans is increasingly recognized.

It i not the policy of the Farm Security Administration to set fees for dental se1·vices. In accord with a policy approved by the Am(->rican Dental Association, final agreements are made by the local dentists and the farm families, and the details of the programs are worked out with the local and State dental sccieties.

THE PROGR.li :I.I

Structure of dentcii vz1111s.-Because the principal FSA administrative component is in the county, the dental plans are generally county-wide. Often, however, families of more than one county (usually adjoining) form a district association.

FSA families participating in the rural rehabilitation program may have joine<l health plans which offer only dental ervice or they may have joined a health plan in which the dental service is in combination with other services sueh as general practitioner care, hospitalization, drug-s, or surgical care in any combination. If the plan otrers dental SP1-vices only, or if the membership of the dental plan is separated entirely from Rny other health plan, the dental program is called "separate." When dental care is offered along with one or more other health services, the program is classified as a "combined" plan. Both of the,:p types of programs are built around the principle of group activity. The "special" or "experimental" dental plan repre ent programs which have received extra administrative attention; they have been specially financed and all are unique in their organizational and manng<>rial structure.

l\IonE'y to operate the various plans com s principally from the families' limited rPsourcC's, which frequently is supplenlC'nted by loans from FSA. Efforts are bPing made to overcome the problem of insufficient family funds for adequate dental care by means of financial assi , tA.nce in the form of grants to the special and ex{){'rimental health association. In each plan the families' dues are placed into a common account, and denti ts' bills are paid by a bonded trustee from this common account. Family dues vary from $5 to $15 with an average of $7 per family per year.

Savices offered.-Dl ntal sen·ice olier<'d by the FSA clental programs range from extractions only to fairly complPtP care including dentures. Many plans, particularly the more recent onf'S, include special provision for protective care for children. Combined plans tend to limit their servicPs to extractions because the emplrnsis in such plans is usually on the as oclated medical ser\"ices rather than on dPntal rare. SC'parate plRns tend to give equA.l emphasis to fillings and extractions. Regular oral exRmination and radiographic services are perhRps thP lea, t frequent ser,,ices offPre1l.

Th<' moi-t eomplete care offered to the family was found in a certain type of individual separate plan, ince largPly cliscontinuecl, where the decision as to th<' services to be rPndC'red was left largely to the individual family and dentist, with FS_\ npproving their agreement. In plans of this type, however, much of the financing wa accomplii-hed by grants of Federal funds to the families, making it pos,:ible to consider more complete ervires. ( Such grants are no longer made by F8A.)

ThC' rnngP in coverage of services offerPcl depends principally upon thP intent of the prog-ram and thP way il was established, rather than upon Urn method of payment. Fee-foN::Prvice plans nre slightly more incln!live than those on R capitation basis. Th<.' few separate individual plans formerly in operation were thP most inclu,:ive of all. Extractions are offered most frequently; fillings, treatnwnt., prophylaxes, Pxaminations and X-ray diagnosis appear in plans in the frequency of the order named. l\Iost of the plans inc-lnde a charge for administrRtive purposes (trustee·s ~alary, postage, C'tc.) which averagP about !5 percent of the total fnncls available for dental car<>. A few plans offer extra s<>rYire,;, such as clC'nfure~, crowns. or bridges, by providing reduced rates for the familieR. ·when a rnembPr recC'iveR replA.cements on suc-h terms he pays for it out of hi,; own pocket, rntbPr than drnwing on the poolC'd fundi-.

A quantitatiYe mpasnre of the serviCC'S actually re<·eiwd by thC' families is difficult to dPterminP becan~P dentists usually are relurtnnt to furnish complete records of sPrvices rendered in thC'ir private offices. It is a rPaRonable guess,

•

DENTAL REiiiEARCH AND DENTAL CARE 175

however, that ap1lroximately 80 percent of the service furnished by local dentists to FSA families consists of extractions. '.rhe experimental and per hour plans have shown a greater emphasis on fillings than the u ual FSA rural rehabilita• tion dental programs.

During the fiscal year 1943-44, 87,287 was reported paid on the approved charges of dentists participating in the eparate dental plans and $12,525 in the combined dental programs. The dentists received 92.9 percent of their approved chargrs in the separnte plans and 93.6 percent in the plans combined with medical services.

States with group dental care for Fann Security Administration borrower families Dec. 81, 1944

Separate

State Persons

Combined with medical care

Persons

Total

Per• sons _______ ,, __ ----- --- - - - - - ----- - - --------

Alabama .. ... . ... 34 34 5,157 26, ~30 2 341 1,398 Arkansas . ...... 29 29 1,439 7.091 .... . .•.... .... . ......... Colorado. . . .. ....... I 1 5 22 .••..•............• ··• • -• · Georgia.. . ......... 65 77 3,497 18. 966 Idaho.. . .....• . ••. 1 1 35 179 J..:ans9.s ~------- --- ______ ____ _ __ _ __ ____ _ Louisiana... . . . . ... . 2 2 118 642

141 810 78 457

115 1,126 45 270

Michi~an . . . . ..... .. 2 2 23 110 ..•..... . . . ... •..... ··••-MississiJ_JPi ...... . 14 15 1, 370 6,595 Missouri.. . .... . ..•...•. . ..•...••••..... . .... ···· i · ··· ·6· ·•· 0·5 ·3, 77g" Nebraska ...................... . ........ -•• 6 7 232 1,189 New M exico.···-·· 1 7 320 1,352 1 1 1,145 6,103

~~i~~. ?~~~~i~~ : : ::: .... ~ ..... : ..... ~~ .... ~~ · · ·1· . . . "ii" .. . iiii .. · 269 Oklahoma ... . ... . 1 I 96 474 8 8 759 3,579 Routh Carolina ... 17 17 I, 220 6, 630 South Dakota..... . . ... . ........... . ...... . .. 1 13 · 3R8 ·2, j.j;j 'J'ennessec . .. ...... .•••.. ...••. ..•..... ..... 2 4 65 33~ 1'exas. .. . . . . . • . . . . . . 16 21 784 3, 652 28 31 I, 444 6, 833 Utah _ ·-· ··· -···· ·· 1 2 157 94 .. . . _ . ....•.•..••..... Yirginia . .... . ... .2 2 172 977 1 6 57 322 Washington .... . . . . 2 2 70 219 •-• • ·· . . .. . ....... ... ... . Wyoming......... . . ..... . .. . •.. . . ... . . .. . . ... 1 I 124 633 I' uerlo Hico.. ...................... .. .... .... 1 I 243 1,434

Total, 23 Stales and Puerto

35 29 1

66 2 3 3 2

H I 6 2 2 1 9

17 I 2

•14 1 3 2 I l

36 5, 49 28, 02S 29 1,439 7,091 I 5 22

78 3,638 19,776 2 113 636 3 215 1.126 3 lf,3 P21 2 23 110

15 I, 370 6,595 6 685 3. 778 7 232 I, 189 8 1,405 7,455 2 4n 283 3 69 269 9 855 4,053

17 1,220 6, 630 13 388 2, 144 4 6,, 333

52 2, 22R 10,4% 2 1.,1 94 8 299 1,299 2 70 219 I 124 633 I 213 1,434

Rico.. . .... . .. 100 215 14, 512 74, 716 58 9 6, 031 30, 687 248 304 20, 54 3 105, 403

E.rperimcntai and speciai plans.-Several rural·health plans which include dental care ha,·e receiYed considerable attention from l!'SA. Of five experimental plans for rural hralth developed in cooperation with the Interbureau Committ«>e on Postwa1· Programs of the United States Department of Agriculture, three include clental care as a 1mrt of the general health services. In adclition, two other special plans have been developed by FSA which, although not classified a,- experimental, nevertheless are also furnishing valuable experience in rural clental•health nwlhods.

The experimental and special plans have placed considerable emphasis on local aclministration by the farm fnmilie~. In each plan eligible farm families may beeome members of a nonprofit health assoc:iation, which is usually in• c:orporatNl. 'l'he membership of the health associations is compoi;;e<l either of families who derive the major portion of thefr income from agriculture or is limited to F, A families. Loral rontl'Ol i,; secured hy means of a board of di· rectors composed of elected representatives from the membership. The health association,; operate umler an approved ,:et of bylaws with the boards of di• rectors reiiiponsible for the operation of the program. Each board of directors has employed a full•time manager to run the affairs of the association under its supel'l'ision.

Dental•health services are fumished through agreements between the local dentists and the association , or by dentists E>mployed full time by the associa• tions. Three experimental plans with dental services use local dentist., whereas the special plans follow the pattern of employing full·time dentists who operate

176 DENTAL RESEARCH AND DJilNTAL CARE

in dental trailers or use portable equipment in rural clinics. In all plans considerable emphasis is placed on protective dental care for children. The plans place a greater emphasis on fillings than do the usual rural rehabilitation dental prcgrams.

Funds to operate the programs have come from membership contributions aud su1mlemental grants from FSA to the health associations. The experimental plans use the pooled, fee-for-service, proration system for payment for service, whereas the special plans have placed dentists on a full-time salary basis.

Conside1·able valuable information concerning rural dental services has been gained from the experimental and special plans. Briefly, it has become apparent that a full-time local manager Is invaluable in keeping the program going, maintaining membership and in generally conducting the affairs of the associations. Rufficient information ha been gained to show that the members of the associations have receivecl con,;icJerably more services from the local dentists where they were utilized, than was expecterl. Services received from the salaried dentists tend to be of- good quality and gi,e considerable emphasis to protecti,e care for children. Records of the eYperimental and special plans are far superior to those maintained in the usual FSA dental-care program.

EXHIBIT 25

ST.\TEMENT BY R. B. 1\-f.\RSTON, DillFCTOR, LEGIST.A.TIVE-FEDERAL RELATIONS DIVISION, NATION.\L EDUCATION ASSOCIATION

The broad purposes of S. 190 and S. 1099 are in accord with the objectives in health education advocated by the National Edu,,ation Association.

The gravity of conditions created by dental disease,; is not as widely appreciated as it should he. The penalties of poor dental health weigh heavily upon the welfare of our country. In productive enterprise they reduce the efficiency of workers and ref;ult in lo!Ss of working time. They adveri::ely affect family income. They undrrcut profits of invested capital. They disqualify many men and women for active military service in time of war. The general welfare has a vast st11ke in the irnprovemPnt of the dental henlth of citizem, eYerywhere. Because this is true it follows that the correctron of dental-health deficiencies and their future prevrntion is a proper object for Federal legislation. Data in i::upport of th<>se observations have been placed in the record and oa that account are not repeated h<'re.

Of the two bills under consideration S. 1009 is the more comprehensive in its attack on the problem of impro,ing the dental health of the Nation. Its emphasis upon research and investigations embraces the general purposes of S. 1()0 and in addition authorize grnnts to States and political suhdivisions to estrblish and maintain "adequate m"asures for the prevention, treatment, and control of such diseas;es, including dental-care programs for children."

In cloing the!';e things the program will in all probability lean heavily for its fulfillment upon the resources of the public schools of the Nation. The pre,ention of dental disease is largely a matter of educating youth just as the correction of had dental conditions ought to occur early in the life of such persone. g., school age. For these rca~ons it seems obvious that any comprehensive, worth-while program aimed at thE' "prrvention, treatment, and C'ontrol" of dental diseaf:es will inescapably depend to a vC'ry great degrl'e upon utilization of the facilities of public education.

Thrre are other substantial rensons to support this viewpoint. For 9 months of the yenr children are in school. The daily segregation of child population simplifies the admini tration of youth education. Tlw f:"hool hnilding is the mo!St available place for inf;truction in dental education, for dental examinations, and in f:ome instances for correcting dC'Dtal conditions exif'ting in our school-age population.

The program encompassed in S. 1099 thus seems destined to involve public education. Rection 316 (1) calls for "the trainin" of personnel for State and local dental-health work, and the devefopment and maintenance of effective means for the education of the public con,.erning dental dif;eases." Section 316 (2) authorizes grants "to l'ducational institutions and other nonprofit agencies" and for "the twining of peI sonnel participating in dental-health programs."

•

..


Regardless of the extent to which the proposed program involves utilization of the facilities of public education, the administration of that part of the program should be made the re'ponsibility of the regularly constituted educational agencies on the Federal, State, and local levels. Any other arrangement is impractical and subversive of the soundest p1:inciples governing FederalState relationships.

With this in mind, it follows, therefore, that whatever bill or bills Congress may enact should contain proper safegnarcls for the preservation and encouragement of State and local controls in the fielcl of education. Inrnfar as the proposed program involves relation~hips with education on the F<'deral level it is appropriate that it be ch:umelf'd through the United States Office of Education and on the State level through the State department-of education or other corresponding agency or agencies.

The selection of personnel, the administration, the courses of study, the methods of instruction. and the materials of instruction in respect to dental educa• tion, as well as dental examination and practice within any public-school system, should be determined in precisely the same way as in other fields of learning included in the work of the schools.

Such safeguards o,er State and local controls can and should be explicitly set forth in any bill the ongress sees fit to enact.

The foregoing observations are in support of the purpo es set forth in S. 190 and S. 1099.

Hon. CLAUDE PEPPER,

EXHIBIT 26

OFFICE FOR EilfER0ENCY MANAOEJIIENT, WAR .l\1ANPOWER COMJIITHSION,

Washington 25, D. C., July 18, 1945.

United, States Senate, Washington, D. C. DEAR SENATOR PEPPER: This is with further reference to your letter of June 22

regarding S. lflO, a dental-research bill. and . 1099, a df'ntal-care bill, now under consideration by a subcommittee of the Senate Committee on Education and Labor.

Regarding Senate bill 190, "A bill to pro,ide for, foster, and aid in coor<linating research relating to dental diseases and condition,;; to establish the National Institute of Di>ntal Research; and for other purposes"; and S. 10::JO, "A bill to 11.mend the Public IIealth Service Act so as to pro,ide assistance to States in developing and maintaining dental-health programs, and for other pm·po ·es"; the War Manpowf>r Commission bas the honor to submit the following information and recommendation:

The United States Selective Service Systf>m has accumulated a great den! of basic information concerning the dental condition of men being recruited for the armed forces during the la>1t G Y<'ars. ThC>se statiRtic·s reveal that of a total of 400,000 registrants reject<'d by July of 10-11, the largest i::ingle group, over 18 percent, or 75,000 men, w<'re rejC>cted for serious dental ill-health. This is the equivalent of five full infantry divisions which were prevented from serving during the most critical military period our country e,er facPd. A large majority of those accepted during the same period required a substantial amount of dental care before they wPre con,;ider<'d fit to train for active military ,;ervice. Dental standard;; for admi,;;;ion to the armed forces have Rince been drastically reduced nnd the Army and Navy have had to organize dental sen•ice programs to qualify over 1,000,000 men who otherwi,;e would have been rejected. During 1042, dentists at induction stations found that rpgistrants bad an average of more than six missing teeth, almost one derayed tooth requiring extraction per person, and just over one decayed tooth per person which could be saved by filling.

While these men were being rejected or rehabilitated, thousands of other men and women in the general population were suffering from equal or greater amounts of dental defects, which were reflected in rejections from employment, in complicating illnesses, and in lessened productive capacity during the increasingly critical periods of manpower shortage on the home front. It is selfevident, therefore, that a scientific program for the prevention and rontrol of dental disease should be adopted if the future military security, productive capacity, and well-being of our Nation ls to be improved. In order to accomplish these ends, it Is vitally important that a program should be devised which will accomplish the following objectives:


1. Intensified research to secure more information regardiug the causes of dental diseases, thus making preventive measures more effective and eventually decreasing the amount of dental disease;

2. A national program of dental health education to motivate people to utilize present methods of prevention and control of dental diseases; and

3. Programs for dental service, particularly for children, since the most effective prevention and control can be accomplished in this age group.

This agency's consideration of dental problems over the past 3 years in connection with the procuring and assigning of dental personnel to the armed forces and the civilian population bas demonstrated the fact that there is a considerable shortage of dental personnel to meet the accumulated and potential dental needs of the future. It is necessar~, therefore, for the Nation to utilize all avenues of approach to the problem of reducing the incidence of dental caries and minimizing of other dental diseases, in addition to increasing the output of dentists; and three of the prime requisites are adequate research, dental education, and dental-care programs. Because of lack of funds, dentistry, unfortunately, has not been able to project adequate programs of dental research, dental education, and dental care; but a careful study of these bills indicates that the afore-mentioned program can be scientifically approached through the medium of this legislation.

'l'be \Var Manpower Commission, therefore, approves the principles and policies contained in each of these bills.

Sincerely yours,

Ex:HIBIT 27

FRANK L. MCNAMEE, Acting Chairman.

STATEMENT ON DENTAL HEALTH SERVICES FOR CHILDREN BY l\IARTHA M. ELIOT, M. D., ASSOCIATE OHIEI' , UIIILDUEN'S BUREAU, UNITED STATES DEPARTMENT OF LABOR

I appreciate very much your invitation to prepare a statement setting forth my views on S. 190, a dental-research bill, and S. 1099, a dental-care bill, and to supply information on the special dental needs of children and mothers. These two bills, the purpose of which we in the Children's Bur(;'au fully approve, are of special interest to the Children's Bureau. My comments to your committee on dental needs and administration are taken from the experience of the Children's Bureau in working with the State health agencies and advice received from our advisory groups composed of persons in the dental and other allied professions and representati,es of the public interest.

For many years the Children's Bureau, as I am sure the committee is aware, bas been giving consideration to the clental neecls of children and mothers and bas been studying the various methods-including organization and administration-for meeting these needs. We have for the past 10 years been encouraging dental health demonstration programs through ~rants-in-aid made by the Children's Bureau to State health agencies under p'rovisions of title V of the Social Security Act. Many of the State health agencies which now ha,e such programs desire additional funds to expand their services in accordance with patterns of organization and methods of administration which experience has shown to be successful.

This past February a group of dentists, State administrators, and others concerned with the dentnl problem in the United States conferred with the Children's Bureau on problems of dental cnre of children. This conference was called because of the pressing national need for review of the problems of dental services for children and the country-wide interest in expanding programs of dental services for children. The dental health of the 'ation's children has been given, also, special study by the National Commission on Children in Wartimk. The recommendations of this Commission, with refer(;'nce to children's dental services, are of concern to your committee ancl I will, therefore, wish to incorporate these recommendations into my statement.

From the findings of selectiYe-service examinations. and from other sources, the dental needs of the adult are well known. Unfortunately, our information on the health status of our children is not so well known; we have not had a national inventory of their health. 'rhis serious lack in our national health

_.,

DE 'l'AL RESEARCH AND DENTAL CARE 179

planning means that there is much about the health needs of children that we do not know, such as the exact number of blind and deaf children, the number with heart disease, or the number needing dental care. 'l'be best information available has been presented at the hearing on these two bills. However, we have no really satisfacto ry figures for the country as a whole-for white aud :Kegro children, for urbau and rural, and for r·hildren living in different SE'Ctions of the country. Only by pooling isolated studie , studies often set up with different criteria and aims, can we arrive at an approximate picture. l\Io t of our information concerns school children. ,ve have practically no information 011 the dental needs of the pre,<chool child. Further study of this age grou]) is high on the agt'nda of research work that is urgent in the field of child hC'alth.

,ve <lo know, howevPr, that the amount of dt>ntal care meded for children is very grent-whetllC'r we take the Jigure of thre<'-fourths of a carious permanent tooth or one carious tooth per ye,n·. \Ve know, too, that under our present system children are gC'tting only nbont one-fifth of the dental care lhl>y need. The Commission on Children in ,vartimP eoncludPll in its 1·pport, Duilding tlie FuturP for l 'hilclren and Youth, i ;;nrcl in April 1!143, that "provision for correcth·e dental cnre of pri>sc-hool nncl i-chool ehildn'n and of pregnant ancl nursing mothers is seriously inncli>quate in practically nil c·ities, town,;, and eounties."

We do luwe the variom; experimental 01· pilot program;; which have givPn us a laboratory for ti>sting metltorls of making available to all ehilclren till' brnefits of dental knowledge and skill. 'l'he rPsults to be obtained, and the social value of sufficiently financed and coordinated dental re:,:l>arc:h lwve bPl>n made perfectly dl>ar to us by thl> results of tht' limited nmount of dl'ntnl r('search that bas been possible in the pa><t. The need for clevelopnwnt ,u1d promotion of dental research is unquestioned.

,Yhen we considl>r a national tll>ntal-lwalth program, it is obvious that thl> total nee<l of all the people is far in exce"" of availablP n'l'-ources of pPr:onnel and facilities, e,·en though thP most efficiPnt organiz:ttion known to ut- woulcl be utilizrd. Should we be bold enough to ;say that through organizPd public diort dental care shall be provided to all our people now, tlw 11n11leai-:ant fac-t is that w1J could not immediately, or for some timP to come, 1kli\·er sueh n bill of goods. Our ac·culllulatl>d nC'glret is so great alJ(l our distribution of pi>rsonnel so unequnl that e,·pn allowing for thP inertia of pPr,ons in acee1iting care when it is made availablP, wP could not hope to mei>t thP clPmand. 'fherpfo1·e, it be<·omes necessary to eonsider what parts of a dental prngram i;;hould be suppliPll fir><t and to what gi·oups it should be given.

Onr ultimate goal should be kept in mind in making the ::;election of what should be done fir, t, as well as the principles that must npply to an;v public effort, whether a partial Sl>I"Yice or a complete serYice is undertaken. Complete care for all who wish to participate in such a public program is a criterion of first importance. Other considerations include the nece~sary provisiom, to make the initial effort a unit of the complete program and to mnke it possible to permit a continuous expansion of the partial program so thnt over a period of time the complete program wm be renlizC'd as rapidly as prr;.;onnel and facilities will allow. Concurrently it is to be hop<>d that the research workers will produce the information that is urgl>ntly needl>d to prevent caric!; and other dental disease and tlm, gradually reduce the necessary extl>nt of the program.

Obviom;ly, as ,-tnted b;v many of tlw (Xpnt;; who han' appeared b"forr your committee, care of children is one answer to this apparent dilemma. Emergency care for ncluW, might alRo be n pnrt of thl> initial program, but carC' for children should constitute the rC'al core of any public dental program. If only rmergency carP or if ouly partial carl> wl>re given to nll the 1wople, we coulcl not hope to achiPve clC'ntnl health in this country for man;v dl>cadeR. ,()n thl> other hand, if children-or even a sl>gment of the child popnlatiou-were givl>n complete care and their dental health maintained into nclnlt life, in a compnratively Rhort time we would eliminate our harklog of dental 1wglect and have only maintenance care remaining for nil the people.

Caring for children is the most economical and the most ~ound method of rl>nchlng the ultimate gonl of care for all.' Then, too, public health agencil>s have already amply demon trated that they have the know-how to . tage such a program for children.

1 The Chilclren'R Bureau nclvi~or.v eonferen<'e hel<l in Fcbrunr:v 194i'i macle the following recommenclution after consl<leratlon of the various problems In estnhllshing n nntionnl rlental cnre program: "That when ser\"ices cannot be suonlle(l to nil. ehilclren enterin,:,: tl1elr first year In school each year be i;:iven priority, and that maintenance care be continued thereafter for these children from rear to yenr."


There are other reasons why care for children in a public dental program is the most feasible group in the entire population for whom a partial program could be initiated. Public concern for the welfare of children, as typified by our public educational system, is a part of our American tradition. Public responsibility for the care of children is more generally acknowledged and accepted by both the public and the professions than is similar public responsibility for all the people. The framework for dental servces to children already exists in child-health conferences and school-bealth services which are to be found in most communities today. Because children are thus already drawn together in groups, care can be economically given and a coverage can approach completeness.

In their report issued in April 1945, Building the Future for Children and Youth, the National Commission on Children in Wartime, which is composed of 80 well-known leaders in professions and organizations concerned with children, recommended that under the grant-in-aid principle a Nation-wide children's dental program be established. This recommendation, which was made in connection with the expansion of the Nation's maternal and child health services, in the language of the Commission is as follows :

"A dental-care program for children, starting with complete service to children as they enter scbool and providing for care to maintain dental health for these children throughout their school years. The service should be extended to older and younger children until finally it is made available to the whole population of preschool and school age. 'l'he dental-health program for children should be coordinated with both the school and community health services. Dental research into the causes of caries and other dental diseases and into methods of prevention and treatment should go forward simultaneously with the program of care."

Should an additional argument for giving priority to children's dentistry be needed, the picture can be completed by repeating the often-made statement that during childhood is the time to make health education useful and effective. Experience has shown us that dental-health education for any segment of the population, without provision of dental care, is an ineffective public health measure. When a combination of dental-health education and dental care exists, substantial progress can be made toward national dental health.

The IJUPstion has been aii'ked, "What con!';titutPi;:: complPte dental care for children?" After conrnltation with members of the dental profession, State fldministrators, and others concernl'd with the problem, I should fonnulate the following as a preliminary answer to this question:

1. Emergency care to include the alleviation of pain, extr,action of nonrestorable teeth, and treatment of acute dental infections.

2. Periodic examination by a dl'ntist to include X-ray ancl other necessary diagnostic procedures and prophylaxis.

3. ('are on a planned and continuing basis to keep the mouth in the best possible condition.

4. 'I'reatment of malocclusion when necessary -for mastication. Essential elements of the national program outlined above--emergency care,

examination, continuing care, and treatment of malocclusion-are presented as parts of a program, because it is conceivable that resources may be insufficient to develop the whole prop·am at the beginning. Especially is this apt to be the situation at the beginning of a Nation-wide program and until persons trained through the program are available for providing a complete service. If this situation should be the one we have to face, a part of our child population could receive complete care while the remainder might have to receive only a partial service, such as emergency care only. One might conceive of a complete service to all school-age child1·en, or possibly all 6-year-olcls, with emergency care for the remainder of the population. It is doubtful whether provision should be made for examination without provision of care, even in a partial program.

Examination without provision nf care is a pattern that has been followed much too extensive]~, in this country, and it is a pattern probably not worth the expenditure of public money and professional effort.

Figures on the cost of a complete dental s<>rvice for children up to 21 years of age are not readily availablt>. Whl're we can start can be determined only by consideration of thP amount of care needed by different age groups and the resources in the country to meet immediately these needs. Specialists in clt>ntistry for chilr1.ren should advise on the groups that should be g:iven priority. A good basic program might appear to be complete care for all children 6 to 12 years old, with emergency care for all others. But possibly the resources would be such that the complete program may have to be limited to all 6- to 9-year-old children, or pos-

..


sibly just all of the 6-year-old children. In any case lbe plan should provide for a continuous maintenance service for the age group served.

For example, If 6- to 12-year-old children are included in the first year, then, beginning with the second year, all 13-year-old children wculd be eligible for care, and the children who would become 6 yf'nrs old would be eligible for the first time. It is only in this manner that eventually service will be complete for all :1ge groups.

Special considC'ration should be given to the dental neecls of the pregnant woman. In the past it has been customary in selecting groups to receive dental care to give high priority to pregnant and lactating women. Important answers to the prcbJC'mS of dental care for this group of the population need reconsideration by obstetricians and dentists. The research workers stu<lying dental health offer answers to many of the dental healt!:! problems affecting mothers. Research tu this field must not be neglected.

Certainly we know now that emergency care should be given to all pregnant women. This should includt> putting the mouth in the best functional condition with as little trauma as possible. Early trt>atment of all acute infections Hhould be included. These services are of wore advantage both to mother and infant than extensive restoration.

Nutrition is a part of any comprehensiYe plan for dental care and dental re:search. l!'rom studies already completed or in progreia:s, there is e,·it!ence that ovtirnal diet is conducive to dt>ntal health, and this influence on dental health is most marked dnriug developmental periods; that is, during pregnancy, lactation, and childhood. Health agencies ha Ye found that nutrit1on services are an important facto1· in maternal and child-health programs. Developing dental services to mothe1s and children as part of a complete ruaternal and chi](l-health program will m<>an that the nutrition service of the health agency will make its full contribution to national dental health.

Although enough is known of the relation of diet to 1lental health to warrant inclusion of nutrition services in a clental program, there are many questions still to be answered before health workers can be sure that their efforts in this direction are bringing maximum results. It i,; generally agrE'('d that research in nutrition as related to dental health should be concentrated on children and pregnant and lactating women, both because thei1· food needs are great and any amelioration of their dental status woulu l1ave lifelong results. Such research is most productive when it is carried on through the combined C'fforts of ~pecially trained workers in the fields of dentistry, medicine, biochemistry, and nutrition, and cnnsequently throws light on dental nutrition in relntion to the general health of the child or the mother. Funds invested today in well-conceived and soundly executed programs of dental nutrition research will pay generous dividenus in the nrar future in reduced incidence of dental disease and suffering.

The administrative machinery for a dt>ntal care program needs much thought Dental care programs on a prepayment basis have been less extensive than have the medical care programs. It seems obvious that dental car(' should be part of an over-all medical care plan and should be administered by the same public agency-l•'edernl, State, and local-under a grant-in-aid plan.

For adults, an insurance scheme may possibly be the answer, as the method for financing. l~or childrC'u, appropriations from public tax funds seem to be the method most suitable for financing care for all children whose parents wish to vnrticipate in such a program. Under a gi·ant-in-aid program, a State can wo:rk out its own problems in the light of existing needs and its resonrces. Plans submitted by States should meet certain stallllards of content, co,·erage, quality of care, and provide for 1,nch admini:-trative procedures as are necessary to realize the intent for which the Federal money is appropriated.

A busic program should be assured in the poorer States, anrl there should be no curb on those States which wish to go ahead with a more advanced program of services.

Methods for providing care will probably need to vary from State to State and within the States. !◄'or children clinic serviC'eS, with either full-time or part-time personnel, would seem the most fem;ible method in the va, t ma,iority of instances. ~uch clinic se1 vices should be closely related to school-hf'alth services and to health centC'I"S. In sparsely settl<'<l arE>ns or areas without adequate local pprsonnel and facilities iti11erant services may be needed.

To assure a high quality of care and to remove any apprehension concerning the quality of C'are whieh is to be provided, provision should be made .for adequate supervision. l!~or children this is especially important. Few persons have been trained in children's dentistry and few have had opportunity to acquire


eithe1· the special dental skills or the art of approaching and caring for children. \Ve all know that the best work is done in our teaching institutions where super"Vision i · possible. ·we should, therefore, include in our program for children, in addition to a well-planned program of profes ional training, consultation service by qualified personnel to help and to teach those less well trained.

Earlier in this statement reference is made to programs now operating under title V of the Social Security Act and the need for the expansion of these servic:es. Many State ancl local l!ealth departments have for years carried on dental programs of various kinds, and some of these have been financed entirely or partially through funds granted to the 8tates by the Children's Bureau. Plans fot· the expenditure of funds l.Jave been developed by the States in cooperation with the Children's Bureau.

In round terms, about $UOO,OOO yearlJ', or (l percent of the total of nearly $10,-000,000 of maternal and child-health funds, is expended by the States under the Fet!eral-State program for dental ser\'ices. 'l'he amount varies from year to ~·ear, (h•pending on the plans which States make for using their money. What part this sum repreHents of total fumls available for dental servic:es I have no way of knowing. State and local funds are available, as are funds from the

nite(l States Public llealth Servi(·e. Other Federal ·agencies, such as the Farm Slcurity Administration, haYe programs, and there are local voluntary agencies operating in the field of dental c·ure. In othf'r words, though there are on the crPdit si<le of the ledger numerous small items, these are frequently unrelated and do not add up to enough to balance more than a fra<'tion of the need.

Of the very small i-um-$GC0,000--of maternal and child-health funds used by States uncler the Fedcral-8tate program for dental ervices, I can speak in somewhat more detail. States ::;1wncl this money according to their own pattcrni-. Some StateR spend none of their maternal and child-health funds :wailable under the Federal-State program for dental sen·ices; a few ·pend rather Jaige proportions; one State spends about 23 perc:ent of its total maternal uml childhealth funcls for dental health.

The <lf'ntal programs as clescribecl in State plan fall into three main groupseclueation, examination, and correC'tion. In many of the States the educational aspc>ct is the major, or in some instnnce8 the only, activity. 8tates differ, of course, in their c:oncept of ecluc-ation in relation to dental health. In some, the main emphasis is on staff edu('ation,, particularly educatio11 of the public-health nurse who works with mother,-; and children. l:iome St ates put the emphasis on the education of teac-hers. Otheri,; attempt to do a direct job from staff dPntist ancl dental hygienist to women and chil<lr~n.- Education of the dentist through extramural refl'esh(•r com·Hes in C'hild1·en's dentistry is a rmrt of some 8tate programs. In 1!)42, G,:il 7 clenth,ts attended such courses in 18 States. In addition, several States financed po;;tg-raduate courses for staff dentists in general public health and in public-health dentistry.

~Jany of tlw programs are of the old-time in~pectinn and rPft>1Tal type, making no provision for obtainin~ C'are. In some Stat<'S there are corrective sen-ices, but too often they are limited to a small gPograpbical area and to a small segment of the population, ancl arc, of com'HP, primarily on a demonstration basis. Methods of providing care vary wiclPly, though the most common procedure is that of employing full-time ,-1.afI for educational and prophylactic phases of the program and of using local prncticing dentists for correctiYe work.

,Referente is made in this Htatenwnt to the conferencf' on dcntnl care for children, which waH held on Febrnary ~ ancl 2:l, 1()45, to advise with the Children's Bureau on thiH Hubject. Becau;;p o[ thP ;;ignifica1we of the 1·(•eommPndations ma<le to the Children's Bureau by thiR conferPnce, I wish to include in this statement the following recon11nenclations prevarrcl by thiH ach·isory group:

"Recognizing- the great nel'd for a Nation-wide program of dental services and e<lucation for childrrn, all(! rl'tOgnizing the desirability of a;;sociating clrntal sen·ice for children with all other health sen·ices for children and mothers in order that full benefits of progn11ns for improving- nutrition, controlling inft•ctions, and providing- medical and surgical care may accrue to the rhildren receiving the dental health ,crvice, und in order that the organization of the maternal and childhealth program, including the ,chool health service and health edu('ation program, may bf' utilized to the fnllest extPnt, it is re ·ommenclrcl:

"1. That adequate Federal funds be made available to the Children's Bureau for grant to State health agencies to cl velop programs of dental services for children, including the training of personnel, dental health Pdnr•ntion, and demonstrations.


"2. That funds be made available to the Children's Bureau for research• in problems relating to the dental health of children.

"3. That adequate dental care be made available to all children regardless of income or geographic location.

"4. That varied and coordinated methods of supplying service, such as through trailers, clinics, school health services, the offices of practicing dentists, etc., should be considered in planning a service applicable to the local situation.

"5. 'l'hat in a public dental-care program provi ·ion be macle for sufficient professional supervision of service to insure maintenance of standards and quality, such supervision to be developed in accordance with the method of. providing care.

"6. That in a national dental-care program records of a standard type should be developed and used in order to permit comparative evaluation of finding and results.

"7. That when services cannot be supplied to all, children entering their first year in school each year be given priority, and that maintenance care be continued thereafter for these children from year to year."

Exmmr 28

TIIEl EFFECT OF IlJ;J;\LTII INSURANCE ON TUE DEMAND FOR HEALTH SERVICES 1

(By L. Richter)

[Reprinted from the Canadian Journal of Economics and Political Science, vol. X, No. 2, l\Iay 1944]

How will the introduction of health insurance infiuc-nce the demand for health services? In the discussions on the reform of our health services this que tion has been seldom put and hardly ever answered. Expressly or tacitly, the assumption is mqde that the present demand can be used as a yardstick for measuring future needs under a system which it is thought aims mainly at a more equitable distribution of available services.

The problem is, however, of a more fundamental nature. \Vhat health insurance would achieve is to remove the whole field of health care from the automatism of the price system. The fee-for-service system based on the individual's ability to pay for medical care will disappear. A compulsory scheme of prepayments will be introduced which will entitle insured persons to services whenever they need them or whenever they feel that they do. Economic and 1) ychological factors about which very little is known so far will come into play, and are bound to have a profound influence on the demand for health care. Changes may be of a quantitative and of a qualitative nature; not only may the demand increase but it may also be directed toward other type of health care than in the past.

All these factors ham to be considered when the foundations of a national system of health insurance are being laid. They are, of course, decisive for the cost of the scheme and for the supply of health persounel. But the evaluation of the potential demand will also have a bearing on the type of services to be offered, on the form of organization and administration, and, above all, on the methods used for making the beneficiaries of the scheme conscious of their responsibilities.

In order to clarify some of these issues an attempt was made shortly before the war by the Institute of Public Affairs at Dalhousie University to compare the demand for medical care under health insurance and under the present-day system of medical services. The work was carried out in cooperation with the Dalhou ie Medical School and with the assistance of gt·ants from the Rockefeller Foundation. A decisive factor for embarking on the research project was the presence in the province of Nova Scotia of an organization which probably repre ents the oldest system of health insurance in Canada, if not in the Americas. The scheme is a self-help organization set up some O year ago by the miners in the Cape Breton coal fields in the vicinity of Glace Bay for the. provisi•m of health care for themselves and their families. The plan has been operating continuously up to the present time. It differs from other com-

1 This study was undertaken by the writer In coop~ratlon with the late Dr. A. L. McLean and l\Ilss Jenn Peabody of the Dalhousie l\Iedlcnl School, both of whom have made eHsential contributions. The writer Is further inclebtecl to Dr. Enid Charles, Ottawa, Dr. Selwyn Collins, Washington; Dr. lichael Davis, New York; and Miss Margaret C. Klem, Washington, who read the manuscript and made valuable suggestions for its improvement. Through the courtesy of the Dominion Bureau of Statistics, unpublished census material was made available for the study.


pany schemes, not only through its age, but also through its wide coverage of persons and risks and its method of financing: the funds are, with negligible exceptions, provided by the miners themselves. The organization is health insurance in everything but name. It was felt that a survey conducted among families covered by the scheme would provide a fine opportunity for studying the behavior of the beneficiaries of an insurance system, the demand foL· health services, and the effect of this demand on the practice of medicine. A sample of some 13,500 persons was deemed to be large enough for that purpose.

In order to contrast the findings of the survey with conditions prevailing in arl'as without insurance protection, it was decided to make a parallel studya sort of control experiment-in the town of Yarmouth situated at the other end of the Nova Scotian peninsula. Yarmouth was chosen not only on account of its . imilar geographical, climatic, and ethnical conditions. but also for reason of its rather isolated location. All the health care available to the 7,500 inhabitants is rendered by 1 hospital and 12 resident physicians, all of whom were willing to cooperate in the proposed study.

noth areas were surveyed for twelve coni;,eentive months between December 1, 1!)37, and July 31, 1939. All illnesses and ailments which brought patients in touch with the doctors were tabulated, as wen as all types of care which they received, from a major operation to the prescription of a bottle of medicine; included also were preventive ser.ices of every description.

In evaluating the findings one factor must be strongly emphasized. The survey has in both areas been confined to cases of illness receiving medical attention of some sort. This is in contrast to the procedure of the Committee on the Costs of Medical Care 1 and the United States Public Health Service which in their surveys of representative family groups in the United States attempted to record all cases of illness by way of a house-to-house canvass. In the present survey ill health ,vhich was not served by a doctor remained unrecorded.

Under these circumstances it seemed natmal to us~ the do<-tor for collecting the relevnnt information. In the Glac-e Bay insurance area the task was facilitated by the panel system applied for collecting the doctor's remuneration. '.rhe doctor's panel contains a complPte list of all subscriher8-the term used In Glare Bay for insured persons-who are Pntitlecl to medical services for themselves and for memb<'rs of their families. Tile health carp for the whole insured population is conceutraterl in a few partnerships. For the purpose of condurting the surYey the cooperation of four of thPm wms sought. Their panels rangecl from 460 to 1,190 families. Eight doctors working together supplied health care for 3,24'.5 subscribers and 10,318 depentlPnts. In order to relieve the doctors as far as po1S>1ible and at the same time to safeguard the a<-curac-y of the findings, clerical workers, specially trained by the supC'rvisors of the survey, W<'re employed full time in the doctors' offices throughout the whole surw-y period and entrusted with the routine work in recording. Two types of cards were u8ed for the survey: a family card and a case card. The family card contained detailed information about all families listed on the doclor·s panel irrespec-tive of whether they had com!? in touch with the doctor or not. A cmse card was filled and attached to the family card whPnever illness occu1-re<l.

The same technique waR applie<l and the imme cards us<'d in Yarmouth, the area representative of the present-dny systrm of mf'dical rnre. Since, howPver, no doctor' panels existed, Rpecial arrangemrnts WPre necC'ssary to gather information about those who had gone without medical attention throughout thP survey year. Data for them ha<l to be obtaine1l from the cem,us figures for 1931 and 1941 projPcted to the RurvPy period. ('onscqurntly, information for the urvey group ns a whole is far lrs,; comprPhrnsive in Ynnnonth thnn in Glace Bay where nll the rclrvant rtata coulcl br takrn from the family canls.

The , 11rre11 Areas an,J, tlle S11n·e11 Gro11p8.-Both communitiPs covered hy the pre,:rnt urvey are coastal towns, Glace Day at the eastern encl of Cape Breton Island, faring the Atlnntic Ocean. Yarmouth at the utn .. i~t westprn tip of the ·ova Srotian mainland on the Bny of Fundy jnst opposite Boston. Climatk

c-on,lition,; which are likrly to influence the health of tlw inhabitants are similar in hoth re~ions. ~o is the racial compo~ition of the population. Anglo-Saxons prnlominate, accounting for 83 pPrcent of the survey group in Glare Bay and for 66 prn·rnt of the populntion in Ym·mouth: Sf'ot~ pre,•ail in Glare Ba:v anll Eng-lish in Yarmouth. The ~rcorHl l:rrgest group in both regions i~ l<'ren<'h, but they makP

1 The publication of thl' committee most oftl'n quoted In the present stnd;v Is I. S. Falk. J\Iarimret C. Klem, and Nathan 'inai. the Incldl'nce of lllne~s anrl the Receipt and Costs or Medical Care Among Rcprrsentative Family Groups (Chicago, l 033).

•

"(


up only 8 percent in Glace Bay, while in Yarmouth the French-Acadians, descendants of the first settlers on the North American continent, account for 28 percent. Families of Anglo-Saxon stock tend to be larger in Glace Bay, families of French origin larger in Yarmouth, but the difference is not very marked, as may be seen from table I which shows the family size by racial groups. The factor responsible for the larger family in Glace Bay is probably occupational. It is known from other studies 2 that the number of children in miners' families is above average.

TABLE !.-Size of famiiy by racial origin

Racial origin

English _____________________ ________ ________ • ___________________ -- ----- -- - --- -- - -Scottish ___________________________ _ . ___________________________________________ _ Irish ___ _______ --· ______________________________________________________ ------- - --French _______________ --------·-·-----·---- -- -- -------·------------- -------- -----Others._ .. ____ ·-- ___ . _____ ______ . __ . ____________________ . _______ . -- _ --- __ --- . - . --

All origins_·---······--···--··-·---·---·---··-·-· __ '-- ·······-··--··---·· __

Number of persons per family

Olace Bay Yarmouth

4.8 4. 0 4.6 4,2 5. 2 4. 2 5. 0 5.6 4. 0 4. 7

1----+---4. 7 4. 4

If the age composition of the two survey groups were shown graphically it would be seen that the curves are fairly close to each other in the age groups between 20 and 45, but there are more children and fewer older people in Glace Bay. Yarmouth, on the other band, is remarkable for the distribution of the sexes in the population. For every 100 women in Yarmouth there were 87 men, whereas in Glace Bay there were 109, which corresponds more closely to the Do· minion average of 105.

But the greatest difference between the two areas is in their economic charac• ter. It is cleal'ly noticeable even to the occasional visitor. Glace Bay, the town in and around which the members of the survey group live, is situated in the center of the Cape Breton coal field and is a typical mining community. The ir· regular streets are flanked by old and often dilapidated houses. Nearly everybody living in the area is directly or indtrectly connected with the coal industry. If for lack of markets the output of coal bas to be reduced and the working week shortened, an atmosphere of depression pervades the whole community. Such conditions prevailed during the latter part of the survey period. Unfortunately they have been all too frequent in Cape Breton between the two World Wars. Up to 19-H unemployment figures were relatively high and large sums were spent for relief.

The coal mines are, with very few exceptions, operated by the Dominion Steel & Coal Corp. in Sydney. Elight thousand miners and surface workers, includ• ing nearly all the surveyed wage earners, are employed by the company in the area. Of the 13,563 persons covered by the present survey, 2,550 were under• ground miners, while other adults accounted for 5,738, and children under 15 years for 5,275 persons. Wage earne1·s made up 27 percent of the whole group. Typical yearly earnings for face miners amounted to $1,350; for other underground and for surface workers to $920 in the survey period. The average yearly income for the entire survey group was $1,054.

Yarmouth, more than 400 miles away from Glace Bay, is situated in the nonindustrial part of the Province. It is a very pretty little town and attracts numerous tourists. The streets are wide and well kept and in the residential districts many fine homes are to be found. The population which, according to the census of 1931, was 7,055, had risen 10 years later to 7,790 and was estimated during the survey period at 7,492.

The town is the distributing center for an agricultural neighborhood with wholesale and retail establishments serving the outlying districts. No industry 1we• dominates. Shipbuilding which was once famous all along the Atlantic coast had ceased to exist long before the time of the survey. There are a few small factories of which the most important are ,a cotton mill employing 278 wage

2 Edgar L. Collis, The Coal Miner, IIis Health, Diseases, and General Welfare (Journal of Industrial Hygiene (Harvard), vol. VII (5), May 1925).


patiy schemes, not only through its age, but also through its wide coverage of persons and risks and its method of financing: the funds are, with negligible exceptions, provided by the miners themselves. The organization is health insurnnce in everything but name. It was felt that a suney conducted among families covered by the scheme would provide a fine opportunity for studying the behavior of the beneficiaries of an insurance system, the demand for health services, and the effect of this demand on the practice of medicine. A sample of some 13,500 persons was deemed to be large enough for that purpose.

In order to contrast the findings of the survey with conditions p1·evailing in an•as without insurance protection, it was decided to make a parallel studya sort of control experiment-in the town of Yarmouth situated at the other end of the Noya Scotian peninsula. Yarmouth was chosen not only on account of its ,;imilar geographical, climatic, and ethnical conditions. but also for reason of its rather isolated location. All the health care available to the 7,500 inhnbitants is 1·enderecl by 1 hospital and 12 resident physicians, all of whom were willing to cooperate in the propo ed study.

noth areas wei·e surveyed for twelve conseC'ntive months between December 1, 1037, and July 31, 1939. All illne ses and ailments which brought patients in touch with the doctors were tabulated, as well as all types of care which they received, from a major operation to the prescription of a bottle of medicine; included also were preventive sen-ices of every description.

In evaluating the findings one factor must be strongly emphasized. The survey has in both areas been confined to cases of illness receiving medical attention of some sort. This is in contrast to the procedure of the Committee on the Costs of Medical Care 1 and the United States Public Health Service which in their surveys of representative family groups in the United States attempted to record all cases of illness by way of a house-to-house canvass. In the present survey ill health which was not served by a doctor remained unrecorded.

Under these circumstan '1-'S it seemed natural to u~~ the do<'tor for collecting the .relevant information. In the Glace Bay insurance area the task was facilitated by the panel system applied for collecting- the doctor's remuneration. The doctor's panPl contains a complPtP list of all nbscriher,;-the term used In GlarP Bay for insured persons-who are entitled to metliral services for themselves and for mPmbC'rs of their fnmiliPs. TlH' health carp for the whole in~ured population is concentrate<l in a few partnerships. For the purpose of condurting the survey thP cooperation of four of thPm wni:; sought. Their panels ranged from 460 to 1,190 families. Eil!,'ht doctors working together ·upplied health care for 3,243 suhsc1•ibers and 10,318 depemll-'nts. In order to rl'lic>ve the doctors as far as poRHible and at the same time to safeguard the a<'curaC'y of the findings, clerical workers, specially trainPd by the supervi,;ors of the survey, wC'1·e employC'd full time in the doctors' offices throughout the wholl-' survc·y pc>riod ancl Pntru tecl with the routine work in 1·ecording. Two types of cards were m,ed for the survey: a family card and a case card. The family card contained detailetl information about all families listetl on the dortor·s panel irrespeetive of whether tht•y had comr in touch with the doctor or not. A caise card was fillPd and attached to the family card whPnevPr illnps,;; orern-red.

The some technique wn~ appliP(l and thP same cards used in Yarmouth, the area reprpspntative of the pr!'sent-day systPm of mC'dical care. Sinre, howPver, no doctor's panels exi><tPcl, . pecial arrangenwnts wPre nPcessary to l!,'ather information about thosp who had gone without medical nttPntion througbnut thP ,;urvey ypar. Data for them hacl to be obtnine<I from the census figures for 1931 ancl 1941 projected to the survPy period. ('onsc>quently, information for thP surve~• group as a whole is far less comprPheusive in Ynrmonth thnn in Gluce Bay where all the relevant data ron](l bp taken from the family cat:ciR.

The , 11n·n1 Arras anil flt(' Sun•c11 Gro1111.~.-Roth rommunitiPs rowrecl hv thP present survey are coastal towns, Glace l'3ay at the ea ' tPrn encl of CaJ)P Bi·Pton hilancl, faC'ing the Atlantic Oeean. Yarmouth at the utnH>St we;;tern tip of the Kova S<'oti:111 mainland on the Bny of Fund~· just oppositf' Boston. Climatk c·ornlition!'. whirh are likC'ly to influc>nc-r the health of the inhabitants are !<imilar in hoth re~ions. Ro is thP racial compoi-ition of the population. Anglo-Saxons ]lr(•dominnte, aC'connting for 83 p<'rcent of the surYey gronp in Glare Bny and for 66 per<·!'nt of thp population in Ynrmouth: Sr·ot>< prf'Yail in Glare Bn:v and En~lisl1 in Y11rmouth. The ~C'con<l lrrrgest group in both region i~ l<'renrh, but they makP

1 ThP publication of thl' committee most oftf'n quote(} In the present stud.v Is I. S. Falk. l\Iari:aret C. Klem, and Nathan Sinai. the InclclPnce of IllneRR anrl the Receipt and Costs of Medical Care Among Rcprpsentative Family Groups (Chicago, 1033).

..


up only 8 percent in Glace Bay, while in Yarmouth the French-Acadians, descendants of the first settlers on the North American continent, account for 28 percent. Families of Anglo-Saxon stock tenr1 to be larger in Glace Bay, families of French origin larger in Yarmouth, but the difference is not very marked, as may be seen from table I which sllows the family size by racial groups. The factor responsible for the larger family in Glace Bay is probably occupational. It is known from other studies 2 that the number of children in miners' families is above average.

TABLE I.-Size of family by racial origin

Racial origin

English _________________________________ --- - • ___ --- -- - -_ ---- - __ - --- -- -- -- --- --- - -Scottish ________________________________________________________________________ _ Irish __________________________________________ -___________ -____ ----- --- ----- - -- - -Freuch _______________________ ------------· ___________________________ ------- ----0 thers ____________________ .. _______ --- ______ - --- -- ------- -- - --- -- ---- --- --- ---- ---

All origins _________________________________________ • _____________________ _

Number of persons per family

Olace Bay Yarmouth

4.8 4.0 4. 6 4.2 5. 2 4. 2 5. 0 li.6 4.0 4. 7

1-----1--4. 7 4.4

If the age composition of the two survey groups were shown graphically it would be seen that the curves are fairly close to each other in the age, groups between 20 and 45, but there are more children and fewer older people in Glace Bay. Yarmouth, on the other hand, is remarkable for the distribution of the sexes in the population. For every 100 women in Yarmouth there were 87 men, whereas in Glace Bay there were 109, which corresponds more closely to the Dominion average of 105.

But the greatest difference bet.veen the two areas is in their economic character. It is cleal'ly noticeable even to the occasional visitor. Glace Bay, the town in and around which the members of the survey group live, is situated in the center of the Cape Breton coal field and is a typical mining community. The ir--= regular streets are flanked by old and often dilapidated houses. Nearly everybody living in the area is directly or indfrectly connected with the coal industry. If for lack of markets the output of coal has to be reduced and the working week shortened, an atmosphere of depression pervades the whole community. Such conditions prevailed during the latter part of the survey period. Unfortunately they have been all too frequent in Cape Breton between the two World Wars. Up to 1941 unemployment figures were relatively high and large sums were spent for relief.

The coal mines are, with very few exceptions, operated by the Dominion Steel & Coal Corp. in Sydney. Elight thousand miners and surface workers, including nearly all the surveyed wage earners, are employed by the company in the area. Of the 13,563 persons covered by the present survey, 2,550 were underground miners, while other adults accounted for 5,738, and children under 15 years for 5,275 persons. Wage earners made up 27 percent of the whole group. Typical yearly earnings for face miners amounted to $1,350; for other underground and for surface workers to $9"20 in the survey period. The average yearly income for the entire survey group was $1,054.

Yarmouth, more than 400 miles away from Glace Bay, is situated fo the nonindustrial part of the Province. It is a very pretty little town and attracts numerous tourists. The streets are wide and well kept and i11 the residential districts many fine homes are to be found. The population which, according to the census of 1931, was 7,055, had risen 10 years later to 7,700 and was estimated during the survey period at 7,492.

The town is the distributing center for an ngricultural neighborhood with wholesale and retail establishments serving the outlying districts. No industry predominates. Shipbuilding which was once famous all along the Atlantic coast had ceased to exist long before the time of the survey. There are a few small factories of which the most important are ,a cotton mill employing 278 wage

2 Edgar L. Collis, The Coal Miner, IIis Health, Diseases, and General Welfare (Journal of Industrial Hygiene (Harvard), vol. VII (5), May 1925).


earners, a cheese factory, and several mall fish-curing plants. Wages. in these factories averaged, according to information from the Dominion Bureau of Statistics, $720 in the survey period.3 However, only a small part of the wage <;arners • in Yarmouth, about 500, were employed in manufacturing industries. '.!.'he rest are distributed over the diversified occupations which a town of that size offers. Their income could not be ascertained. But according to a sample of 95 wage-earner families in Yarmouth that was recorded for the 1941 housing census, the average yearly earnings of these fnmilies were $1,237.5 In the survey period they were probably somewhat lower, since wages went up slightly between 1939 and 1941.

No better information is available since the census material does not allow for a break-down by occupational groups suitable for the purposes of the present survey. It must, however, be remembered that the survey group in Yarmouth comprises the whole population of the town, the well-to-do and the needy. A number of residents enjoy a comfortable income as the place is favored by retired businessmen, sea captains, and the like. No unemployment relief was paid during the depression years and outlay of poor relief was small. A visitor in Yarmouth would have the impression that the town was moderately properous. There is, at any rate, no indication that in view of the economic conditions in the community the demand level for medical care was particularly low. Yarmouth may be regarded in this as well as in many other respects as representative of sm811 towns in eastern Canada.

Two objections might be raised against a project which attempts to compare health services for a group of miners and their families with those for a whole community of the character of Yarmouth: (1) That underground miners are an exceptional health risk and that they should therefore not have been included, and (2) that the economic conditions of the two survey groups are too dissimilar to allow for a comparison. It is easy to refute the first objection by tabulating separntely the data obtained for underground miners whenever it eems warranted. They account for only 2,550 persons or 19 percent of the survey group. Their presence, therefore, does not invalidate a comparison of the remaining 11.013 persons-among them 1,054 other wage earners-in Glace Bay with the 7,500 inhabitants of Yarmouth. l\fore significant is the second objection. The best way of meeting it is to put it to a test in the course of the study. One of the purposes of the survey is to measure the extent of health services rendered under the two systems of medical care. It helps to clarify the issue if it is realized that Glace Bay which employs the insurance device is c1eemed to have been at the time of the survey, a somewhat depressed area, while Yarmouth, operating under a fee-per-service s:vstrm is regarded as comparntively prosperous. If the survey should reveal that the poor mining community provides more extensive health services to its members than prosperous Yarmouth, the result could onl v be explained by the operation of the insurance system.

The organization of health care in the tico areas.-In describing the provisions made for the health care of the two survey groups not much needs to be said about Yarmouth. The term "present-clay system" of medical care that is used in this study is self-explanatory. Services were rendered on a fee-per-service basis. The fees were those customary in small communities in Nova Scotia. As a rule $2 was charged for an office call and $3 for a home call, but families of small means would pay less. Medical charity was practised on a wide scale, as no provision for health care of indigent sick existed in Yarmouth except when hospitalization was needed.

The scheme operative in Cape Breton is for all practical purposes compulsory health insurance. Nobody who wants employment in the coal fields can get a job unless he agrees to have certain contributions for health services deducted from his wnges every week. 0 If a person is working for the company ht• is, on the other band, entitled to these sei·vices irrespective of age, ;,ex, occupation, and income, and without the requirement of a medical examination. The scheme provides for treatment by medical practitioners (not by specialists and dentists), for hospital care, operations, drugs and dressings. These services are given without

• In the same year average wages in the manufacturing- industries of Nova Scotia totaled $926 for men and $469 for women (Canacla, Dominion Bureau of Statistics, the Manufacturing Inclustries of Canada in 1938, Ottawa, 1941. p. 45).

• In the 1931 census, 2,039 wage earner8 were counted in Yarmouth in families with wage-earner heads.

• Information from the Dominion Bureau of Statistics. o '1.'his is at any rate the actual practice although there are no written regulations to that

effect.


time limit as long as illnes Ia ts. They are available not only to wage earners but also to all their dependents. Wage earners are in addition entitled to cash benefits from a relief society in case of disabling illness. The scheme is superior to the present British system of health insurance which does not protect the family and does not include hospital care. As in Great Britain, the subscriber may choose his own doctor. But while under the British scheme goYernment and employers share in the cost, the miners in Cape Breton bear the whole outlay for medical and hospital care and finance the larger part of the fund for cash benefits. Their contributions amount to 40 cents a week fot· the ,loctor, 40 cents for the hospital, and 30 cents for the relief society. The contributions are the same for married and unmarried persons.

Incidence of illness.-The frequency with which illness occurs is expressed customarily by "morbidity rates." In the present study 7 which is concerned with medically attended illnesses umler two fundamentally diITerent systems of medical care, variations in the morbidity rate assume a special significance. A higher rate for a certain illness at one place does not mean that this illness is less frequent in the othe1· area but rather that it is less frequently treated. These considerations must be borne in mind when comparing illness rates for the two areas, as shown by the following tables.

TABLE IL-Average number of medically attended illnesses per 1,000 persons per year

Males_________ __ ______ __ _____ __ __ _ __ ________ ____________ ____ ______ _ Moles excluding underground miners ______ ___ _____ ________ ________ _ Females_ __ _ __________ ---· -- -- - ------- ---- - --- ---- --- - ----- - -- - -Children under 15 years of age __ - ---- ----- - - --- - ---- --------------- -Total survey group __ . ___ ____ ______ __ _____ _ -- --- ------- -- -----· __ Total survey group excluding underground miners _________________ _

Illnesses per 1,000 persons Percent ex

cess G!ace 1----------1 Bay over Glacc Bay Yarmouth Yarmouth

850 648 765 676 809 717

407 407 557 292 4 6 486

109 59 37

132 66 48

In the course of a year 34 persons out of every hundred in Yarmouth received medical care compared with 48, or, leavin.!\' out the underground miners, 4G persons in Glace Bay. The two sets of figures do not correspond with each other in eYery respect as some persons experienced several cases of illness in the course of a year. For Glace Bay where detailed information was available about the composition of all families making up tlle survey group, it was possible also to establish morbidity rates for the family unit: 100 families had within a year 378 cases of illuess, 100 individuals had 81 cases. ·

At this juncture only a quantitative analysis is called for. It indicates that under a system of compu!s01·y health insurance the rate of illness receiving medical care is very much higher than under a fee-per-service system. This

• situation characterizes not only the initial stages of an insurance scheme, as is sometimes contendecl, but, the difference in .the inciclence rates i characteristic of the two systems. The rate of attended illness in Glace Bay was higher than in Yarmouth although health in urance had been in operation in Glace Bay for about 80 years and the saturation point had long been reached.

It is surprising to find that the inciclence in Glace Bay is so much like the rate found by the Committee on the Costs of Medical Care for a large-cross-section of the American population, 844 per 1,000 population.• But while all illnesses listed in the Glace Bay survey hacl received medical care, only 78 percent of the cases surveyed by the committee had enjoyed that advantage.• Can it be assumed that

1 Very few morbidity studies ltave so far been undertaken in Canada. The three most comprehensive are: F. E. Jackson, l\Iorbiclity Survev in tlM! l\luniclpnl Doctor AreaR of Manitoba (Canadian Pbblic Ilealth Journal, vol. XXXII (10), October 1941): Nathan Sinai, l\Iargaret F. Ilall, and Ro~•clen E. Ilolmes, ~leclical Relief A<lministrntlon: Finni Report of the Ex1lerience in Essex County, Ontario (1939) ; and Statistical Studies of Illness In the Civil Service of Canada, published annually by the Department or Ilealth in Ottawa and cdlfrd hy Dr. F. S. Burke.

• Fnlk et al., The Incidence of Illness, p. 75. • Ibid., p. 70.

75979-45--13


if the persons surveyed by the committee had been covered by sickness Insurance all their Illnesses recorded in the survey would have recC'ived medical care? It is an interesting speculation which suggests itself by the similarity of the findings. Scientific proof, however, is lacking as it is not known how far the two groups are comparable.

VariaHons in the incidence of illness.-Averages in the incidence of illness as discussed so far may be meaningless if the deviations from the average are very large. These deviations may be of a seasonal character, that is, at certuin times during the year illnesses may be more frequent than at others; or they may reflect special conditions of the survPy group such as sex and age composition, size and racial origin of the family, vocational status and income. Data concerning most of these ,·ariations were collected during the survey and will be analyzed in a later publication. In the present article they will be discussed only so far as they have a bParing on the operation of health insurance. Nor will relation of income to illness come up for examination although this problem has received special emphasis in the surveys of the Committee on the Costs of Medical Care. But thanks to the insurance system operating in Glace Bay a small income in that area did not mean lack of medical attention in the survey period or impaired health owing to previous illnesses not properly cared for.

Illness among wage earners and dependents.-It is no longer disputed that health insurance should cover the whole family. Far more illness occurs among dependents than among wage earners. This is borne out by the present survey as may be seen from table III.

TABLE UL-Percentage distribution of medicall11 attended illness among icage earners and dependents

Olace Bay ___ ---------------------------------------- __ Yarmouth _____________ -------- _______________________ _

Wageeam- Dependent Dependent er males females

32. 9 34.4

21.8 14. 9

45. 3 50. 7

Total

100. 0 100.0

The number of illnesf;es among dependents was about twice as high as the number among wage eamC'rs. That there are in Glace Bay among female dependents over twice as many illnef;ses as among male <lependents is mainly due to the fact that the wl\•es of the wage earners-together with their daughtersare contained in the first group. But it will be seen later on that men enjoy generally better health than women.

Bei·eral illnesses in familiPs.-The Incidence of illness is very unevenly distributed among families, a small part of the community haYing a disproportionately large share of the cases of illness. This is borne out for Glace Bay by table IV. A fifth of the surveyed families accounted for half of all illnesses which received medical attention in the course of the year. For Yarmouth no comparable figures can be given, for the reasons previously mentioned.

TABLE IV.-The distribution of medically attended illnesses among families in Glace Bay

Number I1lness per family

Families _____________________ , _____ _ 0------------------------------------------------------L - --- - ------ -- --- - - ------- -- - ----- - - . - -- -- ----- -- --- - -2-------------------------------------------------------3_ - - -- - - -- - -- -- -- -- ---- -- - -- --- -- - - - - -- - ----- ---- - - - -- - -4_ ----- ----- ----- ----- - -- - --- - ----. -- - --------- - --- -- - -5_ - - - ------- ---- -- ---- --- - - -- -- ------- - - - - -- --- • - -- -- - --5_ - -- ---- -- -- - -- - - - ---- - - - - -- -- -- - - - --- - - --- - - - -- -- -- ---7 - - -- -- -- ------ ---- -- - --- -- -- ---- - --- - ----- - -- - - --- -- ---8 __________ ____________________________________________ _ 9 and over ________________________________ ----- · _______ _

461 467 370 344 277 240 177 154 122 ~9

Illnesses --------•-------

467 740

1,0.12 I, !08 1,200 1,062 1,0i8

9i6

Percentage distribution

Famllles Illnesses

15. 9 ------------16.1 4. 3 12.8 6. 7 11.8 9.4 9. 5 10.1 8.3 10.9 6.1 9. 7 5.3 9.8 4. 2 8.9

10.0 30. 2 3,314 1------1-----1------1-----Total __________________________________________ _ 2,001 10,977 100.0 100, 0

•


Size of fam-ily.-It might be expected that the larger the family the greater would be the number of illnesses from which their members suffer during the year. While this is true in a general way, the two sets of figures do not correspond to each other tluoughout. The study of the Committee on the Costs of Medical Care 10 bas shown that the increase is not exactly proportionate, large families having a relatively smaller illness rate than families with fewer members. The same observation can be made in the present survey, as may be seen from table V.

TABLE V .-Medically attended illness and the size of family

Family size

I and 2 • •• ... •... . . .....•...••....•. ... •• ••• . . •. .• . . . .... . •••. . • 3 •••• •••• •••••••••••.• • ·•••••••••••••·• • ·•••·••••••••••••• • ••••• • 4 .. . . . . ········· ····•·· .. . . . • . . . ... . ... ... ...... ... . . . . .. .. 5 ••.••.••••••• • ••• •• ••.•••••• •• ••••• • •••••••• • ••••••••••• 6 and 7 .•••• •• ••••••• • • • ••••••••• • •••• •••• • •• •••• ••••••• • • • • • 8 and over • . ••. . ...•. . ..•.••.• ••. ..... •. ..•. ...••• .. .. . . ..•...

1 Falk, ct al., The Incidence ()f Illness, p. 57.

Average number or illnesses per family per year

Olace Bay

1.3 2. 7 3.6 4. 3 5. 1 6. 7

Yarmouth

1. 8 2. 3 2. 7 2. 8 2.8 3. 7

Representative families 1

($1,200--$2,000)

1.9 2.8 3.8 3. 9 4.6 4.9

• 'l'he I-r crson families Jn Olnce Day consist mainly of unmarried miners boarding with married couples or tho surv~y group.

But more important are the differences between the two survey groups which have their cause in the organization of lbe medical services in the two areas. In Yarmouth families of one and two persons-that is, in the main, single persons and childless couples-have a higher rate of medically attended illness than the corresponding group in Glace Bay. But for larger families the picture is quite different. In Glace Bay there is for every additional person in the family a marked increase. The Yarmouth illneFs rate for families with from foui· to seven persons hardly rises with an increase in the number of persons. It is about the same as the Glace Bay rate for families of three. Families with eight and more pen;om; in Yarmouth get only half (G5.2 percent) of the atten• tion which comparable families in Glace Bay enjoy.

'.rhe following conc-lusions sngges·t themselves: The larger the family the greater Is the benefit which they derive from an insm·ance system. Where it is absf'nt the tf'ndency to economize in the outlay for medical care is less marked in small families, while larger families do not get their share of medical servicei;. For very good reasons some Eurol)('an countries have made sickness insurance an important instrument in population policy. It is indeed a power• ful protection for large families .

For purposes of comparison, the incidence rate found by the Committee on the Costs of Medical l 'are for families with an income of $1,200 to $2,000 has been included in tablf' V. Once morf' a striking similarity is found between the committee's casf's and the Glace Bay group. For large families the Glace Bay rate ls even slightly higher, in spite of the fact that all the cases in Glace Bay have received medical attention in contrast to only 78 percent of the committee cases.

Age and sex, Glace Ray.-It is a fact well known to lay people and medical men alike that age and sex are among the most important factors determining the rate of illness. The findings in the two survey groups may first be examined separately.

10 Ibid., p. 57.


- Uncfc.r9 r: ,,,.-,,.,.,., __ o!hu- males

••• Fc,,,of•~

1-S' 1--------------- - - ----- ------1

~ i 1-0 1--------- - ,-.-.-----------=------- --- - ---l !.. , --- .....

} ~--,-' /- ----~ 51------~--=---~---------------- -~

-I

10 20 so 70 +

Frnuam l.-Me11lcally attended illnesses per person at each age, Glace Bay.

TABLE VI.-The incidence of medicany attended illness according to sex and age in Glace Bay

Ago group

Number surveyed Number ol illnesses Illness,,s per person

Under• Other t;:;~r~ males

Fe• Undcr· Other males ~Y~r~ males

Under· 0 Fe• wound thcr males miners rualc.s nia1~s Total

- ------l----11----l•------------------------

fl~ L::::::::::::: ·-······ 1, g~~ ~~~ :::::::: m ~l :::::::: o: ~ o: ~ o: ~ 10tol4 .•.• - ....... _. ....•... 778 803 ..•..... 529 MO -----·· .68 .68 .GS 15 to 19..____________ 48 635 682 62 321 445 J. 29 . 51 . 65 . 61 20 to 24 _____ . --·----- 266 324 644 358 153 461 J. 34 . 4 7 • 72 . 79 25 to 34·----·--·---·- 774 296 883 913 154 864 1. I . 52 . 98 . 99 35 to 44 .•• ----------- 628 168 641 703 132 62j 1. 12 . ; . 98 J. 02 45 to 64--·-·--------- 737 310 823 026 218 724 J. 26 . 70 . 88 1. 00 65 and over_·-·-·---- 97 125 207 117 91 145 J. 20 . 73 . 70 . 82

All ages ___ --·- 2, 550 4, 620 6, 493 3, 079 I 2, 9281 4, 970 j J. 21 . 65 . 76 . 81

In table VI and figure 1 the incidence rates for Glace Bay are shown by age and sex, the males broken down into underground miners and others. If underground miners had been included among the males a wrong impression of heallh conditions in that group would ba,·e been created, and for that reason no separate curve has been plotted for all males.

Certain trends are recognizable from table VI: (1) Morbidity is relatively low in childhood. Boys and girls up to 5 years show the b ghest incidence rate among children. (2) Youths 15 to 19 years represent the healthiest age group. (3) The illness curve rises from 20 to 34 years and remains rather constant from then until 65. (4) Underground miners have more illne ses than any other group. (5) Men between 15 and 65 years not employed in underground mining show in each age group a lower incidence rate than women.

The decline of the illness curve for per. ons over 65 years, which has no counterpart in other surveys, is probably no sign of good bealtll but due to the fact that a good many people in this age group are no longer entitled to mPdical services. Under the insurance system thef:e services are rendered to a family only as long as one of its members is a wage earner and has contr ibutions checked off'..

•

•

•

• DENTAL RESEARCH AND DENTAL CARE 191

Persons who have retired from work on account of age, and their families, can therefore only get medical attention by paying for it at the regular fees or by way of charity, though in many cases their former panel doctors continue to look after them.

If all males, irrespective of their occupation, were contrasted with all females, the latter would show a lower illness rate and would no longer appear as the weaker sex. What brings about that re ult is not the sturdiness of women in Glace Bay but the high morbidity rate for underground miners which pushes up the illness curve for males. By breaking down the male illness figures according to occupational status a result is obtained that corresponds to the observations of previous studies: the incidence of illness among females is higher than among males-with the exception of underground miners. It rises to it greatest height in the age groups between 25 and 45 years, that is, in the years of childbearing .

The findings derived from the above analysis of sickness data are confirmed when studying the persons who have not sought medical services during the whole survey period. It must not be expected that the two sets of figures will correspond to each other in every respect. The rate for the incidence of sickness bas been obtained by dividing the total number of illnesses experienced by all members of an age group by the number of persons in that group. Thus persons who bad no illness are contrasted with those who may have experienced a number of illnesses. The "age curve of good health"-as Sydenstricker has called the

-charts showing the percentage at each age of persons reporting no illness-is presented in figure 2. Underground miners are left out altogether. Again it is apparent that women are a less favorable health risk than men.

- Malt~ uel. undc"I• "" ...... --- ft,..al••

-

r ""-.. -- - - " ........ - --- ' - ,, -p , _________

-~ .. ...

cf 2o

-JO 20 so 70 +

FIGURE 2.-Percent at each age without medically attended lllness, Glace Bay.

Age and sew, Yarmout11.-IIow many illnesses receiving medical attention have occurred in Yarmouth under the present-day system of medical care and how were they distributed over the various age groups? The answer is given in table VII and figurE' 2. The results are what one might expect and do not require much explanation, as the rates conform in their general trend with the findings of previous surveys.

Women between 15 and 65 years have in all age groups a higher incidence rate than men. 'l'he difference is greatest in the years of childbearing: for the age group 20 to 24 years, for instance, it amounted to over 100 percent. But women ove1· the age of 65 seem to neecl or, at any rate, receive le1,s nttention than men of the same age group, and boys and girls under 15 show little difference. A similar trend for older women was found by the Committee on the Cost of lV[pdi<'al C'nre.11

n Ibid., p. 266, table b 11.

• 192 DENTAL RESEARCH AND DENTAL CARE

TABLE VII.-The incidence of medically attended illness according to se,c and age in Yarmouth

Number surveyed Number or illnesses Illne!'S~ per person Age group

Males Females Males Females Males Females Total

o to 4 433 397 152 150 .35 . 38 .36 6 to 9 .....•..•.......•••.•.•... 385 387 113 81 .20 . 21 .25 10 to 14 ....•.............•...•• 376 3f8 95 93 . 25 . 25 .25 15 to 10 ..........•........•.•... 361 351 98 144 .'l:l .41 .34 20 to 24 318 353 Ill ~2 . 35 . 74 .56 25 to 34 .••••.••••••.•••••••••••• 494 cco 214 423 . 43 .64 .55 35 to 44 ----------------------- 386 446 1n 314 .46 . 70 . 59 4..'i to fl4 559 662 280 44R .50 . 67 .59 65 and over ........•........... 207 349 102 299 . 93 .86 .88

All ages ..............••.. 3,519 3,973 1,432 2,212 .41 .56 .49

It is also in keeping with previous surveys tbat 11 clf'<'rt'llSt' of the illness rate is found after tile fir t 5 years that from 15 year;; on there is a graclual increase which, as might be expectl'd, is more irregular for women than for men.12 But while the rate of meclically attended illne:ses in Yarmouth for children under 5 is higher than for children betw<>en 5 and 15, namely, !36 C'Ompared with 25 illnesses per 100 persons, it is onl.v about one.third of the rate found by the committee for early childhood in the low•in<'ome group:,:;.

Age and sl'x, comvnrison bl'tween Glael' Bay and Yarmo11t1,.-,Vhen finally, a compari on is made of the findings for the two surve>y arNtii. it i,; again the grnup of small children which attracts attention. 'l'he Glace Bay rates are for early chilclhood (0 to 4 years) twice as high, and for the ng<' group 5 to 14 ~-ears, nearly three times as high as in Yarmouth. '.!.'he differenc·e is more markecl than in any other group. This leads to the conclusion that if a family has to economize in its expenditure for medical care, children are likely to sulipr mo~t. '.!.'his is readily understandable, as in families with small incomes the health of the breadwinner and of the mother are thf' most valuable a~sets. \Vhil<' it was stated previou ly that large families are the chief beneficiaries of sickness insurance, it can now be added that children uo to 15 years suffer most from its absence.

TABLE VIII.-The incidence of medically attended illness according to age in Glaee Bay and rannouth

.\ge group

Illnesses per person per year

Olace Bay

Including under· !!found mircrs

Excluding Yarmouth under• ground miners

Oto4............................................................... 0.71 0.71 0.36 5to9 •......•••.•................••....•......•.........•.•.•...... .63 .63 .25 10 to 14 .....•.•....•..••...................•...........• ,........ .68 .68 .25 J5to19 ... • .••......••••.•....•..•.....••.......••••..•...•....•..• .61 .58 .34 20to?4 ...............••........•. , .•...•.........•................ 79 .6-1 .li6 2.5to34............................................................. .99 .86 .55 35to44............................................................. 1.02 .94 .59 45to64 .....•.........••......•.•..•...•.•......•••••..•..•........ 1.00 .83 .59 65 and over.. .•..••.•....................... ••.•...... ..•..... .••. . 82 . 71 . 88

f-----1-----+----All ages•..................................................... .82 .71 .48

1 The rates for all ages have been adjusted according to the age and sex compOSit,on of tbe 1931 Nova Scotia population.

u Ibid.

•

,

DENTAL RESEARCH AND DENTAL CARE

- Glac.e Sa'J fbllll GI«• 8•y~,d,,,,.,,r.

•• Yarmouth

193

1-S- 1------------------------------

' .,,, ,_ 10 Zo so ,o

FIG UBE 3.-Medically attended illnesses per person at each age, Glace Bay and Yarmouth.

+

Equally remarkable is the difference in the rates of persons over 65 years. The findings in Yarmouth seem to indicate that the incidence rate for old people in Glace Bay would be much higher if they were entitled to medical care in the same way as insured persons.

The illness cunes for other age groups, 20 to 64 years, run, as may be seen from figure 3, more or less parallel, but the level of the Glace Bay curve is much higher than in Yarmouth, even when underground miners are left out of the comparison. There is only a small difference in the incidence rate of the two areas for young people between 20 and 24 when underground miners are disregarded. It is evidently one of the healthiest periods of life.

Incapacitating illness, Glace Bay.-In the present survey the term "incapacitating illness" is used only for illnesses of wage earners which have the effect of keeping them away from their work for at least a day." This is in keeping with the practice in countries which have old-established systems of sickness insurance. 'l'his practice is also followed in the valuable Statistical Studies of Illness in the Civil Service of Canada.,. The question whether an illness prevents a person from doing work is one criterion for its severity. Another is its duration. The two factors are so closely interrelated that they must be examined jointly.

Of the 3,609 cases of illne,:s which were found among the surveyed wage earners in Glace Bay, 1,221 were disabling for one or more days. In other words, out of three cases of illness, one caused an absence from work.

The 951 wage earners who suffered from one or more disabling illnesses lost on account of them throughout the year 35,589 days. The average loss of time per case of incapacitating illness was 29 days. During the year as many as 71 percent of the wage earners were free of incapacitating illness, a ratio nearly as favorable as the one found for insured wage earners in Scotland during 193G-37, namely, 75 percent.'"

Since the risk of sickness among the workers of a mining company is likely to differ according to their occupational status, the above figures for incapacitating illness have been broken down for underground miners and other insured wage earners. The following results are obtained. Among 1,000 underground

13 In the surveys of the Committee on the Costs of Me<lical Care and some surveys of the United States Public Health Service. housewives and school children are counted as disabled when confined to bed, hospitnlize<I. or othnwise unable to attend to their work (Falk et al., The Inci<lence of Illness, p. 76, ancl Selwyn D. Collins, CaseR ancl Days of Illness Amon~ I\Iales ancl Females with Special Reference to Confinement in Bed, Public Health Reports, Reprint No. 2129, 1940).

14 Cf. footnote 7. "'AnnuAI Report on Incnpaeitatlng Illness Among Wage Earners In Scotlancl for 1937

(Department of Health for Scotland, p. 7).

194 DE TAL RESEARCH AND DENTAL CARE

miners there occurred in the course of a year 1,207 cases of illness. But only in 407 cases was it an illness which caused the men to miss their work. On the average, 29 days were lost per case. If the total number of days lost in a year is related to the total number of underground miners, the average loss of time due to illness was 12 days per mine1·. Workers employed on the surface suffe1·ed much less from illness: 1,000 such workers experienced in the course of a year 763 cases of illness, 263 of which were incapacitating. The time they lost on account of disabling illness, 28 day pe1· case, was not much less than for underg1·otmd miners. If the total number of days lost in a year is related to the total number of workers emplored on the surface, it is found that the average loss of time due to illness was 7 days per man.

The facts just stated are shown in table IX. It is interesting to compare these data with figures which are available about absenteeism caused by illness in the Scottish and German coal fields. (See table X.) All three areas show a striking similarity in the incidence rates, Glace Bay and Germany also in the time lost, while Scottish figures are higher in that respect. All the statistics were collected between 1930 and 1938.

TABLE IX.-Cases of incapacitating illness and da11s lost in Glace Bay

Cases of Days of Cases of iacapacitat- Days or Incapacity Days of

iacapacitat- iog illness per cage of iacapa_city lag illness per 1,000 incapacity iacapacitat- permmer

mine-rs Ing illness ---------

Uadcr~rouad miners. ________ ___ __________ l,03~ 407 30,510 29.4 12. 0 Other insured wage-careers .. ______________ 183 263 5,o;o 2;, 7 7.3

Total group _________________________ 1,221 370 35, 58g 29.1 11.0

TABLE X.-Absenteeis1n among miners due to illness in Glace Bay, Scotland, and Germany

f'ases of incapacitating illness per

1,000 miners

Days of iacapacitf per case of 1ncnpacitating

ilJDe!'S

Days of incapacity

per miner

----------·-----------------------------0 lace Bay. ____________________________ ___ _____________________ _ Scotlancl •-- ___ .... __ -· ___ ___ _ _ ----------------------------Oermaay •------------------- ________________________________ _

407 405 413

29.4 45 28. 4

12.0 18 11.4

1 The Scottish figures give the average during 3 years coding June 30, 1933 (Report on Incapacitating Dlncss ia the Insured Population of Srotland During the Year 1st July, 1933, to 30th June, 1934, Department or Hralth for Scotland, 1935, p. 45).

• The German fl~ures rpfer to the year 1034. They giYe in contrast to the Olace Bay and Scottish figures averages for all wage earners employed in the mining industry whrther undergrouud or on the surface. However, the percentage employed ou the surface is comparatively small (Statlstik der Krankenversichcrung he! den Ortskrankcnkasscn, Berlin, 1035, p. 23).

Comparisons of international data are rather dangerous as conditions in the various countrie may differ widely. nut in the present C'ase the facts, namely, absenteeism on account of illness expres ed in days lo. t, are easily ascertainable and are taken from official source . Differences, howe,·er, may exist in the age di tribution of the group and in the proportion employed underground and on the surface, factors which might have some bearing on health conditions and about which information was not a,ailable.

Incapacitating illness, Yannottth.-Of the 1,252 cases of illness among wage earners which were counted in Yarmouth, 3:H or 2 percent were incapacitating. The 307 persons who received medical treatment for such an illnes lost altogether 4,910 days. On the average one case lasted 31 days. It ha , however, to be considered that all the information in the survey was obtained from the doctors and that under a fee-per-service system the doctor would be less accurately informed about the termiHation of illness than under insurance.

Incapacitating illness, comparison beticeen tlle two areas.-The reservation made above applies only to the Yarmouth figures of duration of illness, not to the ratio between incapacitating and non-incapacitating illness. In that respect

:,

DENTAL RESEARCH AND DENTAL CARE l95 the findings of the two areas may be safely compared. Of the 3,609 cases of Illness among wage earners in Glace Bay, 1,2-21 or 34 percent were incapacitating, that is, they compelled the man to interrupt bis work for at least 1 day. In Yarmouth, of 1,232 cases of illness among gainfully employed persons, 355 cases or Q'B percent were incapacitating.

At first glance it seems smprising lhat the percentage of incapacitating illness should be so similar in the two areas. It might be expected that under an insurance system the percentage would be lower because the insured persons would make ample or even excessive use of the facilities of free medical treatment for minor non-incapacitating diseases. This, however, is true only for the group of dependents, not for the wage earners for whom data are presented here. In Yarmouth, on the other hancl, the situation is just the reverse. The breadwinner whose health is essential for the maintenance of the family income gels more in the way of medical services than the rest of the family. If the relation between disabling and nondisabling illness in the two areas is so similar, the reasons for the phenomenon are very different in each case.

Causes of illness.-This is not a treatise on causes of illness such as those undertaken by epidemiologists or public health authorities in search of more effective methods for combatting disease. The purpose of the subsequent discussion is to find out what prompts people to go to the doctor under the present-day system of health care and how the situation is likely to be changed through l;lealth_insurance. The existence of an insurance plan will not only remove the PConomic barrier between doctor and patient but will also have a profound influence on the patient's concepts of the need for medical services. The change may be for the better or for the worse ; the patient may become health conscious and pay greater attention to types of illness hitherto neglected, or he may merely seek to get his money's worth for his contribution ancl impose without jus tifi:1ble reason on the doctor and the insurance fund. It is difficult to ascertain whether in a given case the one or the other moth-e preYails. The result at any rate will be a considerable change in cope and character of the services which the general practitioner has to render. It is not claimed that the findings of the present survey are typical of the difference between the two systems, but they are probably indicative of the general trend.

TanLE XI.- Causes of m eclically attenclea illness in Glace Bay and, Yarmouth-broad classification

Diagnosis class

J. Infectious __ __ _____ -------·----- - --- --- ____ ---- -- -_ 2. Cancer _________ ____ --------------------------------3. Rheumatic _____ ___________________________ ________ _

4. Blood____ . -- - -------·-· - --- - ------------ - - · --5. Chronic poisoning __ ______________ ---------------·-6. Nervous __________________ ____________________ , ___ _ _ 7. Circulatory------·------- __________________ -·- ____ _ 8. Respiratory __ ___________ . _ _______________ ·---- ·---9. Digpstive ·-·-··---·-----·- --- --- -----·-------·--

JO. Genito-urinary_-- -----·---- ------------------------11. Puerperal__. __________ ·-·---- -------------·----- __ . 12. Skin - --- -- ·---------·--- -----·------------ ___ _ ,., Bones . ____________ ----· --- . -----· ---·--------------17. Accidents ' ·----• --·----------·--------------------18. liHlcfined and other __________________________ _____ _

All causes __ --- ------- --· ---- -- --· ------- -----

Number or illnesses Percentage distribution

Olace Bay Yarmouth Olace Bay Yarmouth

I, 354 62

4S0 30 28

915 291

I, 325 2,104

385 479

1, 331 68

l , 920 205

JO, 977

5.'lO 33

154 85 9

562 237 407 481 254 159 311

39 338 45

3, 644

12. 3 . 6

4. 4 . 3 .2

8. 3 2.6

12. l 19. 2 3. 5 4.4

12.1 .6

17. 5 J.9

100.0

14. 5 .9

4. 2 2. 3 .2

15. 4 6. 5

11. 2 13. 2 7. 0 4. 4 8. 5 J. 1 9.3 1.2

100. 0

1 C'la.•ses 14 to 16 of the international list bave been combined with class 18 as they contained only very few cases.

For discussing the causes of illness the cases which occurred in the survey group are presented in two different ways. The cases are hown in table XI classified according to the broad headings of the international list of causes of death. This classification had to be resorted to as there does not yet exist a generally accepted international list of causes of illness in spite of attempts by the International Labor Office to bring about an un<lerstanding on a common procedure in this important field of vital statistlcs.1

• Obviously a metbocl devised

•• International Labor Office, Statistical Methods for Measuring Occupational Morbidity and Mortality (Geneva, 1930), ch. VII.


for presenting death statistics is not always suitable in the field of morbidity. But the method is used in a number of other surveys and in order to facilitate comparison with them is emplored here.

It can be seen from table XI how the case load of the insurance practitioner differs from that which his colleague has to carry on a fee-per-service basis. Diseases of the digestive system, accidents, infectious diseases, and skin and respiratory diseases take the first five places in Glace Bay, while diseases of the nervous system and organs of special sense (ear and eye) and infectious diseases rank l1ighest in Yarmouth, digestive, respiratory and skin diseases following. The Yarmouth doctor also seems to be proportionately more preoccupied than his Glace Bay colleague with illnesses of the genito-urinary system, the blood and the circulatory system.

A different and it is thou~ht improved method for giving the results of the present sun·ey is used in table XII. It shows certain types of illness which are prevalent in the two areas along with classes of the international list. It is a compromise which makes comparison with other studies more difficult but helps to clarify the picture. To have the discussion exclusively based on the broad classifications of the international list would often conYey a wrong impres;;ion. ' ervous disorders, for instance, are combined in the international list with diseases of the eyes and ears. Dental conclitious and tonsillitis are among the illnesses of the digestive system.

TABLE XII.-Annual rates of medically attended illness per 1,000 persons for selected causes

?\umber

Glace Bay

Under• ground miners

Others Total

Rate per 1,000 rersons

GlaceBay Yer•

mouth, Under• total yround Others Total

miners

Yar• mouth, total

___________ , ____ - - - - - - - - - ---------- --Accidents ..• . •.• -. .. .. . ......... 9U3 95i 1,020 338 378 87 142 45 Skin . . ..... ...•. .. 3!19 032 1, 3~1 311 156 85 08 42 Colrts and bronchitis... .. . .. 253 851 1, 104 3fi8 00 77 81 41 Influcnz,1 .. . . . 215 784 90'J 384 84 71 74 51 Minor dii:c•stivc . . . . _ .• 167 530 697 16U 60 48 51 22 Pucrrcral Rnd fem air l?Cnital. ... .. . __ . 644 c.44 284 • • •• • . • 58 47 38 'fonsils and larynx . . . ... . .. . 98 526 624 12i 38 48 46 17 'l'cctb . . • . .. • !l4 390 5C4 41 46 35 37 6 Rheumatism and arthritis . . .•. _ 2( '0 245 454 113 82 22 33 15 N ervons • . . . • •••..•.. .. • . • . •. • • 99 294 3H3 153 39 2i 29 20 Enr ···-- -••· -·-·-······· 154 222 376 80 60 20 28 11 Circulatory. ···- .. .. .•... . . ii 214 201 237 30 10 21 32 Eye 50 Q6 146 329 20 9 11 44 .All other. . .. ..... . . . . . ....... . . . 2!<1 1, 213 1, 494 770 110 IJO IW 103

All causes ... _···-· · · · ···-·l--3-,-0,-9-l--7,-b-D8-1 10, 977 1 3, 644 ~ ~ ~ ~

When analyzing the causes of illness in the two areas on the basis of table XII, a word of caution seems to be called for. In the first plaC'e differences of opinion and habits among the doctors who are diagnosing have to be reckoned with. Perhaps more Important, the conditions under which they work must be considered. It has been contended by a medical expert in tbE! field of social insurance 11 that insurance doctors, in view of their great case load, could not pay much attention to the refinements of subdivisions as found in some of the customary classifications of illnesses. This may also be true of Glace Bay and may in part explain the frequency of diagnosis of a rather general character.

For all cau es except two, rates are higher in Glace Bay than in Yarmouth. In spite of the fact that underground miners are disregarded, accidents, skin diseases, and colds head the list of illnesses. These contingencies hring the insured person to the doctor twice as often as the uninsured. Evidently, under insurance, cases of minor surgery such as bruises or infected fingers are no longer treated with home remedies; the ><ame is true fo1· the common cold.

Tonsillitis and laryngitis are attended in Glrce Bay three times as often as in Yarmouth. This is noteworthy not only because it is the highest differential

" Ibid., p. 70.

('

,


rate of the whole list but also In view of the serious complications which may occur in cases of this type. Digestive upsets come twice as often to the doctors' attention in Glace Bay as in Yarmouth. But while, in table XI (based on the broad beadings of the international list) they were combined with dental and other cases and represented the largest number of illnesses, in table XII in Glace Bay minor digestive troubles have a rate of only 48 per 1,000 and take sixth place.

Looking at the Glace Bay picture as a whole, it would appear that light illn,es es such as minor accidents, skin infE>ctions, colds, and indi11:estio11 are rather frequent, more so than In Yarmouth. ~be same obsen·ation has been made in the operation of European insurance schemes and it bas been found that these "light" cases by receiving adequate treatment at an early stage not only do not become "serious" cases but that they also bring the population in touch with the doctors and facilitate preventive work of a general character.

In Yarmouth, according to table XII, there are two types of illnesses which come more often to the doctor's attention than in Glace Bay-diseases of the eyes and of the circulatory system (heart). The list can be enla1·ged by other gt·oups which, because of the relatively small number of cases, have not been tabulated separately and are included in table XII among other causes. They are, per thousand of the population:

Yarmouth Olace Bay

Anaemia ..•..................•••••.•.....•••••••.•..••...............••••.•••.•• Venereal diseases .........................•.......•.•.....•...................... Diseases or the gall bladder ....•.•.•.•••.•.•••.•••••••••..••.....•.•.•••••..•.... Tuberculosis .. _. _ ... _. _ ..... ___ . _. _. _ ••. _ ..... _ ..••.•..•. _ .•• _ •. _____ • _. _. ___ • _.

11. 2 6.1 4.8 3. 2

2.4 2.1 2.3 2.6

A change is also made in table XII in the denominator used. What interests us most is the rate of a given illness per 1,000 population, not its role as a con• stituent part of the doctor's practice. Finally rates in Glace Bay have been broken down for underground miners and the rest of the survey group. In order to avoid any distortions which might be caused by the peculiar health conditions of underground miners, they will Jil"st be disre11:arded in the compari ·on and their situation will be briefly· discussed at the end of this section.

In most of these cases the illnesses a1·e of a type which in larger cities would receive treatment by specialists. '.rhe explanation of the higher rates in Yarmouth seems to be that while Yarmouth doctors, w_itb one exception, carried on a general practice, some of them were known to the public by their special experience in certain fields of medicine and were accordingly consulted. There is no parallel for this in Glace Bay. It is therefore likely that the small rate of eye ca es in Glace Bay is due to the absence of specialist service under the insurance scheme.

Rather surprising is the large number of cases of an·emia in Yarmouth. It is probably not a condition peculiar to the population. Anemia seems to be an ailment for which families with a comfortable income-which are quite frequent in Yarmouth-are more inclined to seek medical advice than the families of miners.

TABLE XIII.-Rates of medically attended illness per 1,000 population for certain causes among undergromuz miners and other members of the survey group

Diagnosis

Accidents-···· •-······· .•..•.•..•...•......•.•................... Rheumatism and arthritis.·-···················· •.•.••..•.•...•••. Ear_ ..••.. ······-··· ............•. ···- ......••...•..........•....... Eye ..•................ ··-··········································· Skin .............•.. ··-· ••........•. ·- ••.. -· ...•.•...•............. Circulatory .....•..•..... ·- ......••.•.. -.•...••...••..•...•.•....••• Minor digestive ...........•...•..... -······· ...................... . Nervous .. ··•········-· ..................•..•.......•.•...•....... Colds and bronchitis .. -· ......••..•••......•.•.....•••.•.•.•.•..... Tooth···············•····-·-······························ -······-

Annual rnte per 1,000 persons

Miners All others

378 87 82 22 60 20 30 19

156 85 30 19 65 48 39 27 99 77 45 35

Ratio miners to all others

4.3 3. 7 3.0 2.2 1.8 1.6 1.4 1.4 I. 3 1. 3


Undoubtedly a result of the insurance scheme is the treatment of G04 dental cases with an annual incidence rate of 37.2 per 1,000 population in Glace Bay, while in Yarmouth only 41 ca es with an incidence rate of 5.5 were treated. As the insurance scheme does not provide for dental care the physician is urged by the patient to do the work of the dentist. If, ou the other hand, as in Yarmouth, the patient has to pay tile physician a fee for extracting a tooth, he prefers to have the job done by the more experienced dentist.

So far the 2,5GO underground miners iuclucled in the Glace Bay survey group have been left out of the di~cussion. The causes of illnesses occurring among them may now be briefly examined. Their morbidity rates are, as may be seen from table XII, above average, 1,207 per 1,000 population compared with 717 for the rest of the group. Are miners more susceptible to certain types of illness than others? Are they suffering from "indu ·trial diseases" not yet recognized by workmen's compPnsation legislation? Is it justifiable to speak of miners as unfavorable health risks?

An attempt is made to answer these questions by showing in table XIII those classes of frequently occuning illnesses in which the> incidence rate is appreciably higher for underground minPrs than for the remainder of the surveyed population. If the large group of accidents Is disregarded it seems that rheumati m and skin di~eases are the mnin afttictiou<; of the miner. '.rbe frf'quency of rheumatism is most probably due to the dampne, s of the mines in which the men work. Likewise the frequency of diseases of the skin can be traced to the character, of the miner's work. In the Scottish mining nreas "inflammatory skin," 1

• as one of the most prevalent skin diseases is called there, tops the listinfluenza and accidents are disregarded-with an incidence of 41 per 1,000 and a ratio of 2.5 between miners and other males in Scotland. Why the other diseases listed in table XIII should orcur among miner. more often than among other .veoole must remain a matter for further investil!;ation.

Rrccipt of mcdi, al care.-ThP prece11ing cliscu1,sion of causc>s of illness re<'eiving mPdical treatment reprPsPnted a qualitatiYe analyRis of the changPs which sicknPss insnranc:e will bring into the pr::t<'tic·e of lllC'diC'ine. 'l'he composition and character of the cloctors' case loacl came up for reviPw, not the amount of work performed by them. For a few rasc>s of serious illnPss may mnkP greater demands on the doctor's time and enC'rgy than a s'cnre of colds ancl cligc>stive troubles. Wlwther and to what c>xtc>nt hc>nlth im;nranr<' will mean more work for the doctor will beeome apparent when in the following paragrnphs the services rendered to the people un<ler thP two systc>m,; nre c>xmninc>cl. Comparison will, however, be llmitecl to those Sl:'rvkes whi<-h are most likc>ly to be affected hy the new system. They are, according to EuropC'an experience. cloctors' calls anrl the di,:ppnsing or preseription of clrngs aud urt'S ings. In a latl:'r publi<:ation, l1ospital care, operations, and preventive measures will be di~cnssed.

Looking at the problem from the point of view of the community, the fir,;t task is to find out what proportion of the population had acce;;s to medical servires in the two arc'as and to what extent these were prodded. 'Therefore the quantity and type of services renclPred for illnesses whiC'l1 occmTPcl in the two areas during the survey period will be compared. Does a given case rc>cc>i,e more or less attc>ntion under an insurance syRIPm? This h,, of c-ourse, a quantitative> measurement and does not say anything about the adequacy of the treatment receivPd.

Doctors' calls.-WhPn examining the inci,lc>nce of illness-which in the present survey means medically attended illness-it has already been found that the rate was much hig-her in Glace lfa~· than in Yarmouth. A i;,imilar difference may therefore be expectc>d in the amount of medical Sf'rYices rendered to the surveyed population. 'l'hf' two systems vary wiclely in that respect-1,000 persons under, an immrance scheme recPive 64 percent more in the way of doctors' calls-that is, offlee, borne, and night cnlls taken together-than a group of similar size lacking insurance protection. Or, to put it diITc>rently, a ppr,;on in Glace nay bad on the avernge 2.4 medical calls per year ( excluding- underground miners, 2.1 calls) while a person in Yarmouth had 1.4 calls. No such differPnce exists in the rnte of calls made in the cour~e of an illnc>ss. The Glare Bay doctor sees his patient in office or hornP on the avPrage 3 timps <luring nn illnes,·, the Ynrmonth doctor 2.8 times. '!.'able XIV shows the rc>ceipt of calls broken 1lown according to type.

18 Rpport on Incnpn<'ltntlng SkkneRs In the Jnsurerl Pormlntlon of Scotlancl During the Year July 1, 1933, to June 30, 1934 (Department of Health for Scotland, p. 40).

,


TABLE XIV.-Do<:tors' of/ice and home calls

Calls per 1,000 persons Calls per 1,000 illnesses Type or calls

Glace Bay Yarmouth Glaoo Bay Yarmouth

Office caJJ_ __________________ • ----------- ------------- -Homr call (daytime) _____ _____________________________ _ Night can _________________________ ______ ------------ __ .

972 687 ], 201 l, 413 l, 376 656 1,700 l, 349

61 30 76 62 Total ___________________________________________ _ 2,409 l, 373 2,977 2,824

The most striking difference is in the number of home visits per 1,000 persons, whether by day or night. They are twice as frequent in Glace Bay. The difference seems much less pronounced in the rate of oflice calls. But the figures in question do not give a full picture of the work performed by the Glace Bay doctors in their oflices. They have, in addition, dispensed or prescribed medicines and dressings or have given advice in no less than 16,185 ca es on the basis of "complaints" reported to them by a member of the patient's family. If these "complaint" cases are added to the calls made by the patients themselves to the doctor's office, the rate of office calls jumps from 972 to 2,165 per 1,000 persons.

The frequency of calls may be influenced to some extent by the use which the doctor makes of hospital facilities. The findings of the Dalhousie survey on hospital care could not be pre ented in this article but it ml\Y be stated that they do not materially change the picture given in the precPding paragraphs.

Doctor's calls by age.-It has been shown by previous studies 1• that the demand fo1· health services varies with age and ex. WomPn in certain age groups need more medical care tlrnn men; both sexe are, when growing older, not only more subject to illness, but their ailments are apt to be more serious and protra~ted and therefore require more in thP way of medical services. Tht>se observations are confirmed by the present survey. The call r:ites at variom; age levels can be seen from table XV. Sex variations have been omitted for lack of space.

The table, as far as it deals with calls per 1,000 population, is illustrated by figure 4. Such calls are in Glace Bay, as one would expeC't, for the insured population is on a hi,~her level than in Yarmouth throughout all ages. The difference is considerable anrl the picture does not change very much when influred wage C'arners, most of them underground miners, are left out of tM comparison. The curves come closest to each other in the age group 20 to 24. Afterward, that is between 2:; and 65 years, the rates in Glace Bay are constantly 100 percent higher. This is only in part due to the presence of insured wage earners as can be seen clearly from figure 4.

T.ABLE XV.-Oall rates b11 age in Glace Bay and Yarmouth 1

. Age group

All Oto 4 5 to 9 10 to 15 to 20 to 25 to 35to 45 to 65and ages 14 19 24 34 44 64 over

------------------CalloFa:01:if~-~~~~~~: ______ _ 2,409 1,835 1,619 l, 685 ], 582 2,355 3,085 3,083 3,523 3,492

Yarmouth ______ _________ 1,373 735 515 lil3 851 1,644 1,525 1,490 l, 778 3,619

CalloPn~l~-i'.l~-e-~~: ______ 2,077 2,581 2,569 2,471 2,608 2,900 3,120 3,034 3,527 4,244 Yarmouth _______________ 2, 824 2,020 2,051 2,032 2,504 2,957 2,763 2,640 2,990 4,098

' Combined rate for office end borne calls.

1• Selwyn D. Collins, Frequency and Volume of Doctors' Calls Among Males and Females In 9,000 Families Based on Natlon-w!l1e Periodic Canvasses, 192 31 (U. S. Public Health Report, Reprint No. 2205, p. 12).

•


'f;OOO ,------------------------------~

~ 3,ooo 1----------~~~~~-------_;.'.:._ __ -' Q /

~ , t ,. o 2,ooo 1---------___,,__ ___________ ____,,, _______ ---1 ! _, -------~ /,ooo 1------------..1-------------------------1

0 V ' ✓ , __ , - Gloe,: s., total

-- G loce eo, ucl. ins. w.e. - - Yarmouffl

Jo 40 A,e

10 20 50 6o 70 +

FIGURE 4.-Calls per 1,000 persons at each age, Glace Bay and Yarmouth.

It is interesting to note that in both areas the rates remain more or less constant between 25 and 45 years. Persons over age 65 have fewer calls in Glace Bay than in Yarmouth since they are, as previously explained, no longer entitled to insurance benefits. Examining the type of calls-for lack of space the tables have been omitted-it is found that home calls are m'1st frequent for infants and older people. In both Glace Bay and Yarmouth· office calls have a· peak at the age group 20--2-! years and show afterward a decline. As people grow older they not only fall victims to illness more frequently, but once ill require more attention than when younger. Calls per case of illness, as may be seen from table XV, are more frequent in Glace Bay than in Yarmouth. The difference is, however, much less marked than was found when rates per 1,000 population were examined.

2.000-----------------------, I Cloce &y

lfl V'o""'°""'

l,S'OO 1------------------------; .,, C: 0 :? ~

J. l,ooo

~ 0 soo----u

FIGURE 5.-0fllce and home calls per 1,000 children under 15 years, Glace Bay and Yarmouth.

•


But a far more important difference between the two areas becomes apparent when the care given to children up to 15 years of age is more closely studied. Table XVI reveals that Glace Bay children under 5 years have two and a half times, chilflren 5-14 years three times, the number of calls of the children in Yarmouth."' As the difference is most marked in the case of home calls it is likely that the reasons are of an economic nature; a home call is more expensive than an office call.

TABLE XYI.-Call rates for children under 15 years, in Glace Bay and Yarmouth,

Calls J)<'r 1,000 children Calls per 1,000 illnesses

Glace Bay Yarmouth Glace Bay Yarmouth

o to 4 years: Otfice caJls ___________________________ ------------- _ 167 247 235 Home calls_________________________________________ 1,668 488 2,346

1-----1-----1-----1-TotaL___________________________________________ 1,835 735 2,581

1====11====1====1 5 to 9 years: Office calls ________________________________________ _

Home calls _________ ------ -- ---- ------ -- --- -- ------ -

Total ____________ --------------------------------

10 to 14 years: Otnce calls ___________________________ ------------ __ Home calls __________ ---- __________________ ________ _

'rota!_ -- ----- --- -- -- ---- ---- ------ ------ -------- -

524 1,095

1,619

683 1,002

1,685

225 831 290 1,738

515 2,569

243 1,001 270 1,470

513 2,471

679 1,341

2,020

897 1,155

2,052

9G3 1,069

2,032

Drugs and dressing.~.-Under the rull's of the insurance system operated in GltH:e Bay doctors cannot make n charge for medicine which they dispense, but prescriptions fillecl by the druggist have to be paid for by the patients. In Yarmouth as everywhere in private medical practice, there is no bard-and-fast rule for the payment of dispensed medicine. Their costs are sometimes included in the medical fee, and s01uetimes, particularly in the case of more expensive drugs. are charged separately.

The dispensing rathe1· than prescribing of drugs and dressings is the rule in both areas. llowever, prescriptions are relatively far more frequent under the present-day system than under insurance. They account for one-third of all drugs used by patients in Yarmouth but only for one-quarter in Qlace Bay. These factors have to l>e considerPd when the use of drugs and dressings in the two areas is examined. The differences are very considerable as may l>e seen from table XVII.

TABLE XVII.-Volume of drugs and dressings dispensed and prescribed

Drugs Dressings

Olace Bay Yarmouth Olace Bay Yarmouth

Rate per 1,000 persons: Dispensed__________________________________________ 1,124 447 368 82 Prescribed_________________________________________ 361 224 8 6

1-----1----+-----1-----TotaJ.___________________________________________ 1,485 671 376 88

Rate per 1,000 Illnesses: Dis11"nsed ___ . ______________ --___ -_ ---- -___ ------__ -Prescribed ________________________________________ _

Total __________________________________________ _

1,389 446

1,835

919 461

1,380

455 9

464

168 12

180

"The call rates thus correspond more or less to the rates of Incidence of illness which were previously Jouncl for these age groups.


Tbe insured group In Glace Bay used more than twice as many drugs and more than four times as mnny dressings as the population of Yarmouth. The difference is mu<:h higher than the one in the illness rate which amounted to 66 percent. In the case of dressiugs the Glace Bay figures may be partly explained by the high accident rates which accounted for 218 dressings per 1,000 population. But no such explanation can be offered in the case of drugs. It may be argued that drugs unrecorded in the survey might have been bought over the counter by patients in Yarmouth to a greater extent than by the in ured persons in Glace Bay who receive them without cost from their doctors. This would be an important consideration in a comparison of medically unattended cases but eems not of great relevance un<ler the conditions of the present survey. '.!:he reason for the higher drug rate in Glace Bay appears to be that the insurance doctor makes a wider use of drugs than the practitioner under the pre ·ent-day system. The same observations have been made in social-insurance systems in Europe. The share of the two sexes in the use of drugs and dressings does not show major differences. As may be seen from figure 6, appa1·ently in both areas women get somewhat more medicine 21 than men. 'l'he opposite is true in the case of dre sings. The demand shows an increase with advancing age•

4,ooo - Gfou: e., -'-• - - (i(OCG ••1 fo"'°lc$ -- Yor~""' "'°le!. - - yo,-,cl, f•-1<$

' J.0001--------------------------------i

10 20 ,. ♦

FIGURE 6.-Drugs per 1,000 persons, by sex and age, Glace Bay and Yarmouth.

So far only rates per 1,000 population have been examined, the findings being naturally influenced by the differences in the illne s rates in the two areas. This factor is ruled out when the drugs and dressings used per 1,000 c2ses of illness are being considered ( table XVII). Glace Bay is still ahead of Yarmouth but the difference, in the case of drugs, is only 33 percent. In Glace Bay 1,835 drugs are u,:ed pe1· 1,000 illnesses; in Yarmouth, 1,380.

These figures do not, however, tell the whole story. They do not include those Glace Bay casrs in which medical advice has been sought for patients who receive no medical examination and whose complaints are reported to the doctor by a membe1· of their family. These "complaint" ca es, it will be rememberecl, amounted to 16,185, exceeding the number of medically attended cases of illness by nearly one-half ( 47.4 percent). The report made to the doctor about the patient's complaints results nearly always in the dispensing of drugs. Altogether there were, in cases of that type, 19,575 drugs di pensed, 40! drugs prrscribed, and 336 dressings dispensed. The e dispensations and prescriptions amount to 1,498 drugs per 1,000 population. In other words, every three

21 This ls in keeping with the findings macle in the survey of 9,000 representative families. Collins bas stated that of 100 cases of medically ·attended illness with preHcrlptions tbere were among womPn 54 prescriptions ancl among men 52. See Splwrn D. Collins. The Frequency of Doctors' Prescriptions aud of Laboratory and RP!ated Services in the Treatment of Illness (the Mlllbank Memorial Fund Quarterly, vol. XXI (4), October 1943, p. 10).

•

"

...,

--~


persons in the survey group .get two drugs or dressings by that method in the course of a year. If the drugs and dressings which go to patients in the ordinary cour e of medical practice are added, the high rate of 3,359 per 1,000 population is arrived at for GJace Bay.

The dispensin!!: of drugs in the "complaint" cases is worthy of observation. l'rescribing medicine without examining the patient is eYidently the method used in Glace Bay to amid an excessiYe demand for medical services. It is doubtful whether this practice would be allowed to continue under the regime of a Government-controlled health-insurance scheme. But since the demand of th<' insured families for free medicine would probably continue to make itself felt, it is likely that the patients concerned will try to see the doctor in person in order to get the medicine. In that way most of the "complaint" cases would become home or office calls, a change that would have a far-reaching influence on the operation of the insurance scheme.

Oonl'lusions.-Some of the main findings of the Dalhousie survey as presented in this artide may be briefly s11m111arized: 1. lIE>alth insurance is likely to bring about a cousiderable rise in thE' d<>rnand for lwalth serticc:i. '.l'he rate of increase will to ome extent depend upon the prcyions level of demand in the population. An in<"rea:;e of 55 percent ns found in thE' survey may be regarded as indicative of the genernl trend in em;rern Cmrnda if the two communities surveyed are dePmed to be represcntati\·e. The increase might be greater in areas with uufnvornble benlth condition;; or amoni-( Yocatioual groups which are exposed to special risks. The insured population of Glace Bay, including underground miners, had 7G percent more doctors' calls than the uninsured group in Yarmouth. 2. A demand level as indicated by the imn·ey apppar,; to be a perman<.'ut feature of health in~ura1we ai,; the in~urance scheme surveyed in Glace Bay had been in operation for about 80 years. 3. Health insurance appear. to be most benP1icial for large families and for children. It is borne out by the survey that under the preseut-day systPm of medical care children between 5 and 15 years t·eceivc only about one-thinl of the nwtlicnl care which cllildren of the same age enjoy under health immrance. 4. There appears to be need for making available to the population untlcr health insurance not only care by the general practitioner but also the SPn-ices of specialii-ts whenever they seem indicated, according to the state of medical ,cience. Only illne. s which required specialist treatment were found in the survey to have receiYed more nwdical attention u11der the pre ent-day system than undPt· insurance. 5. Henltb insurance seems to bring about an excessive demand for drngs if they a1·e obtainable without cost to the p'ltiE'nt. An annual rate of more than three drugs per person in the survey group was found to exist under insurance.

The IIonorable CLAUDE PEPPF.R,

ExHIDIT 29

NATIONAL CATHOLIC .WELFARE CoNFEREXOE, Washington 5, D. 0., July 13, 191,5.

United States Senate O.tfioo Building, Washington, D. 0. DEAR SENATOR PEPPEit: I acknowledge your e;;teemE'd letter of June 22. As the

subject is of particular concern to the department of eclucation of the National f'atholic ,velfare Conference, I ba,e referred it to the very Reverend l\Isgr. FrcclPrick G. Hocbwalt, director of the department, from whom you may expect to hear directly.

With every good wish, I remain, Sincerely yom·s,

HOWARD J. CARROLL, General Seoretar,1.

DEPAR'.nfl!lNT OF EDUCATION, NATION,\L CATHOLIO WEl.FARE CONFERENC'E.

Washington 5, D. 0., July 16. 1915. The Honorable CLA UTIE PEPPEllll,

Chairman. SubC'ommitt<'e 011 wm·tiine HPaUh and Education, United States Senate, Washington, D. O.

DEAR SENATOR Pl!lPPElR: The Department of Education of the National Catholic Welfare Conference welcomes the oppoi·tunity to offer its comment· to the Committee on Education and Labor with reference to S. 100 and S. 1099.

75979-45--14


In drafting legislation for the proposed S. 190, some definite assurance should be given that research will be stimulated in educational institutions. In order to assure an adequate distribution of funds there should be written into this bill language indicating that the majority of funds appropriated must be distributed among the educational institutions of our Nation on the basis of projects approved as helpful to the national interest. The inclusion of such a statement could obviate any danger that the research fund be used increasingly for the development of a centralized Federal program. By making a fair and equitable distribution among the educational institutions of the Nation, the Committee on Education and Labor can make a worthy contribution to the entire field of research.

The legislation proposed in S. 1099 raises the question of the relationship of the Federal Government to non-tax-supported institutions or to individuals who are attending such institutions. It is not clear in the present wording of the bill whether the proposed health programs would be limited or restricted to taxsupported institutions in those States in which State funds, which include Federal funds appropriated to the States, cannot be allocated to p1·ivate educational institutions. If the committee believes that dental programs in schools and colleges should be assisted on the basis of increasing health services to individuals, regardless of the institution in which they are enrolled, then it will be necessary to pro,·ide for a di1•ect contractual relationship between a Fede1·al agency arid an individual school or college. The comprehensive progrnm of dental care proposed in this legislation should be made as available to children and young people in private as in public educational institutions.

Very sincerely yours, FREDERICK G. HOCHWALT, Director.

EXHIBIT 30

l\IIssoURI STATE DENTAL ASSOCIATION, St. Louis, Mo., Juiy 13, 1945.

The Honorable CLAUDE PEPPER, Chairman of Subcommittee on Wartime Heaith and Education,

United States Senate, Washington, D. O. l\Iy DE-IB SENATOR PEPPER: On behalf of the Missouri State Dental Association

I wish to record our approval of Senate bill 190 and Senate bill 10!:JD. These bills as we understand them provide for dental research, dental care and public health education. It is on this tripod that the American Dental Association belieYeS that the approach to dental health of the Nation can best be built and we are in accord with it.

At a recent business session of the council of the Missouri State Dental Association, the approval of such a program was recommended by the council on dental- health and the legislative committee and these recommendations were adopted.

Cordially yours,

Senator CLAUDE PEPPER.

TIIE M1ssonu STATE DENTAL ASSOCIATION, 0. W. BRANDHORST,

President. J. FLOYD .ALcORN,

Ohairman, Council on Dental HeaUh. El B. OWEN,

Chairman, Legislative Committee.

ExHimT 31

NEW YORK, N. Y., August 2, 1945.

Chairman, Senate Subcommittee on Wartime Health and Education, Senate Office Building, Washington, D. C.

DEAR 8E:\'ATOR PEPPER: As an individual, I wish to endorse the two bills, s. 100 and S. 1099, and urge that they be amended or redrafted according to the testimony and suggestions given by Dr. Charles L. Hyser, D. D. S., and others of the American Association for Dental Health.

Respectfully yours, KINGSLEY ROBERTS, M. D.

t'-

)

-

DENTAL RESEARCH AND DENTAL CARE

EXHIBIT 32

[Submitted by Dr. Alfred J. Asgis]

DENTISTRY IN SOCIAL SECURITY PLANNISO

(By N. Kobrin, D. D. S., Brooklyn, N. Y.)

205

The pattern for the health servicf'S of tomorrow is being shaped today by social, professional, and lay groups seriously interested in ecurity and health problems who are actively engaged in efforts aimed at expanding the present social security laws to include medical, hospital, and dental benefits. Trends of security legislation pertaining to dentistry may he gaged, therefore, by ex~mining the position of outstanding organizations on the dental aspect of this question.

The American Association for Social Security publicized a model health bill in 1938. It provided specifically for "dental service for r lief of pain through surgical intervention" and empowered the board "subject to such limitations and conditions as it may prescribf'," to provide any or part of the following benefits: Special surgical or dental appliances, the services of a general dental practitioner or a dental specialist. The association supports these proposals at the present time.

The Physicians Forum, headed by Ernst P. Boas and consisting in the main of liberal New York physicians, "approved the general features of the medical section of the Wagner-Murray-Dingell bill" and in a published analysis of its health and medical features had this to say about dentistry: "We regret that provisions for dental care and nurning care are not included in the bill, although we recognfae that this might be done more effectively at a later date. We are pleased, therefore, with the provision which directs the council to make studies and surveys concerning the inclusion of these services."

The national committee on social legislation of the National Lawyers Guild endorses the Wagner bill, calls it "a new social security charter for America" and declares that "dental and nursing care are an indispensable part of adequate medical care. The bill cloes not provide any dental care or nursing outside of hospitals. It does direct that a study concerning these ben< fits and their expected costs be made. Canada's proposed national health bill would provide nursing outside of hospitals when ordered by a physician, free dental services to all children, 11 nd additional care to the extent that Canadian dental facilities are a,ailable. We believe that the bill should provide dental and nursing cam at least equal to the Canadian proposals."

The health council of the Amel'ican Labor Party, viewing the bill from a laborprofessional angle and wholeheartedly supporting its spirit and objectives, offers the following two recommendations relating to dentistrt as amendments to the bill:

RECOMMENDATION 1

Dentistry and dental service.-"Dentistry" and "clental services" should apply only to services rendered by practitioners of dentistry who are duly accredited and licensed graduates of dentistry; and the term "appliance" shall not be interpreted to apply to dental, prosthetic, operative, or orthodontic restorations.

RECOMMENDATION 2

Minimum dental health services.-A minimum of basic d<'ntal health services by the dentist should be included with "medical" and "hospital benefits." The following dental services should be inclu(led as part of "health benefiti;:," from the very start of the establishment of health insurance:

1. Full mouth examination: history, X-rays, study models, diagnostic aids. 2. Prophylaxis: at least one annual treatment. 3. Fillings: plastic and alloys. 4. Removal of teeth: extraction to eliminate infection and eradicate disease. 5. l\Iouth replacements: essential for employment.

Declares I . S. Falk, director, Bureau of Research and Statistics of the Social Security Board in the 1942 Social Security Yearbook, "While disabling illness is more common and more severe among low-income groups than among those in more comfortable circumstances, under the present fee-for-service method of paying for medical care the low-income groups receive le s care, on the average, while spending a larger percentage of their income for this purpose. * • • If


spread over the whole population at risk, the aggregate cost of adequate medical care can be borne by self-supporting families. Compensation for the wage losses and medical co ts occasioned by sickness and di ability is therefore a field to which the principle of social insurance is particularly applicable."

Thus is the wave of the future projected. Out of bricks and straw progress is born. Perspectives and ideals shift in a changing world. New values arise. Health has become a matter of national concern in wartime. \Vaste of human resources will not again be tolerated. Security, for the Individual and for the nation, has become the elixir and matrix of life.

EXHIBIT 33

NEEDHAM, MASS., .August 4, 1945. Senator CLAUDE PEPPER,

Senate Office Building, Washington, D. C. DEAR SENATOR PEPPER: I have, for many years, been interested and concerned

about the great deficiency of dental care offered to the people of the United States. It thus follows that I am much interested in your bill S. 1099 and Senator Murray's bill S. 190.

Though dental research is obviously a crying need I want particularly to call your attention to the statement made by Dr. Charles L. Ilyser at the hearIng on these bills on June 27. I have been quite closely aRsociated with Dr. Hyser in the plans of the American Association for Dental Health. I feel very strongly that the consolidation of denti ts into groups is a very important step in improving care and reducing expense. Under the pre ent system of individual practice the cost of properly looking after the teeth of our people would I think be literally staggering. The setting up of an experimental organization such as Dr. Ilyser describes seems to me a very important step in establishing improved methods and facts as to cost.

I am most hopeful, therefore, that your committee will give most careful consideration to Dr. llyser's suggestion to set up "pilot" plants in order to chart the cour e.

Sincerely,

Mr. CARL MALMBERO,

Huan CABOT.

EXHIBIT 34

STATE DEPA.RTMENT OF HEALTH, Suit Lake City, Utah, July 3, 1945.

Chief Jnv<'8fi.(Jator, Subcommittee 011 Wartime Health and Education, Committee on Education and Labor, United, States Senate, Washington, D. O.

DEAR Mn. MALMBERG: In accordance with the suggestion in your letter of June 16, 1045, I have this day submitted a formal statement relating to bills S. 190 and S. 1099 to Senator Pepper for consideration by his committee, a copy of which is herewith enclosed.

Please be assured of my grateful appreciation for the courtesy thus extended. Sincerely yours,

R. C. DALGLEISH, Director, Division of Dentai Health.

STATEME 'T OF DR. R. C. DALGLEISH, DIUECTOR OF DF~'ITAL .IblALTH, UTAH STATE DEP.IBTMENT OF IlEALTII, TO THE PNITED STATES SENATE SUBC0MMl'ITEE ON EDc;CATJO;s' AXD LAnou, RELATI:\'0 TO s. 190 AND S. 1099

Dr. R. C. DalglPish. director of dental lwalth, Utah f-tatP Department of Ilealth and a member of th,, executive council of th<> American AsHocintion of Public Health DentiHts, is a past president of the Utah State D1•ntnl ,\ssoi-iation. Utah 'talc Public Health Association, and American Association of Public Health Dentists

There is· deep concern among our citizenry and in the Congress about the fact that 40 percent of America's young meu were found to be physically unfit for military service.

There iR deep concern in the dental profession about the fact that the largest single share of those founu physically unfit were physically unfit because they

,,


were dentally unfit. This fact was not heartening to the dental profession which has long recognized the need for extension of dental health services to more people. After years of study the profession has established a definite and clearcut public dental health policy designed objectively to prevent or control dental disease through research, education, and care.

The profession properly disclaims re. ponsibllity for the economic problem relating thereto but recognizes and points out the responsibility of the individual, the family and the comruunity if the economic problem occasioned by lack of adequate dental health care is to be met. In doing so they have committed themselves to an ideal: "Dental health care should be available to all regardless of income or geographic location," the attainment of which will contribute substantially to social equality and economic security.

Grants-in-aid to Stat<'s as provided in S. 1099 will activate the development and maintenance of dental-health programs necessary to meet the need on a practical basis.

The Nation exists for its citizens, and health is their greatest asset. S. 190 and S. 1UU9 are proposals sponsored by the organized dental profession of America in the interest of and for the welfare of the citizens of this country. Surely it is proper for the Congress to appropriate funds for research designed to determine the cause of, or to reveal more effective means of, prevention and control of dental disease, and for rare to correct, partially at least, existing defects to maintain optimal dental health in the citizenry.

'l'here is no disease which affects mankind more nearly universally than dental caries. Few a1·e immune to the ravages and concomitant results of dental decay. Therefore, Congress and the people should be interested as all may be directly affected by the good re:,;ultf'; that can accrue from these enactments. '!.'he iuvestnwnt should pay sub;;tantial dividends in human welfare.

The philosophy of the clC'ntal profei,,sitm is clear. They recognize the impracticability of pre ently 1mown control methods at the clhiposal of an inadeqnately manned profession. They recognize the need for research which can Himplify the problem by finding partial pre,·enti,e agents or measure . They recognize the need for public health education that will bring to people a realization of the neee,;sity and importance of ndeqnate dental health care for tl1C'm8Plves ancl their familiPs. They recognize the present inability of tlle profci,;sion to meet the needs of a dPntal-l1C'alth-a ~·are public'. Public dental health ednration has acl,anced beyond the ability of the profession to meet the demands of people for dental health service. The induction of i::o many ciYilian dentists into service with the armed forces has made it increasingly more difficult for dental health needs to be met.

'l'lle renlistic npproach of the drntal profe<;><ion to :1 <>olution of this problem is romnwnclable. We ,vho are pioneering in the field of public health dentistry are proud to acknowledge the faC't that progress thus far in the field of public dental health has bel'n bec·am;e of the dental profession and not in spite of it. The profession knows as we do that dentistry's position in public health needs to be Mrl'n~theiwd :rnn that the hef';t and most fPasible wa, of m1irml'nting and implementing this service if< thronl!h Ft>deral grants-in-aid Pxtencled existiug and le~itimately rPC'OgnizPd agencies through Rtatp agenries upon appliC'ation and approyal as outlined in the provisions of the prnposed le;dslation. Responsibility for technical proC'ecluref<. therpfore, will rest as it should upon the only agency qualified ednC'ntionally and legally to a,-sume it, the dental profession.

'l'hp obligntion and commitment of the profesf<ion is cl<'ar in their sponsorship, and in their anno\111ced and aYowed policy. 'l'hey ai·e proceeding C'ouragpously upon rl'cognition of :1 great social need. Is it not indeed impressivP tlint the prof<>ssion is asking con1-1iderntion of this problPm and favorable action by the Congrrf:s? A hnf';icnlly conect npproach to mepting a problem of speC'ific neP!i.

Realism demands n frank appraisal of the car<> provisions of S. 10!)9. Programs of C'a r<> pres<>nt a different problem than does either a program of r<>searrh or eduC'ntion. It is, howevN, esser>tial <'specially in light of our lnrk of knowll'dgP nnd undl'rf<tanding to conelate all. Programs of ca1•p connnt<> nn angmC>nted prof<>ssion, a situation acknowl<>dged by this request for provision of fundf'; nnd faC'ilit i<'f'; for tmining dentistf: to prepare thPm for participation in programs to he a]'>-11rowd. Herl'tofore, Droposnls for rare that hav<> bPen ndvnnC'ed have bPen imprart'eal as wonlti any program whiC'h aims to providP dental-h<>nlth f';Prvices beyond the inrlinntion and nhility of thP clPntal profession to snpply. The d<>ntal profp~sinn if< fnllv awnre of thP miumitncle of the prl's 0 nt d<>ntnl henlth problem and the impossibility of solving It in this generation, for even with unlimited funds


there are yet too few dentists to correct the backlog of accumulated defects and provide for the incremental needs of our more than 130,000,000 people. l<'ortunately, this proposal will permit ad'l'i ed planning under supervision to meet recognized and indicated need for the purpose of pointing the way to a logical and practical solution.

It is a recognized fact that lack of dental-health facilities is not dne to wartime conditions. Prior to the war the total number of practicing dentists in the country was decreasing at an alarming rate. The inability of dc>ntistry to increase its numbers bPars a significant relationship to the whole problem and presents a problem difficult of immediate solution. A wartime stimulated increase in the number of students in dental schools, no doubt a result of subsidies and defermPnt pro'l'idcd by the Army and Navy for the purpose of providing dentists for those sen·ices, sugge,-ts one possible partial approach. Enrollments have fallen sharply with the discontinuance of the student-training p1·ogram. Means of making the profession of dentistry more attractive and as holding possibilitr of income, socinl position, and economic security con istent with prof0 s ional education of this type and its cost is sorely needed. Once values of health services are reconcileti thls should not be too difficult. Public health education should in time teach p<'ople to appreciate the value of such services and to be willing to pay fairly and equitably for them.

Some plan must be devised to provide for the dental-hi>altb needs of children. Dentists either have not found the practice of dentistry for children economically profitable or they do not wish to take care of children. In spite of the fact that most dentists believl' that our best opportunities for practicing protective dentistry and controlling dental disease lie with young children a small part of the arnrng,, d<'ntist's time is spent on children who comprise a substantial share of the population. Grants-in-aid can support experiment:tl dental health-care programs for children which should point the way to the discovery of some economically, sound method or methods of meeting the chilclren·s dental-health problem.

By providing for the training of dentists in technical procedure for children which <'an be praC'tiC<'d on an e<'onomically ;;ouud basis, 11rivate practitioners can assume a fai1· proportion of an adequate care program for children. To suppli>ment this trained public IH'alth dentists ean carry on supervised clinical programs for children. Thus by training m<'n who will de'l'ote time to the dentalhealth care of children (an accepted prncticaJ approach) the major dental problems in future generations of adults can be larg<'ly prevented.

There are many rural areas, whole counties and districts in every State, that are without dental-health fac-iliti('s. Th<'se shortages exist largely because dentiRts have found it economic•ally impractical to practice there. Hence, the great concentration of dentists is in metropolitan or nrban areas. The unequal distribution of an admittedly inad('quate total number of vracticing dentists creates a situation in which it is extr('mely difficult if not impossibl(' for thousands of people to obtain n('('clC'd dcntal-henltb care for themselves and their families. Some method of providing facilities and service must be found if dental-health care is "to be aYailable to all regardles,; of income or geographic location." While it is not likely that the accumulated need can be taken care of due to lack of available resources and manpower, the n<'eds of children in such situations can no donht larg,ely be met by specially trained public health dentists employed In State health departments to operate service or care programs in such areas, cooperating with schools and other local agencies and utilizing portable or mobile unit facilities. Sufficient experimental demonstration of this type has been carried on to justify expansion of itinerant serYice of this nature. Thus need that evidently cannot be met on th<' basis of individual responsibility can bi> met on the ba!'iS of community responsibility as allowed in the provisions of S. 1099.

It should he understood that no ~atisfactory economic solution of universal application for preventing, controlling. or reducing to any significant extent dental di,;eases which constitute one of thP country's most important and demandIng public health problems has ;vet bei>n found. TherPfore, ri>search to dPtermine the cause and means of prevention should be stimulated and subsidized. Since this ii; a pnblic health matter of economic concern affi>cting all people, the Congres shou](l proYide necessary funds to snbsidize resear<-11 as provided in S. l!lO.

It should be underi;;tood that th!' total dental manpower of the country iR insufllcli>nt to meet exi ting need on the basi,; of knowu methods of control. Therefore. attention i-hould be given to and provision should be made for federated programs of dental health care for preschool and gratie-school children under supervision and on a controllPd basis to assist communities in meeting an apparently

·!]"


otherwise un olvable problem. Solution of the children's dental-health problem will reduce the magnitude of the whole dental-health problem and ultimately should eliminate the possibility of future duplication of present-day adult needs.

This connotes a diversion of dental manpower to the field of children's dentistry, the provision of special training in technical procedures in children's dentistry, and a greatly augmented personnel of trained public health dentists in State health departments, employed on a full-time basis, canying on supervised and controlled experimental dental health service programs.

At the moment there is no practical way in which the dental-health needs of the country can be met. The provisions of these bills do not contemplate complete dental care for all the people. Under the provisions with additional earmarked funds available, research and experimental programs and studies can be ca1Tie<l on cooperatively with the profe~sion on the basis of C'ommunity responsibility under the admini trative authority of divisions of dental health of State health departments to iuitiate and develop sound pntctical m<'thods of prevention treatment and control of dental di ·eases, especially in children.

This can be considered only as a constructive beginning on the problem of attaining dentistry's ultimate objective, the extension of recognized dental health service to all without regard to income or geographic location.

Mr. CHARLES KR.AMER.

EXHIBIT 33

UNl'l'tD STATES DEI',\RTMENT m• AGlllC'1lLTt'RE, Bum;Au OF AomcUL1'\ 11:Al, EcONOMIC'S,

Washington, D. 0., Scvtcmber 1, 1945.

Staff Director. Suuco111mittee on W11rti111e Jicallh and Eduration, United States Srnate, 1Va-sl1inyto11, D. 0.

DEAlt 1\1.u. KuA1rn1t: This is in reply to your letter of August 28 to the Secretary of Ai.;riculture directed to my attention. In complianc-e witb your request, we are hnewith transmitting two copies of the manuscript, the Farm Security Administration Dental Program of Randolph County, On. Since this bas been clearC'd with the appropriate oflieinls in the DrvartmPnf, you are at liberty to includ<' it in the r11ipenclix of the reco1·d of the recent hearings 011 two dental bills, S. 190 and S. 1090.

Sincerely,

Enclosure-I ( Dupl.)

CAllL ('. TAYLOR, Head, Dicision of Ji'arm l'opulation and Rural Welf11re.

THE FARM SKC'URlTY AD11tINJSTR..lTION DENT.\L PROGRAM OF RANDOLPII COUNTY. GA.•

(By Margaret Lantis, an<I M. R. Hanger, social ~cientists. Bureau of Agricultural Economics, and Philip W. Woods, dental oflicer, Farm Security AdminiF:tration) (This paper is a conden, ation of a report under a , imilnr title and by the same

authors, SIJOnsored jointly by the Health Services Division of the Farm SC>curity Administration and the Bureau of Agricultural Economics, United States Department of Agriculture.)

• 'l'hls report is the eighth In a series of rural health reports covering the activities of medical and dental prepayment plans among rural families. The stuclies arc under the general direction of Douglas Ensminger, Bureau of .Agricultural Economics, U. S. Department of Agricnlture.

Other studies in the series are: 1. Taos County Cooperative Health Asso('!atlon. 1942- 43, Taos County, N. Mex. 2. Newton County A!!"ricultural Health As~oclatlon, Newton County, llflss. 3. Cass ('ountv Rural Health Service. 1942- 44. Cass Count.,·, Tt'x. 4. Hamilton Countv l\Iedlcal Arn .Association, Hamilton County. Nehr. 5. Nevada County Rural Health Servict's Association, Inc., 1942-44, Nevada Coi.nt:r, Ar~. 6. "Walton County .A!!rlculturnl Health Associntlon, Walton County. On. 7. Wheeler County Rural Health SPrvlces Association, Wheeler County, Tex.


THE F.\RM SECURITY .\.DMIN ISTR-\TION DENTAL PROGRAM OF RaNDOLPH COUNTY, GA.

PUHPOSE m' THE STUDY

In December 1944, 20.343 farm families in the United States belonged to dentalcare units organized on a voluntary pr payment basis under sponsor. hip of the Farm Security Aclministration. These group program were started for the benefit of Farm Security Administration borrowers, who are families with low cash income, struggling to establish tht>mselYes as independent farmers, either renters (Rural Rehabilitation burrowers) or owners (Fann Ownership borrower ) . Medical care programs had been set up as early as 1036, and at first dental senice was given only when recommended by a physician. Soon, however, it was realized that more coruprehen 'ive dental care ( to be determined by dentist rather than physician) was needed, whether offPrecl with medical care in one genenll group health unit or in a separate unit. At present, most of the dental programs have their own funds and memberships.

In the eat·ly days of organizing the FSA dental units, the scope of the individual program was determined largely by these two necessities: Limiting the services to emergenci s ancl keE'ping their cost within the ability of families to pay back the loans obtained for this and other farming and living expenses. 'l'he prograws pro,i<led at first only extractions, then they expanded their covPrage by including cleanini;s, treatments, and "simple fillings." Gold work and dentures were thus excluded.

Early in its experience, the Farm Security Administration became aware of the desperate need for dentistry for rural chi](lren and began to emphasize the provision of such service. Recently tlw fC1llmYing objectives have been considered, or added in some cases, in order to improve the dental programs:

(1) "Saving teeth" by placing a filling rather than extracting. (1) 11:stablishing a maintenance program after accumulated needs have been

cared for. (3) Increasing the amount of money for dental care, to provide as complete

service as possible. Nevertheles , the trend of organization, people served, and kind of service

given in a typical county dental progrnm were unknown, the regional and county stafis having been freed as mueh as possible from close Federal supervision ancl investigation. Just how close was the program approaching its objectivE's in dental care for different age groups and different income groups? What clid the members and the clpntists think of the program, for example, in regard to size of fee and percentage of payments? Many such questions finally were grouped into the following thrPe la,rge ones by taff members of the llealth Services Division of lhe Farm Security Administration and the I3ureau of Agricultural Economics:

(1) Have the dental programs achieved tl1eir purpose in dental care? (2) Wllat factors haYe a isled 01· prevented the full functioning of the

program? (3) What suggestions and recommendations can be made regarding future

policies? With limited funds, time, and personnel with which to make such an ap

prai al, it was decided that no detailed suLTey of all or even a large sample of the 250 FSA dental units C'Ould be umlertaken, especially since first-hand information was needed. Therefore, an intensive study of one representative county was undertaken in J\Iay 1045.

TUE COUNTY SELECTED

Randolph County, Ga., was chos n because of the following characteristics: (1) It is nn agricultural county, with fewer than 500 people employed in

lumher, wood pulp, arnl its other very minor industriPs, out of a population of 16,60V in 19-10; with an agriculture reasonably representative of its region.

(2) In 1030, 66 percent of Randolph's farms made less than $600 gross income, that is, total value of farm production. Thus the rural people have a background of income inaclpquate to co,·er usual medical and dental costs a well a other expenses; ancl although there has been an increase of income during the war. the arPa is not f<>rtile enough aml thE' agriculture not sufficiently mechanized to procluce heavily and yield steadily a higher income. The

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DE TAL RESEARCH AND DENTAL CARE 211

FSA case load of 101 families in May 1943 was quite high, also indicating continued need and a potentially large membership in the dental asso<'ifltion.1

(3) 'l.'he· dental unit is one part of a general health program, but its funds are maintained and administered separately from those of the medical unit. It is currently functioning, hence a part of present expPrience, not something remembered from the past, and is likely to continue, o far as outsiders could tell lwfore studying the progrnm.

(4) The FSA supervisory personnel in the county was known to be favorable and cooperative toward fact-finding research.

Randolph County is not submarginal or even marginal but on the other hand it is not highly produetive. Its partially dPplete<l red clay soil, ero ion, and rather serubby econd-growth timber are typical of a large area in the Southeast. But it is not a typical cotton-~rowing county, for it has moved during the past 20 3'ea1-s toward a soutbeaRt vnriant of diversified farming. Cotton was dominant until peanuts were introduced 20 years ago.

Today the three big crops are corn ( much of which is consumed on the farm), peanuts and cotton. ows are kept for home milk consumption and hogs for the home meat supply.

The farm unit of the individual sharecropper or renter is larger than in many parts of the Southeast and often includes ,voodlnnd, blackberry patches, and a vasture as well as cropland. Although 20 percent of the county's individually operated farm units were, in 1940, in the "40 acres and a mule" class (specifically 30-49 acres), at the same time 23.6 percent were in the 50 to 90 acre category. The average size of farm was 07.3 acres.

The county has a fundamental Old-South stability despite a gradual change away from a typical cotton economy. It. plantations are not large businesses, with absentee ownc>rs, paid managers, and the tenant ancl labor uncertainties of corporation farming. Most people in all classes seem to have a feeling of stability, although some aspects of share cropping such as dependency and little production for home use are present. Another evidence of local cohesiveness and stability is that all the physicians and dentists now practicing in the county, the Fi"<A farm supen•i,;or, ancl most othPr Federal an<l State emplo;vees are olcl resiclentR. In many ways the county can be typical of any of the older rural areas in the United States.

Of the 1,0[;2 farm operators in Randolph County, 62.6 percent were Negro according to the 1940 Census of Agriculture. Of the same number of operntors, 1,138--or almost 50 percent-were sharecroppers, 27.9 percent of the white farmers and 76.4 percent of the nonwhite.

Most houses of the low-income farmers are very old, weather-beaten, and often lopsided; their furnishings are mcagC'r and usually olcl-fashionecl. Although a dri,·e around the county shows evidences of poverty ancl backwardness, it also reveals new elements that have come both with ancl without Government assistance. For example, peanut cultivation has fostered mechanization of fa1•m cultivation, a process just begun and sure to continue. Soil-conservation pr:wtices are general. With the increased farm income of the war years, the people are planning further improvement of their farms.'

In thl' future, there may be fewer peop!C' on the land, and there probably will be a higher level of living. The1·e is, ho,Yever, an accumulated need for modern goods, acc-umulatecl not during the pa t ;; years hut during 2;; years or more, so that there will be rnany demands for the increasC'cl cash of the family, and dental care still may he relatively neglectPd. 'l'he farmers probably will remain for some time very "rural," picking up the goods ancl wnys of town people in a hit-and-miss way but lacking a full range of modern facilities and protections of health.

Old and new ways are intermingled strikingly. The culture seems full of anchronisms. Whoopin~ cought a111l typhoid "shots," rural ice deliYery, field terracing, and lighting by the Rural Electrification Administration are found on some of the same farms and in the same families as faith doctoring, barefooted women in the fields, and a diet of hoecake an1l salt pork. Although the exact elements vary from place to place, this uneveness of advancement (both technical and social) typifies many rural counties besides Randolph.

1 Fnmili<-s are Jare:e whic•h further redur<'I! the> amount avnllnhle for the Rupport of each lndi1•1(lual. The FSA re<'or<lA show an al"Hae:<' or f\.8 peraona ppr flfrnily for th<' fnmll!es helone:lng to tile dental nasorintion. Thia fl!rure. hii:h aa it is. atill is nn undpratntement. Ro mnnv ~·onng unmnrriNl 11rople baYe left home during the war-some of whom wilJ return-thnt the nvernge size of family mn~t he ronal<lere<l nA more tbnn 6 peraons.

2 Accor<llng to the 1940 <'<'nAus of Ai:ricultnre, Randolph County's approximately 2,000 farms hacl only 54 tractors, 71 telephones, and 503 automobiks.


Regarding health, there are not onl:v new specific elements but two relatively new organized health programs, the county health department, under the Georgia State Department of Public health, and the medical and dental care associatious under the sponsorship of the Farm Security Administration.

Oounty health dt>partment Service free to any patient in the county, Government subsidized. No rhoice of medical personnel. Service given at public clinics and, for school children, at the schools. No corrective dental program. Service given in these types of rases: Diagnosis of tuberculosis and recom

mendation for hospitalization, venereal disease diagnosis and treatment, hookworm diagnosis and treatmPnt; immunization: smallpox, typhoid, diphtheria, whooping cough; prenatal instruction at prenatal clinic; training of midwives.

FSA health program Patient pays an annual fee, membership limited to FSA borrowers, no Govern

ment subsidy. Choice among physicians as all doctors in the county but one participate in the

program. SPrvice in physicians' offices, emergency home calls. For dental service, same as above, except home calls. (Service outlined else

where.) Service given within the following limits: General medical rare; emergency

operations, including charges for surgeon and hospital; serums in rase of emergency, as for snake bite; up to $35 of the standard $50 maternity fee paid (and hospitalization if emergency); maximum $10 midwife fee; first filling of each prescription in every new illness.

This county is better off than 40 percent of the counties of the United States in having a county public health unit: that is, only GO percent have any such service. It is also better off than 40 percent (not necessarily the same counties) in having a hospital. It has a 50-bed private hospital of good reputation. It has 6 physieians and 2 dentists for a population of approximately 15,000. The death rate is a little higher than that of the whole State, but the infant mortality rate is lown· than Georgia's rate, according to the 19-10 Census of population.• However, debilitating inCectioni-, parasites, and clefic-iencies, surh as hooh,vorm infestation, still are common and a retarding influence in daily life even if not fatal. In this class of ailments are the dental conditions.

PROCEDUI!E OF THE STUDY

In tl1e limited time available for field study, only a sample of the cunent membe1·sbip of the dental unit could be studied in 1·egard to present dental condition, services received, and attitude toward the FSA dental program. Accor<lingly, 41 of the 74 currently participating families were selected on the basis of size of family, rare, and income. They varied in size from 2 to ]3 members, in gross income (19-14) from $3CO to $2,800; 21 families were white, 20 Negro.

Use of a "control group" of families who were not and never harl been participants in the dental pt·ogram was thought necesl"ary to the validity of the stucly, and 20 such families were selected undn· the same criteria as the members.

Since the study was designed to employ mouth health as one measure of the program's effectivene s, the condition of all family members' mouths (in the sample) was noted and recorded by a clentist. This was done in visits to the homes, with an attempt to do as good a job as possible under daylight-always outdoors-by use of a month mirror and explorer. The caries incidence is underestimated because cavities between the teeth in many cases were not detected.

An interviewer accompanied the dentist on these home visits, talking with one or more members of the family in an informal way but attempting to cover the same questions for all families. Occasionally, notes were taken in their presence if they seemed sufficiently at ease. After the visit, their statements were recorded as exactly as practic;:tble on a questionnaire which ·was used more as a guide than as a fixed instrument.

All families were courteous, permitted the examination, and responded as hon-

1 Crude death rnte for Gt>orgia, by place of occurrence: 10.4 per 1,000 enumerated population; for Randolph County. 12.6. Infant death rate (under 1 year of age) for Georgia, by place of occarren~P, 57.9 per 1,000 live births; tor Randolph County, 51.4.

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DE YTAL RESEARCH AND DENTAL CARE 213

estly and freely as could be expected in a somewhat strange situation. It is thought that, as a group, they gave well-considered, sincere answers.

A third person at the same time was obtaining background cultural data and information on the administration of the dental progrm. In this work also courtesy and helpfulness were the rule.

APPR.11:S.\L OF R.\NDOLPH COUNTY DENTAL PROGRAM

Organization and administration So that the Fam1 Security dental programs could be adapted to local needs and

to avoid complete centralization of authority, no set rules for organization and administration have been formulated nationally. Farm Security Administration tloes have a general policy CYf making possible a family's participation in a dental or medical program, by working out with each family a plan of farm and home production and expenditures and when necessary, including in the loan to the family the amount of its aunnal health membership fee. '.l'hus FSA makes sure that the family can belong to a medical or dental unit, or both, if the family wants to belong. Asitle from such general policy, the contribution of FSA staff from national to county level is impetus and guidance in the establishment of local health units and some supervision of their progress, by the field medical officer -,t' each administrative reg-ion.

As no one form was specified, the degree of organization of members, for example, has varied considerably. Some units are formal associations while many are not associations at all. However, in this and other respects they generally conform to a pattern characteristic of each administrntive region of FSA.'

In region V ( Ah bama, Florida, G"org-ia, and South Carolina), the following elements characterize most of the health programs:

( l) D:mtal programs have been in operation 5 years or more. (2) The F8A case load has continue(] higher than in any other region, indi

cating continued heavy need fo1· health serYices, along with many other needs. This high case load also means many families eligible for a dental association, hence potentially, ancl in most cases actually, large enough membership in each unit to maintain a progr!tm on the same basis over a period of J·ears.

(3) 'l'he dental units are representatiYe of those that have gone just beyond u strictly limited or emergency i;;ervice, now generally providing extractions, treatments, cleanings, and fillings but not complete dental care including X-ray, 1·eplacernents of teeth, and orthodontia.

(4) In ma1Jy units now, special emphasis is supposed to be given to protectiYe dental care for children.

The FSA clental plans in Georgia have followed rather consistently one Statewide pattern since their beginning in 193 . Servi(-es offered are the same fundamental four mentioned in (::3) above. Annual participation dues usually are $3 for husband and wife ])Ins "0 cents per chilcl l\1aximnrn annual dnes per family are u,;ually $7. D i'ntal seniees at these rates and with the services and characteristics listed aboYe have been available to FSA clients in Randolph County since January l!Ml. 'l'he ob.iectives set at the beginning of the program were (1) to remove mouth infE'<'tions such as pyorrhea by extracting teeth and giving treatmf'nts, (2) to siwe teeth by filling them, and (3) ultimately to establish a maintenance program.

An informal arrangement was made with the two dentists in the county seat by which they unclc-rtook to furnish the prf'S('ribed i;:ervices to members at what were apparently their regnlar fees although no written scale of fees appears eve1· to have been adopted. Hence this is referred to as a fee-for-service plan, the most <'ommon type and the one closest to f'veryday private practice. A fl>w FSA dental plans have other methods of payment.

The two dentists cooperating in the program are the only ones in the county, two others having moved away within the past 10 years. (One of these had practiced only half time.) The population of Randolph Connty, estimatf'd as of NovembC'r 1!>43, was slightly over 14.000. In addition, these dentists are depended upon by sizable nurnbPrs of people from other <'Otmties, with the result thnt they must each serve more than 7,000 potential patients.

One of tlw two dentists has done more than three-fonrths of the work for program members, for reasons haying nothing to clo with the administration of the program, principally the rea on that this dentist spends more time on his

•Fora fuller RtntPment. see DPntal Care Proi:ram of 1he Farm Security Administration, report from the Ilenlth Snvi<"es Division, FSA, July 1944.


practice. Both dentists have farming interests which take part of their time; both apparently woul<l welcome a younger· dentist in the county. The office equipment of each is clean and adequate except that equipment in the operating rooms for Xcgroes is inferio1· to that for the whites. This is characteri tic not merely of Randolph County but of the culture of the area. The program sponsors have aec<>pted available personnel, equipment, standarcls, aud scale of charges, and have matle their first-and so far, their only-attack on the problem of adequate dental care for low-income farm people by introducing the group prepayment principle rather than by setting new standards or making other changes.

Of 217 eligible familie~ in rn-n, lfl2 familie~, containing 1,199 persons, were enrollecl in the new dental unit. The next year was the peak year so far as membership was concerned, 215 of the 223 eligible families being included, with a coverage of 1,269 individuals. The membership has cleclined steadily to its present size (l\1ay 1045) of 74 families, containing 387 persons; 36 families are Negro. No new families have joined in 1045, and no Negro families have joined for 2 yt:'ars. E,en so, the enrollment relative to the total number eligible bas been high in this county; 68.2 percent in 1944, compared with 40.4 percent, the a.erage among all fee-for-service dental programs in Georgia. It dropped to 44.3 percent in Randolph County in 1045, but this is still high in comparison with other counties.

The following causes of the decrease in membership are suggested: (1) The FSA loan program as a whole has decreased from 217 to 191 eligible

families ·nee the dental program was started in 1941. (2) As families, especially the older one , have had teeth extracted or have

imtisfied otherwise their most urgent dental needs, they have dropped out of the dental association. This leaves a residue of members with obvious and continuing large dental need . Thus the program is adversely . elective.

(3) A few people bad joined because the FSA county supervisor made a strong plea that they shoulcl belong and because almost all other borrowers were joining, but have since made individual decisions on various personal grounds without regard to arguments made by the program sponsors.

( 4) Some have been actively di atisfled with the protram.• There is no organization of members with board of directors, committees, or

other positions of re ponsibility held by members. At the annual meetings of Farm Owner, hip and of Rural Rehabilitation borrowers (held separately ancl both attenclecl by Negroes as well as whites), the meclical and dental prngrams ha,e been discussed. However, with crop acreages, farm equipment, ancl many other urgent matters also to be discussed at these meetings, the farmers usually give little attention to the health program. The county and home RupPrvisors have given it much personal interest and effort, but it has had little attention from any other source. Moreover, administrative procedures have been poorly defin<'cl or irrP1mlarl;v followP<l. For example, membt>r,-hip cards havt:' not been kept up to date, and regular procedures of submitting, approving, and paying hills have not been worked out.

The dental care program is known as "separate" since it maintains a member. hip roll and fund separate from the medical program. In other words, a famil;v Pan join <>ither or both." A trustPe, who receh'es for her services 3 percent of both funds, bandies the finances and other routine administrative matters.

In 1944 the average annual dental membership fee per family wa · $-1.56, comparecl with a $4.64 average for all Georgia fee-for-service dental units and a $'>.02 average for the United States. The funds are prorated for the months of the year, one-twelfth of the total sum h<>ing allocated for the payment of bills each month. If dentists' bills submitted in any month clo not equal the allotment, the surplus is kept until the encl of thl' year. If the charges excel'd the allotment, payments are scaled clown to it, the dentist receiving only the resultant percentage of his submitted bills .

.Although all record-kerping by dentists and trustee has been haphazard, one thing i!'! clear: There has heen a surplus at the end of each year except one, after nearly 100-percent payment to the dentists and some money apparently held as a reserve. Except fot· th<' small amount at the end of 1944 which was addecl to the 1945 fund, these surpluses have not been disposed of. •

• AR thoRP who hnrl rlronnNl out of tl1P rl<>ntnl unit w<>re not interview<>d, the exact nu1T1hf'r in f'R<'h of thN~f' ln~t ~ l!ronni:- i~ unkown.

• Tn !,[nv 1!145. of 74 fnmiliPR in thl' cll'ntnl ,nit, only 4 WPrl' not nlRO m!'mbers of the medical unit: 19 fnmllil'S bPlongNl to the lnttl'r but not to the clentnl unit.


Do they Indicate that the membership fees are too high, that the members have received full care within the defined limits of the program and that there still is a surplu of money? Unfortunately, the people have not received the basic care that they need, as hown by the dental examination made in this survey, the fees are not too high, and so anothet· explanation of the urplus must be found. However, before dental needs and senices are evaluated, the organization and administration of the program is appraised as follows:

On the s trong side: The program bas included all available dental personnel and facilities of the

county. The Fat·m Secmity Administration bas made possible the joining of all those

who want to belong, by (1) keeping membership dues within the ability of the families to pay, (2) setting up the health unit on the group prepayment principle, and (3) recognizing derital need by its inclusion in the farm and home plan and loan.

It has enrolled more than half of the FSA borrowers up to, but not including, the present year. (But with no new members and with a decrease in old members, its future is uncertain.)

Payment to the dentists bas been excellent. on· the weak side: Thne is no clearly defined responsibility for the operation of the program. There is no written agreement between FSA and dentists or between the

dentists and the member:;;, and no written fee schedule. Recording-keeping is poor.

Dentai service The only service for some age groups and the principal service for all ages

has bPen extraction of teeth. There has been no entrance examination for wcmbers so that the df'ntal condition at the start of the program ana of each family before joining is unknown. However, from a dental survey of Randolph school children in 1938, a dental survey of FSA families in a similar county in southwest Georgia-,vortb County-in 1939, and from sample nonmember families examined in the present study, there are indications that the average rural person ( all ages) bad four carious teeth, one of them showing advanced decay and perhap even being absce sed, and that nearly half of all adults beyond 25 years had adrnnced pyorrhea. White children under 20 years each had five carious teeth and Negro children had an average of 2.G on the same basis of PStimation as the above.

Toclay the examination of the sample member families suggests that although there have been many extractions because of pyorrhea, the proportion of people needing full extractions for this cause has not decreased. In any case, GO percent nf the total of members examined in the age group 2G years old or older who still have some teeth, need full extraction . The usual process of pyorrhea apparently is occurring in the middle-age group so that as some older people obtain extractions, others become eligible for them. The young adults from 20 to 34 years show a more hopeful dental condition. They have significantly fewer cnries than the children and adol scents and do not show-at least not yet-the gum conditions of the older people. Probably they can be prevented from developing such conditions. However, few prophylaxes and treatments have been given.

Among members the caries rate (not "total carie ei....-perieuce") is now three decayed teeth per person for whites and 2.-! for Negroes of all ages, which probably is a slight decrease among the rneml.Jers within the past 5 years, although such decrease is not proven beyond doubt since the rate in 1941 is not known exactly. White chilclren under 20 years show no better condition in compari<,on with the figures for all the children, both white and Ne;::ro; but when compared with thP non-FSA white sample alone, thf'y are better. Even so, children of the sample member families still have mu('h uncarc>d-for tooth df'cay. Also, the total sample of members ( that is, all ages) is not much different from the nonmember sample. The greatest difference is the number of abscesses; they are more numerous among nonmembers.

On the assumption that the incidence of tooth decay has remained the same in the past 5 years, a decrease in caries (present upon examination) of even one carious tooth per person would mean that caries has been eliminated at that rate, by filling or extraction. Ilowever, members have obtained fillings at a rate of only 0.3 per person;' and there is no inclicntion that there has been a

'Fillings for whites, 0.6 person; for Negroes, almost none, 0.05 per person.


rate of one extraction for caries per person. (The dentists have uot kept records of exact wo1·k done for each member, hence the evidence must be taken from mouth examination, with its many limitations such as confusion of dental work done before and after a person joined the dental group.) It is true that members have had more than four extractions per person, but most of these have been because of gum conditions. The conclusion, then, is that if there has been any decrease in the caries rate, probuuly it is a decrease in basic occunence (incidence) of decay, rather than through professional care.

StlYenteen families, 23 percent of the current 74 member families, have received no service (apparently n_ot having sought any) iu the past 21;.i years, although oral examination revealed that several of these families have urgent needs in both caries and pyrorrhea. While this figure (23 percent) probably is not high compared with the proportion of the general rural population not getting dcutal care in this period, the lack of care in the Randolph County group is less excm:mble than in the genernl population since dental service has already been paid for by the families.

'l'he general conclusion on the basis of the examinations is that the program has acrnmplished something by reducing the number of cases of abscesses and other extreme conditions of neglect, but has not given full service even up to Its defined limits.

The service alRO has not been dist1·ibuted evenly between the two races and among all ages, i11come groups, autl siz,•s of family, figured 011 fee value of service rather than type of service.• White members as a group have received a monetary value of service greater than the amount tlwy ha,-e paicl into the dental program whereas the Negroes have received less than the amount of their dues; and it cannot be argued justifiably that the Negroes' dental need is less. Althon~h NPgro chi](lren have Jess caries thun white children among both FSA and non-FSA samples examined, Negro adults show worse oral conditions than do the white adults. The greatest a<.lven;e /Service diJI.irence between Negro and white members is in the, 651 to $1.050 annual gro8s income uracket although there is a disadvantage for the Negroes in all income brackets. l!'or both races, families in the middle-income ra11ge of $651 to $1,450 hnve been get ting more dental care than either those below or those above, figured on either a family or individual basis.•

In regard to ize of family, the small white families of 2 to 4 member;: have been getting, as a group, 32 percent of all service given on the FSA dental program. In other words, a group comprising only 14.7 percent of individuals belonging to the dental unit received nearly one-third of the care (by value rather than type of ervice, one must remember). The next highest group consists of the I\1. •gro families with 8 or more in each family, which received a total of 25 percent of the service. If again one considers the individuals included in the e families rather than the numbe1· of families, one finds that a group totaling 32 percent of the members received only 25 percent of the service.

Finally, children have been grossly neglPCted, especially in the care of de<'iduous teeth, in which rampant caries waR found.

In regard to dental care given, the Ranctolph dental care program can be appraised in summary as follows:

It has provided many extractions for older adults, this being the principal service.

It has provided enough extractions for all ages to remove most of the abscessed teeth.

Pyorrhea is getting dental attention, but by extraction of all the teeth rather than by treatment of the gums.

Members have received very few fillings. Evidently few have had their teeth cleaned, although this is not so easily

verified as the number of fillinJ!:S. 'l'he service has been unevE>nly distributed, with the children of all ages up to

20 being the most seriously neglected group. NEc>groe)< ar<' not re<'eiving their share of the service according to the membership

clues that they are paying.

• 'l.'hP computatlonR on <liAtrlbullon of servlcP are ma,lP from th~ dPutlsts' and truRtee's monthlv records from Januarr 1, 1043, to . pril 30, 1945. Because In most cases only the pttti~nt's name, family, and the fee charged were recorded, specific services could be figured only on this basis.

• FamllleA have been grouped Into 4 brackets according to gross Income for 1944: $250 to $650; $651 to $1,050; $1,051 to $1,450; $1.451 and over. Regarding size of family, they have been grouped as follows: 2 to 4, 5 to 7, 8 or more members.

DENTAL RESEARCH AND DEN'l'AL CARE 217

The lowest iucome group is not receiving its share of the service, those in the middle-income brackets receiving more.

The small white family is gettiug more ca1·e than any other size of family in either race.

'lhis surumary indicates the answer to the first question asked at the beginning of the study: Has the dental progrnm achieved its purpose in dental care? The answer is "Yes" so far as the initial objective of emergency care is con· cernetl. The answer is "No" so far as the next objective is concerned; that is, full care including preventive care, es_vecially among children ( except replacement work and orthodontia).

Why has this dental unit-and probably many others-not gone further in 5 years of operation ·1 This brings up the second question originally proposed: What factors have assisted or prevented the full functioning of the program?

CUL'l'URAL FAC'l'ORS AFl,'EO'l'ING 'l'IIE DEN'l'AL PROGRAM

The first and most important point is that the FSA dental program in this county-and in most counties-hall made no changes in dental personnel, facilities, schedule of fees, or habits and concepts of dental care. 'l'hc only change is in the method by t{;hich the family pays for cl nlal care.-For example, in this area many dentists and rural famiiies alike Lave been unconcerned about decay in deciduous teeth; they point out that these teeth are shed anyway and they forget that a child may have to use a tooth for 4 or 5 years after it has startecl to decay. The chilclren's mouth as well as the families' statements demonstrate that there has been little change of attitude or practice in this regarcl.

Within the clental program itself, the following factors are hindering its accomplishment of full care:

Lack of organization, absence of membe1· (lnrl community responsibilit1;. For an almost completely word-of-mouth organization, with its personal informal agreements (characteristic of local rurnl business relntions as a whole), the health program here works with surprisingly little friction. However, if a change in local FSA personnel were to bring in people not so strongly interested in health as is the present staff, there would be no other ndministrative group to keep the program going, suc-h as a ml'mbers' boar<l of directors. The present metlical unit which is more complex, with more members and cooperating physicians, already shows the effect of lack of defined direction ancl responsibilitythere is misunderstanding and dissati,-faction. The dental progrnm has got along chiefly because it has been simple, not very many people have been in• volved in it, and the dentist who does most of the work for memb·,rs has goodwill toward the FSA dental unit, rather than that its Sl't-up is adequate and effective.

Lrl(·J.- of knowledge. and misinformation re{larding the program.-The members' lack of knowledge (shown in interviews) of even sueb funclamentals a, the dental services to which they are entitled dPmonstrates that the program bas lacked both organization and a plnn for informing and educating the mernber1ship. There is no written statemPnt of admiuistrntion and of servicC's available to which members can refer. Members, physirians. anrl oentisti- individually nsk county superviso1-. home supervif'or, or trustee for specific information on the rulPs of the program, occasionnlly getting sincerc but conflicting nnswers. The rP ult is that when 41 .i,ample families were interviewed, 26 coulrl nnme only 2 of the 4 services provided: Extraction, filling. cleaning, and gum treatment. Onl~· 3 famili!'S could name all 4 services, wbilP 10 families knew 3 of the fundamental 4. This and other surprising ignorance of thc pro~ram-for example, thP bac:is of computing th!' family'i:; m!'mhership fee or ev!'n the total amount of the familv's own annnal dues-repr!',:enti- mPrel~• the following: ·

(1) Lark of time anrl personnel for both organizational and henlth erlnration of membPrs.

(2) TTnnwarenei=:s of th!' necec:sity for continn!'il Information, after the initiation of tl1c progrnm (no group endeavor ran be nllowed to orift).

rn) MrrnbPrs' J:ick of p1·evions expericnre with l1ealth servicPs anrl arrompnnylng low i=:tnnoard of henlth cnre.

To phyRicians and rlPntistc:. the peopl!' may .i,om!'timcs Reem oemnnrling, but actunlly they dri not expect full car<' because they do not kn0w what it iR, dei::pite their nrg-,..nt neeo for It. Al1so, the rlE'ntistf', hnving nll tlie work thev wnnt or can hanrll!'. rlo not enconrag!' m!'mbers to iaeek mor!' thnn !'mergencv i-er'l"iC'I'. Final]~·. the Npgrocs e1sp!'rially nel'd information. ·

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Lack of oral examination.-Since tbe members bave not had oral examinations, neitber the dentists nor tbe familie know exactly what tbe families need, altbough after long practice in the county the dentists naturally have a fairly clear concepion of dental conditions among the farm families. The mi fortune is that the people tlo not know. If they underestimate their need and do not m,k for dental care, they can be satisfied at a low l<'vel of dental servi<"e. By comparing the family's statement of the dental ancl oral conclition of each m('mb~r with the examinin;; d ntist's rc,port on each, the ,nit('l'S secured a fairly exact measure of the members' understanding of nee<!. Of the 41 samvle member families, 24 undere timated their children's need of dental care, 9 hatl an approximate knowledge, 1 family overestimated the need. (The r('mainder hall no chilclrrn.) In contrast, 29 families had an approximate knowledge of adults' needs, 8 families underestimated it, and 4 overestimated it.

These figures illustmte amazingly well what bas been the actual practice: Dental care has been proviued atlult but not chilclr<'n. Also, although about the same number of Nc groes and whites underestimated their chiWren's dental needs, the Negroes bacl less clear knowledge of the condition of their a<lult members; and :Negro adults actually have been getti11g le;;s dental care than white adults. Oral examination sboulcl be made on ('ntrance, not to eliminate any family, but to indicate to each family what should and can be done within the limits of the program. Of course, if the members sought all the care that they rreed, neither dental per onnel nor funcls wou](l be adequate. The examinations still would b~ valuable, however, in gaging the requirements beyond the limits of the program.

Attitude of dentists and physi<:ians.-Aside from their being hurried-especially now when there is a shnrtage of phy •ician and dentists-and perhaps occasionally brusque or condescending, thei1· most significant attitude pertaining speciJ'c·ally to the FSA health program is that it is charity. Or at least that the prnf1>s,donal sen·ice given is in part charity, even if not entirely so. Some of the members, especially those seeking to i>stablish thems Ives in financial independence on a somewhat higher socio-economic level than their old one, quickly pick up this attitude. If all people in the dental unit knew that the dentists have reeeive<l a high percentage paym€'nt on their bills submitted, undoubtedly no one would feel a hamP.d or even relu:'tant to receiYe or giYe service on this program. Through their mistmderstanding of such terms as "simple fl'lings," which the progrnm provides but which probably has never been explained to the memb?rs, and through rumors regar<ling treatnwnt, Rome have come to think that clenlal service given FSA people is inferior. However, there is no objective evidence that the quality of the work is infc>rior.

Other influential attitudes pertain to type or extent of dental service, one of which-regarding care of deciduous teeth-has been mentioned. Two cornm0n beliefs of the area are maintained, perhaps unknowingly, by the dentists-that gum treatments are not worth while and even that fillings may not be worth while. It is true that trealm('nts may be ineffectual, that a filling may fall out, or that a tooth may hav(' to be extracted because of pyorrhea even when decay has been stopped by a filling. The local dentists, avowedly preferring extraction work, do not always giYe the argum('nts favorable to such protective services or give th('m convincingly. Perhaps cli1<coun1g cl by th<> poor dental conditions that confront them, they take the easiest course, which is to extract the toothor all the teeth. When such assumptions, probably more common among rural than among town people, are reinforced by transportation clifficultie of the family in getting to the <kntist ancl by their great frar of dentistry, thl'n the mere fact that such care is vaid for and t('C'hnically available is not enough to balance all the e'ement trat arc> against any long process of care.

Outside the program itself, the following aclverse factors seem to Jw operating: Problems of tmnsportation and communication.-\Vith no telephone in any

of the sample FSA homes visited an<l only 71 among all the 1,!)32 farm homes of the county (U. S. Cemms of Agriculture for 19.JO), the mf'mbers have no way of making a dental ap!)ointment exC'ept by a special trip to the county seat. However, few tenant farmers have autemohilrs; some live too far from town to make many trips with a wagon ancl team of mules; the schedules on some of th(' local lms routes are inconvenient for farm people trying to keep an nppointm('nt; ancl neighhor,; cannot be depended upon to take a per1<on to town at the right time. Moreover, the bus fa rf'S ( or even the hiring of a neighhor's car which seems to be common practice here) necessary to take several children to the dentist and up to a total that looks big to a tenant farmer without much money in his pocket.

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Both deutists reserve Saturday for extractions, given without appointment. For all other days, an appointment must be made. Therefore, to get a filling or treatment of the gums, the patient must go to town, make the appointment ancl return home, to wait 10 days or 2 weeks for the second trip to keep it, unless he is fortunate enough to get one later the same day. In this case, he waits around for mauy hours. People needing a seri"'S of treatments or extractions make a e1·ies of appointments weeks in advance. But the patient <"annot notify the dentist in case anything prevents him from keeping the appointment. In this situation, either the dentist or the family is irritated before all the dental work is finished. The dentist can scarcely be blamed for preferring town clients or large landowners who have telephones in their farm homes.

Sooiai factors.-Some of the influential facto1·s have developed from or are now dependent upon economic status, although the eoconmic factor cannot be taken as the only fundamental element. After many yPa1-s of living under the share-crop system, low-income farmers have lost or have neve1· developed independence and initiative. The typical share cropper in the past has obtained dental care only when his landowner was willing to advance money to pay for it, the money being paid by the owner directly to the dentist and then charged against the cropper's harvest account. Naturally, little money for such "a" purpose was advanced and only when the toothache was severe. The small cash center coulcl exercise initiative but seldom did, since he had to ask the dentist fo1• credit. The share-crop system especially helps to explain why dentistry for poor rural people consists of e.-..:tractions and rarely includes therapeutic and corrective services.

Actually three factors have limited dental care and still limit it, in the thinking and !habits of the people: Low cash income; the custom of "settling up" in late NovembN· 01· December with littl"' expenditure at any other time; and the low incentive to exerch,e initiative in getting dental care--in fact, an evident difficulty in getting it. Also, people who have grown up in share-crop families tend to look upon themselves as "poor folks;" they accept the implied low status and too often accept pain, continuous poor health, disfigured teeth, anrl similar di. abilities as part of life. Now, however, their standards are rising slowly so they want the dental care-perhaps becoming ashamed of teeth that are "only snags"-but they still do not know how, or do not have the self-assurnnce, to go and get it.

Lack of education accompanies low social and economic status and presents further problems in health education and treatment. When families have low incomes and still do much hand culth·ation, as they do here, the labor from an added pair of hands is important. Without any positive incentive to keep f'hildren in school, parents in these families, especially Negro families, tend to withdraw their children from school at about the seventh or eighth grade.

Psyollologu:ai faotors.-Apparently one of the reasons why the Randolph County dental unit has had a surplus of funds and its members have not sought all the service they had paid for and needed is fear. "Fear of the dentist" is part of th(' culture. Although the health of the rural people is generally poor, it does not follow that they are inured to pain. The "shakes," jumpiness, and other locally recognized sensations as well as organic ailments are talked about constantly, making people apprehensive, making them anticipate and magnify suffering.

Moreover, they claim that men are more reluctant to go to the dentist than are the women, although the oral examinations did not show quite the difference between the sexes that people talk about. Male members of the program have only a little more tooth decay and not qnlte so many extractions and fillings as the women; but three times as many men a women do have advanced pyorrhea, needing full extractions. Although inadequate time to make all the necessary trips to the dental office, lack of money to buy the denture (not provided by the program), and fenr of pain influence the men, other factors can be -surmised also : Less concern about appearance, and self-consciousness among farmers when they deal with the professional man. It probably will take time, reassurance, and more active participation among the farm people before they will understand and take for granted the modern methods of dental care.

Poor health, inadequate ho-me rore, and, lack of health education.-Among 22 of the 41 sample FSA familiei- and 10 of th(' 20 non-FSA families, even a cursory interview revealed that father or mother or both bad a chronic ailment, such as stomach ulcers, anemia, goiter, deafness, or rheumatism. When father and mother are sick. neith('r they 1101· the chlldren are likely to organize their energies

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for a series of trips to the dentist. '.l:o get people on a higher level of energy a 11d self-motivation, health education is needed. One of the greatest ob tacles to the effective functioning of the health program here (and in many parts of rural America) is ignorance and mi information regarding physiology and health. "High blood," "sugar liver,'" and "weak stomach" are terms covering a surprising ntriety of ailment and not necessarily referring to high-blood pressure or diabetes, for example. Even the cause of a deficiency disease o simply explained as the prevalent goiter of this area was not known by any of it sufferer who were interviewed.

Folk medicine and home remedies compete with professional medicine and organized health work. For example, faith doctors who cure principally by "talking out" the disease are resorted to by many farm people. In home treatment of toothache, kerosene and turpentine are faYorite medicaments, although almost any other chemical that happens to be available may be used.

Adults do not brush their teeth regularly, although individual exceptions are found, especially among the women in ome of the enterprising young Farm Ownership families. Teachers in both Xegro and white schools urge the children to brush their teeth, and for good home dental care give them illustrated certifi- . cates which are distributed to the schools by a company that sells toothpaste. '£be idea of the certificate is good, although they should come from other than a commercial source, and it can be applied efTectively in other aspects of health education.

Racial factors.-1£he following di!'abilities of the Negroes affect their participation in the FS'A medical and dental programs:

Closer direction of Negro share croppers and renters by white landowners, so that they have had less experience in handling money and exercising their own judgment.

Smaller amount and probably poorer quality of schooling. Less participation in county-wide organizations. Fewer facilities among them for formal communication, such as telephones. The following factor are favorable to this and even to an enlarged program: Prepayment.--Group prepayment is not an entirely new development in Ran

dolph culture. Group hiring of livestock auctioneer and veterinary, burial societies, and possibly other as~ociations on an insurance basis have shown the people several forms of prepayment and group insurance. Although further t!'aching regarding the group prepayment principle is needed, this element of local rural life illu trate the following generalization that should be kept in mind in the planning of new programs: There are in any local situation some mluable predispo ing factors that can be used as illustration and familiar starting point for a new thing.

Oo11nty-1pide and district organizati-011.-Programs of the Coil Conserrntlon Service, Rural Bectrification Administration, and Farm Security Administration now are generally accepted among the people who especially need these servires, although some of the large landowners apparently still think that the poorer Negro farmers are inca~able of benefiting from Government assistance. Among the small farmers themselves, both white and Negro, there seems to the outside observer to be a surprising readine s to accept new programs and facilities, whether public or private. For example, a new privately financed quickfreeze locker plant is receiving good patronage. The common attih1de is willingne s to try the new thing, although the people may be unwilling to struggle to maintain it and reorganize it if they later find that the original backers have been untrustworthy, or that the new program docs not come up to their expectations, or that it conflicts with old habits in unexpected ways. In joining or in dropping out of a new association, the small farmers tend to be apathetic. They accept its formation and they accept its demise.

What they need is experience in organization that is at lea t county-wide and possibly larger. There have been associations of such geographic extent, but they have been leader-controlled. Since this is the local pattern, the program can tart-as this one has-with strong leadership by one or a few people who are accustomed to be leaders. The FSA county supervisor has bad this role in Randolph County. Next, interest and responsibility can spread out from such a person to perhaps younger and slightly less experienced leaders, and from them to their neighbors, and so on through the membership.

Recommendation and encottra.l]ement 1>11 people outside the dental program.-rhe physicians have done probably the most to encourage members to get dental 1are. Sometimes, however, they have rerommended extraction of teeth because "IO satisfactory explanation of a case of arthritis, let us say, could be found,

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and it was decided to try taking out the patient's teeth. In other words, the theory of focal infection seems to have been overworked. In any case, the physicians have shown an appreciated good will toward the dental program. If they, like tlie dentists, sometimes have antagonized members, this occurred because they were expressing themselves as individual rather than as re ponsible members of the program. They probably have not been made to feel enough official responsibility.

Unfortunately the public, especially the town people, know nothing about these medical and dental units. Apparently most low-income farmers who are not FSA borrowers have heard of FSA health units and look upon their members with some envy-a good indication of the need for such programs. However, they do not know exactly how they operate and what service they provide. Given the interest and good will, information can be given and accepted as needed.

Use of services that come to the farmer.-The local scene contains several things that would make dental trailers or movable units understandable and acceptable, if these ever were introduced. Th(;) best established institution is the "rolling store," a general store in a van. Another is the traveling library, but it has been discontinueij recently. The children have become accustomed to regular visits of the count:f'nurse to the schools, where she sets up a temporary clinic. Similarly, a dental unit set up in some permanent building for several days or weeks in first one neighborhood and then another would be accepted, provided other factors-such as confidence in the professional personnel and range of services-were satisfactory.

Also favoring the use of portable or self-propelled units are the habits of informal neighborhood communication which would notify people of the presence of the rolling dental office. Effective use could be made of the constant word-ofmouth communication, fostered by common laundry washing.places near springs or wells, by Sunday afternoon home visiting and the Saturday visit to town, by congregation at the too-frequent wakes and buryings, and other natural gatherings.

Members' satisfaction.-Once a core of satisfaction has been created, it bolds the program together, regardless of the dissatisfaction that may break away some individual families around the edges. Of the 41 member families interviewed (more than 30 of whom had joined in 1941 or 1942, and none less than a year before), 25 said they were satisfied with the dental program, 4 were definitely dissatisfied, and the remainder had particular resenations or doubts but were not thoroughly dissatisfied or antagonistic. It must be remembered, however, that even though more than half of the people who were questioned expressed satisfaction with the dental program, an even larger number at the same time lacked understanding of it. Although they may have been merely unwilling to criticize, it semes likely from the trend of their statements that they were actually satisfied with a limited service, that is, the se1-vice as they knew it. However, sponsors of the dental program can be proud of its general acceptance.

MEMBERS' AND DENTISTS' SUGGESTIONS

Families voluntarily suggested that the county very much needed more dental pe1·~onnf'l ancl facilities. They indicated in indirect ways that thf'y " ·ould likf' to have dentists who could give all their time to their practice and show greater care in it.

Memebers would like to have dentures added to the services provided by the program, and would be willing to pay more for more service. They could not pay much more, but the young families, especially, would not object to slightly higher membership fees.

Their reaction to various suggestions by the examining dentist-who, however, made no promises-is that mobile equipment would solve the very real timeand-transportation problem, except for emergencies. If the mobile unit happened to be somewhere at the other end of the county when a member of the family developed a bad toothache, it would be less useful than the standard

, dental office. (Of course, the reply is that if X-ray is included in the dental association service and if dental care is regular, the bad toothache or E'mf'rgency is not likely to occur.)

Members and comparable nonmember farmers like the idea of the district medical center, which was discussed with a few of them. Through their proximity to Fort Benning with all its facilities, through hearsay of other large hospitals, and through their own experience at the prenatal clinic and other


clinics maintained by the county health department, they have some idea of what a system of medical centers and outlying clinics would be like. They approve it on the assumption that it would be maintained by taxation.

The two participating dentists suggested that X-ray and dentures should be included in the services offered. They would welcome another dentist, and one of the dentists needs a dental hygienist. He is actually making plans to get an assistant to whom he can tum over some of his work.

CONCLUSIONS

Analysis of the data pertaining to this study shows clearly that there are weak, adequate, and strong elements which interplay in the present program. Each of these should be recalled in Us proper relationships although for the purposes of a brief summary they are presented in somewhat arbitrary outline form.

It is strong in-(1) Freeing the farmer from the uncertainty of obtaining credit for each

dental service (he may now get a loan from FSA instead of his landlord but the amount i smaller and better distributed over the years, and he has more as nmnce of being able to pay it).

(2) Providing minimum dental ca1·e to some who would not receive any if not in the dental unit.

(3) Paying close to 100 percent of dental bills, although this should not in, expected and would not be true if people received all the service they need.

( 4) Having the good Will of the dentists and most of the members. The program is adequate in-(1) Extractions for all elements of membership. (2) Quality and kind of dental service given those who ask for it on theu

own initiative (but does not reach those who do not persist). (3) It enrollment of eligible membership, which Is higher than the State

or National average, although still not so high as it could be. The dental program of Randolph County is weak in(1) Limited scope of dental services provided. (2) Organization and administration: No written agreement between dentists

and association; no agreed fee schedule; poor record-keeping; insufficient number of dentists, which could be corrected partially by permitting dentists in adjoining counties to participate; no participation by members in policy making and administration.

(3) Dental service within the defined limits for: Children, Negroes; all ages in regard to protection against dental and oral diseases.

( 4) Instruction of members regarding: Their own needs, which could be ascertained and made known in an entrance dental examination; the service provisions and organization of the program ; dental care in general, especially home care, which can be secured among other means by cooperation with the divi ion of dental health education, State department of public health.

Although administrative recommendations are not pertinent here, it can be stated that future planning and administrative changes-whatever form they may finally take-must attempt to eliminate four difficulties In rural dental care as it exists today in the Southeast and undoubtedly in many other areas of the United States; as follows:

(1) Deficiencies in professional dental personnel and facilities. (2) Transportation and related problems of distribution of dental service. (3) Inadequate local financial resources. ( 4) Misunderstandings and inadequate education. Much misconception of phyidology, disease, and dental ronditions; inexact

knowledge-usually an underestimate-of own individual need; misunderstanding and fear of dental techniques and requirements; both inadequate knowledge and misunderstanding of group health programs.

IMPLICATIONS BEYOND RANDOLPH COUNTY

Every locality hm: some exJ)('rience in group effort and organization and some experience in health care which can be made a familiar and acceptable starting point for any newly organized program. Seldom can a completely new plan be iutrnduced into a community without friction or quickly enough to meet the existing health needs unless the plan's similarities to older customs are pointed

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DENTAL RESEARCH AND DENTAL CARE 223 out, the good will of older organizations and elements of the population is obtained, and the services offered are related specifically to the needs as the people see them, or can be brought to see them. 'l.'he county of this study, in spite of certain outward back\\"ardness in rural housing and sanitation, for example, nevertheless is receptive to new medical techniques and eYen to the group prepayment health plan. If the plan is adjusted to the people in regard to a few fundamentals of their local life, they will adjust surprisingly to the plan in other ways.

Not only can the pr.ogram be strengthened and enlarged, it should be. This study shows that when a dental care program accepts the local system of health care exactly as found, making no new provision except method of payment, the service may not be any better or even have much wider coverage of the public than it had before the new program came. If the local care was inadequate before, for whatrver reasons, it still can be inadequate. For example, if people have not seen in the past why children's devayed deciduous teeth should be filled, they will not immediately and automatically see this upon joining a dental service unit. Therefore, any sponsors of such a program who want to assure dental service to <:hildren must make sure that the local cooperating dentists have time and are willing to treat all the members' children; that the members know what their own children need, what the program can do for them, and why such service is important. If, besides the education needed to secure such understanding, there ure provided more personnel, more funds, and better geographic distribution of services, then dental care for rural people will go beyond its present inadequate condition.

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[COMMITTEE PRINT] Bi,-Db"J ~

tl ~,.... - ~o ~ r t,,

AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

COMMITTEE ON FOREIGN AFFAIRS HOUSE OF REPRESENTATIVES

SEVENTY-NINTH CONGRESS FIRST SESSION

H. J. Res. 145 PROVIDING FOR MEMBERSHIP OF THE UNITED STATES

IN THE FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

70838

TEXT OF H. J. RES. 145: Constitution of the Food and Agriculture

Organization of the United Nations. First Report to the Governments of the

United Nations by the Interim Commission on Food and Agricuture.

Printed for the use of the Committee on Foreign Affairs

UNITED STATES

GOVERNMENT PRINTING OFFICE

WASHING TON : 1945

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COMMITTEE ON FOREIGN AFFAIRS SOL BLOOM, New York, Chairman

LU'I'llER A. JOHNSON, 'l'exas JOHN KEE, West Virginia JAJ\IES P. RICHARDS, South Carolina JOSEPil L. PFEIFER. New York PE'l'E JARMAN, Alabama W. 0. BURGIN, North Carolina WIRT COURTNEY, Tennessee THO:MAS S. GORDO. ·, Illinois JOHN S. WOOD, Georgia EMILY TAFT DOUGLAS, Illinois JAMES W. TRIMBLE, ArkanSB.:1 HELEN GAH.I.GAN DOUGLAS, California JOSEPH F. RYTER, Connecticut DANIEL 1. FLOOD, Pennsylvania

CHARLES A. EATON, New Jersey EDITH N. ROGERS, Massachusetts ROBER'I' B. CHIPERFIELO, lllinois JOH , ' l\f. VORYS, Ohio KARLE. MUNDT, oulh Dakota BARTEL J. JONKMA. , Michigan FRA. 'CES P. BOLTON, Ohio JA~IES W. WADSWORTII, New York CIIARLES L. GERLACH, Pennsylvania LAWRENCE SMITII, Wiscoo.sin CIIESTER E. MERROW, New Hampshire

BOYD CaAwroao, Clerk

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CONTENTS

Page H.J. Res. 145, text oL ________________________ ___________ ______ 1 Constitution______________________________________________________ 2

Annex I __________________________ ------------------------- 9 Annex II ______________________ ------------- ------------- 9

Members of the Interim Commis:sion on Food and Agriculture___________ 10

I. The Interim Commission ____ ------------------------------ 15 A. Constitution and Terms of Reference_________________________ 15 B. Expert Adviser _________________ -------------- _________ 17

II. Introduction___________ ___________ ________ ______________ 18 III. Tho Food and Agriculture Organization of the United Nations______ 20

A. Purposes and Functions __ ____ _________________ _________ 20 l. Research _ _ _ _ _ _ _ _ _ __ __ _ _ _ _ _ _ __ _ __ _ __ _ _ __ __ _ 21

a. SourceH of infori1]-ation_________________________ 21 b. Range of subject matter_______________________ 22

2. Dissemination of knowledge -------------------------- 23 a. Publications _____ --------------------------- 23 b. Education __ ----• ___ _____ 24 c. Library and inquir.v ~erviccs_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 25

3. Advisory function~----- _ _ _ _ ___ _ _________ 25 a. Typical ca~es and procedure__ _ _ _ 26 b. Advice and recommendation;; on other problems__ 27

4. Fisheries, forestry, and non-food-agricultural products ___ 28 a. Fisheries anci marine products_ ________________ 28 b. Fore::;try and fon,;try products_________________ 29 c. Non-food-agricultural products__________________ 30

5. Agricultural credit_ _ __ _ _ _ _ _ _ __ _ __ _ __ _ ___ __ _ _ _ _ _____ 30 6. Commodity arrangements____________________________ 32 7. Admini:;;trative functionH_ _ _ _ _ __ _ __ _ _ _ _ ____ __ _ _ _ _ __ _ _ _ 33

B. Constitution_________ _ _ __ __ __ _ __ _ _ __ _ __ _ _ _ ____ __ ___ __ _ __ _ 34 1. Nature of the Constitution__ _______ _________ 34 2. Membership ___ _ ______________________ ____ 34 3. Limitations on powers of the Organization and on obliga-

tions of :\Icmbers_ __ _ _ _ _ __ __ _ _ __ __ __ _ _ __ _ _ _ _ _ _ _ _ 35 C. Administrative Structure and :Management____________________ 36

1. The Conf Prence_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 36 2. The Executive Committee___ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 36 3. Standing advisory committees_________________________ 36 4. General and special conferences_______________________ 37 5. Director-General _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 37 6. Staff ______________ ----------------------------- 37 7. Regional and liaison offices_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 38 8. Organization and methods of work_____________________ 38

D. Relations with Other Organizations___________________________ 39 1. Other international bodies____________________________ 39 2. Regional and national organizations____________________ 41

E. Fvpenses__________________________________________________ 41 F. Miscellaneous______________________________________________ 43

1. Legal status ____ ----------------------------------- 43 2. Interpretation of Constitution_~--_____________________ 43 3. Languages _________ ------------------------------- 43

G. Need for Early Action_ . _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 43

m

FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

79TH CONGRESS 1ST SESSION H. J. RES. 145

IN THE HOUSE OF REPRESENTATIVES

MARCH 27, 1945

Mr. BLOOM introduced the following joint resolution; which was referred to the Committee on Foreign Affairs

JOINT RESOLUTION Providing for mcmbPrshjp of the United States in the Food and Agri

cuHurc Organization of the United Nations Resolved by the Senate and House of Representatives of the Unit6d

States of America in Congress assembled, That the President is hereby authorized to accept member hip for the United States in the Food and Agriculture Organization ot the United Nations (hereinafter referred to as the "Organization"), the Constitution of which is set forth in Appendix I of the First Report to the Governments of the United Nations by the Int,erim Commission on Food and Agriculture, elated August 1, 1944.

SFc. 2. There is hereby authorized to be appropriated, out of any money in the Treasury not otherwise appropriated, such sums, not to c.-.;:ceed $1,250,000 annually, as may be required for expenditure under the direction of the Secretary of State, for the payment by the United States of its proportionate share in the expenses of the Organization.

SEc. 3. Unless Congre s by law authorizes such action, neither the President nor any person or agency shall on behalf of the United States accept any amendment under paragraph 1 of article XX of the Constitution of the Organization involving any new obligation for the United States.

8F.c. 4. In adopting this joint resolution the Congress does so with tlw unckl'stancling that pal'itgrn.ph 2 of article XIII docs not :>uthorize the Confcrenc<' of the Organirntion to so modify the provisions of its Constitution as to invoke any new obligation for the United States.

1

CONSTITUTION OF THE FOOD AND AGRICULTURE ORGANIZATION OF THE UNITED NATIONS

PREAMBLE

The Nations accepting this Constitution, being determined to promote the common welfare by furthering separate and collective action on their part for the purposes of

raising levels of nutrition and standards of living of the peoples under their respective jurisdictions, securing improvements in the efficiency of the production and distribution of all food and agricultural products, bettering the condition of rural populations, and thus contributing toward an expanding world economy,

hereby establish the Food and Agriculture Organization of the United Nations, hereinafter referred to as the "Organization," through which the Members will report to one another on the measures taken and the progress achieved in the fields of action set forth above.

ARTICLE I (FUNCTIONS OF THE ORGANIZATION)

1. The Organization shall C'ollect, analyze, interpret, and disseminate information relating to nutrition, food and agriculture.

2. The Organization shall promote and, where appropriate, shall recommend national and international action with respect to

(a) scientific, technological, social, and economic research relating to nutrition, food and agriculture;

(b) the improvement of education and administration relating to nutrition, food and agriculture, and the spread of public knowledge of nutritional and agricultural science and practice;

(c) the conservation of natural resources and the adoption of improved methods of agricultural production;

(cl) the improvement of the processing, marketing, and dis~ tribution of food and agricultural products;

(c) the adoption of policies for the provision of adequate agriculturnl credit, national and international;

(f) the adoption of international policies with respect to agri~ cultural commodity arrangements.

3. It shall also be the function of the Organization (a) to furnish such technical assistance as governments may

request: (b) to organize, in cooperation with the governments con

cerned, such missions as may be needed to assist them to fulfill the obligations airising from their acceptance of the recommendations of the United ations Conference on Food and Agriculture; and

2

FOOD AND AGRICULTURE ORGANIZATION OF UNITED N A'l'IONS 3

(c) generally to take all necessary and appropriate action to implement the purposes of the Organization as set forth in the Preamble.

ARTICLE II (MEMBERSHIP)

1. The original Members of the Organization shall be such of the nations specified in Annex I as accept this Constitution in accordance with the provisions of Article XXI.

2. Additional Members may be admitted to the Organization by a vote concurred in by a two-thirds majority of all the members of the Conference and upon acceptance of this Constitution as in force at the time of admission.

ARTICLE III (THE CONFERENCE)

1. There shall be a Conference of the Organization in which each Member nation shall be represented by one member.

2. Each Member nation may appoint an alternate, associates, and advisers to its member of the Conference. The Conference mav make z·ules corcerning the participation of alternates, associates, and advisers in its proceedings, but any such participation shall be without the right to vote except in the case of an alternate or associate participating in the place of 11 member.

3. No member of the Conference may represent more than one Member natior.

4. Each Member nation shall have only one vote . .5. The Conference may invite any public international organiza

tion which has responsibilities related to those of the OrganizA.tion to appoint a representative who shall participate in its meetings on the conditions prescribed by the Conference. No such representative shall have the right to vote.

6. The Conference shall meet at least once in every year. 7. The Conference shall elect its own officers, regulate its own pro

cedure, aud make rules governing the convocation of sessions and the determination of agenda.

8. Except as otherwise expressly provided in this Constitution or by rules made by the Conference, all matters shall bf. decided by the Conference by a simple majority of the votes cast.

ARTICLE IV (FUNC'l'IONS OF THE CONFERENCE)

1. The Conference shall determine the policy and approve the budget of the Organization and shall exercise the other powers conferred upon it by this Constitution.

2. The Conference may by a two-thirds majority of the votes cast make recommendations concerning questions relating to food and agriculture to be submitted to Member nations for consideration with a view to implementation by national action.

3. The Conference may by a two-thirds majority of the votes cast submit conventions concerning questions relating to food and agrieulture to Member nations for consideration with a view to their acceptance by the appropr.iate constitutional procedure.

4 FOOD AND AGRICULTURE ORGANIZATION OF UNITED NATIONS

4. The Conference shall make rules laying down the procedure to be followed to secure:

(a) proper consultation with governments and adequate technical preparation prior to consideration by the Conference of proposed recommendations and conventions; and

(b) proper consultation with governments in regard to relations between the Organization and national institutions or private persons.

5. The Conference may make recommendations to any public international organization regarding any matter pertaining to the purpose of the Organization.

6. The Conference may by a two-thirds majority of the votes cast agree to discharge any other functions consistent with the purposes of the Organization which may be assigned to it by governments or provided for by any arrangement between the Organization and any other public international organization.

ARTICLE V (THE EXECUTIVE COMMITTEE)

1. The Conference shall appoint an Executive Committee consisting of not less than nine or more than fifteen members or alternate or associate members of the Conference or their advisers who are qualified by administrative experience or other special qualifications to contribute. to the attainment of the purpos~ of the Organization. There shall be not more than one member from any Member nation. The tenure and other conditions of office of the members of the Executive Committee shall be subject to rules to be made by the Conference.

2. Subject to the provisions of paragraph 1 of this Article, the Conference shall have regard in appointing the Executive Committee to the desirability that its membership should reflect as varied as possible an experience of different types of economy in relation to food and agriculture.

3. The Conference may delegate to the Executive Committee such powers as it may determine, with the exception of the powers set forth in paragraph 2 of Article II, Article IV, paragraph 1 of Article VII, Article XIII, and Article L"'C of this Constitution.

4. The members of the Executive Committee shall exercise the powers delegated to them by the Conference on behalf of the whole Conference and not as representatives of their respective governments.

5. The Executive Committee shall appoint its own officers and, subject to any decisions of the Conference, shall regulate its own procedure.

ARTICLE VI (OTHER COMMITTEES AND CONFERENCES)

1. The Conference may establish technical and regional standing committees and may appoint committees to study and report on any matter pertaining to the purpose of the Organization.

2. The Conference may convene i:reneral, technical, regional, or other special conferences and may provide for the representation at such conferences, in such manner as it may determine, of national and international bodies concerned with nutrition, food, and agriculture.

FOOD AND AGRICULTURE ORGANIZATION OF UNITED NATIONS 5

ARTICLE VII (THE DrnECTOR-GENFR.\.L)

1. There shall be a Director-General of the Organization who shall be appointed by the Conference by such procedure and on such terms as it may determine.

2. Subject to the general supervision of the Conference and its Executive Committee, the Director General shall have full power and authority to direct the work of the Organization.

3. The Dirccto1·-General or a representati-ve dcsignnted by him shall participate, without the right to vote, in all meetings of the Conference and of its Executive Committee and shall formulate for consideration by the Conference and the Executive Committee proposals for appropriate action in regard to matters coming before them.

ARTICLE VIII (ST.\.FF)

1. The staff of the Organization shall be appointed by the Dir13ctorGeneral in accordance with such procedure as may be determined by rules made by the Conf erencc.

2. The staff of the Organization shall be responsible to the DirectorGeneral. Their responsibilities shall be exclusively international in character and they shall not seek or receive instructions in regard to the discharge thereof from any authority external to the Organization. The Member nations undertake fully t,o respect the international character of the responsibilities of the staff and not to seek to influence any of their nationals in the discharge of such responsibilities.

3. In appointing the staff the Director General shall, subject to the paramount importance of securing the highest standards of efficiency and of technical competence, pay due regard to the importance of selecting personnel recruited on as wide a geographical basis as is possible.

4. Each Member nation undertakes, insofar as it may be possible under its constitutional procedure, to accord to the Director General and senior staff diplomatic privileges and immunities and to accord to other members of the staff all facilities and immunities accorded to non-diplomatic personnel attachC'd to diplomatic missions, or alternatively to accord to such other members of the staff the immunities and facilities which may hereafter bC' accorded to equivalent members of the staffs of other public international organizations.

ARTICLE IX (SEAT)

The seat of the Organization shall be determined by the Conference.

ARTICLE X (REGIONAL AND LIAISON OFFICES)

' 1. There shall be such rC'gional offices as the Director General, with the approval of the Conference, may decide.

2. The Director General may appoint officials for liaison with particular countries or areas subject to the agreement of the government concerned.

ARTICLE XI (REPORTS DY ~1El\IBERS)

1. Each Member nation shall communicate periodically to the Organization reports on the progress made toward achieving the

70838-45-2


purpose of the Organization set forth in the Preamble and on the action taken on the basis of recommendations made and conventions submitted by the Conference.

2. These reports shall be made at such times and in such form and shall contain such particulars as the Conference may request.

3. The Director General shall submit these reports, together with analyses thereof, to the Conference and shall publish such reports and analyses as may be approved for publication by the Conference together with any reports relating thereto adopted by the Conference.

4. The Director General may request any Member nation to submit information relating to the purpose of the Organization.

5. Each Member nation shall, on request, communicate to the Organization, on publication, all laws and regulations and official reports and statistics concerning nutrition, food, and agriculture.

ARTICLE XII (COOPERATION WfTH OTHER ORGANIZA'l'IONS)

1. In order to provide for close cooperation between the Orgainization and other public international organizations with related responsibilities, the Conference may, subject to the provisions of Article XIII, enter into agreements with the competent authorities of such organizations defining the distribution of responsibilities and methods of cooperation.

2. The Director-General may, subject to any decisions of the· Conference, enter into agreements with other public international organizations for the maintenance of common services, for common arrangements in regard to recruitment, tra,ining, conditions of service, and other related matters, and for interchanges of staff.

ARTICLE XIII (RELATION TO ANY GENERAL WORLD ORGANIZATION)

1. The Organization shall, in accordance with the procedure provided for in the following paragraph, constitute a part of a:qy general international organization to which may be entrusted the coordination of the activities of international organizations with specialized responsibilities.

2. Arrangements for defining the relations between the Organization and any such general organization shall be subject to the approval of the Conference. Notwithstanding the provisions of Article XX, such arrangements may, if approved by the Conference by a two-thirds majority of the votes cast, involve modification of the provisions of this Constitution: Provided that no such arrangements shall modify the purposes and limitations of the Organization as set forth in this Constitution. '

ARTICLE XIV (SUPERVISION OF OTHER ORGANIZATIONS)

The Conference may approve arrangements placing other public international organizations dealing with questions relating to food and agriculture under the general authority of the Organization on such terms as may be agreed with the competent authorities of the organization concerned.

.;


ARTICLE xv (LEGAL STATUS)

1. The Organization shall have the capacity of a legal person to perform any legal act appropriate to its purpose which is not beyond the powers granted to it by this Constitution.

2. Each Member nation undertakes, insofar as it may be possible under its constitutional procedure, to accord to the Organization all the immunities and facilities which it accords to diplomatic missions, including inviolability of premises and archives, immunity from suit, and exemptions from taxation.

3. The Conference shall make provision for the determination by an administrative tribunal of disputrs relating to the conditions and terms of appointment of members of the staff.

ARTICLE XVI (FISH AND FOREST PRODUCTS)

In this Constitution the term "agriculture" and its derivatives include fisheries, marine products, forestry, and primary forestry products.

ARTICLE XVII (INTERPRETATION OF CONSTITUTION)

Any question or dispute concerning the interpretation of this Constitution or any international convention adopted thereunder shall be referred for determination to an appropriate international court or arbitral tribunal in the manner prescribed by rules to be adopted by the Conference.

ARTICLE XVIII (EXPENSES)

1. Subject to the provisions of Article XXV, the Director-General shall submit to the Conference an annual budget covering the anticipated expenses of the Organization. Upon approval of a budget the total amount approved shall be allocated among the Member nations in proportions determined, from time to time, by the Conference. Each Member nation undertakes, subject to the requirements of its constitutional procedure, to contribute to the Organization promptly its share of the expenses so determined.

2. Each Member nation shall, upon its acceptance of this Constitution, pay as its first contribution its proportion of the annual budget for the current financial year.

3. The financial year of the Organization shall be July 1 to June 30 unless the Conference should otherwise determine.

AR'l'ICLE XIX (WITHDRAWAL)

Any Member nation may give notice of withdrawal from the Organization at any time ofter the expiration of four years from the date of its acceptance of this Constitution. Such notice shall take effect one year after the date of its communication to the DirectorGeneral of the Organization subject to the Member nation's having at that time paid its annual contribution for each year of its membership including the financial year following the date of such notice.


ARTICLE xx (AMENDMENT OF CONSTITUTION)

1. Amendments to this Constitution involving new obligations for Member nations shall require the approval of the Conference by a vote concurred in by a two-thirds majority of all the members of the Conference and shall take effect on acceptance by two-thirds of the Member nations for each :Member nation accepting the amendment and thereafter for each remaining Member nation on acceptance by it.

2. Other amendments shall take effect on adoption by the Conference by a vote concurred in by a two-thirds majority of all the members of the Conference.

ARTICLE XXI (ENTRY INTO FoRcE OF CoNS'l'ITUTION)

1. This Constitution shall be open to acceptance by the nat,ions specified in .Annex I.

2. The .instruments of acceptance shall be transmitted by each government to the United Nations Interim Commission on Food and Agriculture, which shall notify their receipt to the governments of the nations specified in Annex I. Acceptance may be notified to the Interim Commission through a diplomatic representative, in which case the instrument of acceptance must be transmitted to the Commission as soon as possible thereafter.

3. Upon the receipt by the Interim Commission of twenty notifications of acceptance the Interim Commission shall arrange for this Constitution to be signed in a single copy by the diplomatic representrrt,ives, duly authorized thereto, of the nations who shall have notified their acceptance, and upon being so signed on behalf of not less than twenty of the nations specified in Annex I this Constitution shall come into force immediately.

4. Acceptances the notification of which is received after the entry into force of this ConstiLution shall become effective upou receipt by the Interim Commission or the Organization.

ARTICLE XXII (FIRST SE SION OF THE CONFERENCE)

The United Nations Interim Commission on Food and Agriculture shall convene the first session of the Conference to meet at a suit,able date after the entry into force of thi Constitution.

ARTICLE XXIII (LANGUAGES)

Pending the adoption by the Conference of any rules regarding languages, the business of the Conference shall be transacted in English.

ARTICLE XXIV (TEMPORARY EAT)

The temporary seat of the Organization shall be {l,t Washington unless the Conference should otherwise determine.

FOOD ANb AGRICULTURE ORGANIZATION OF UNITED NATIONS 9

ARTICLE L""\.:V (FrnsT FrKANCIAL YEAR)

The following exceptional arrangements shall apply in respect of the financial year in which this Constitution comes into force·:

(a) the budget shall be the provisional budget set forth in Annex II to this Constitution; and

(b) the amounts to he contributed by the Member nations shall be in the proportions set forth in Annex II to this Constitution: Prorided that each Member nation may deduct therefrom the amount already contributed by it toward the expenses of the Interim Commission.

AR'rICLE X..""'{VI (DTSSOLUTION OF 'THE INTERIM COMMISSION)

On the opening of the .first session of the• Conference, the United Nations Interim Commission on .Food ard Agriculture shall be d<.'cme<l to b£ dissolved and its records and other property shall b<.'come tl10 property of th<.' O1ganization.

ANNEX I. N A'l'IO TS ELIGIBLB FOR ORIGINAL 11EMinjRSHIP.

.Australia Belgium Bolivia Brazil Canada Chile China Colombia Costa Rica Cuba Czechoslovakia Denmark Dominican Republic Ecuador Egypt El Salvador Ethiopia France Greece Guatemala Haiti Honduras Iceland

India Iran Iraq Liberia Luxembourg Mexico N ethcrlands New Zealand Nicaragua Norway Panama Paraguay Peru Philippine Commonwealth Poland Union of South Africa Union of Soviet Socialist Republics United Kingdom United States of America Uruguay Venezuela Yugoslavia

ANNEX II. BUDGET FOR THE FIRST :FmANCrAL YEAR

The provisional budg<.'t for tla, first financial year shall be a sum of 2,500,000 U. S. dollars, the unspent balance of which shall constitute the oucleus of a capital fund.

}Q FOOD AND AGRICULTURE ORGANIZATION OF UNITED NATIONS

This sum shall be contributed by the Member nations in the following proportions:

Percent Australia __________________ . _ 3. 33 Belgium____ __ ___________ ____ 1. 28 Bolivia_________ _____________ . 29 Brazil__ ____________________ • 3. 46 Canada__________ ___________ 5. 06 Chile_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1. 15 China______ ___ _________ _____ 6. 50 Colombia_______ _____________ . 71 Costa Rica__________ ________ . 05 Cuba______________________ . 71 Czechoslovakia______________ 1. 40 Denmark_____ ____ ___________ . 62 Dominican Republic___ _______ . 05 Ecuador________ _____________ . 05 Egypt_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ 1. 73 El Salvador__________________ . 05 Ethiopia. ______ ______ _______ _ . 29 France___ ___________________ 5. 69 Greece__ ________ ____________ . 38 Guatemala____ __________ ____ . 05 Haiti._ _____________________ . 05 Honduras___ ________________ . 05

Iran ______________________ _ Iraq _______________________ _ Liberia _____________________ _ Luxembourg ________________ _ Mexico ____________________ _ Nether lands ________________ _ New Zealand __ __ ___________ _ Nicaragua. __________________ _ Norway ________ . ___________ _ Panama ____________________ _ Paraguay ___________________ _ Peru _______________________ _ Philippines_ _ _ _ _ _ _ _ ________ _ Poland ____________________ _ Union of South Africa _______ . U.S. S. R _________________ _ United Kingdom __________ -~_ U.S. A------------------a--Uruguay ___________________ _ Venezuela __________________ _ Yugoslavia_ _ _ _ _ _ _ _ __ _ Provision for new Members ___ _

Percent

0. 71 . 44 . 05 . 05

1. 87 1. 38 1. 15 . 05 . 62 . 05 . 05 . 71 . 25

1. 19 2. 31 8.00

15. 00 25.00

. 58

. 58

. 71 2. 00

Iceland_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ . 05 India ___________ ____ _ _ 4. 25 Total_ ______________ 100. 00

Done at ll'ashington this __________ day of __________ , one thousand nine hundred and forty ______ , in the English language, in a single copy which will be deposited in the archives of the Food and Agriculture Organization of the United Nations and of which authenticated copies will be transmitted by the Director-General to the governments of the nations enumerated in Annex I to this Constitution and of Members admitted to the Organization by the Conference in accordance with the provisions of Article I I.

IN WITNESS WHEREOF we have appended our signatures:

MEMBERS OF THE INTERIM CoMMISSION ON Foon AND AGRICULTUR.ll: (AS OF JUNE 29, 1944)

L.B. PEARSON (Canada), Chairman P. I. TcHEGOULA (U.S. S. R.), Vice Chairman

P. W. Tsou (China), Vice Chairman AUSTRALIA:

F. L. McDougall Economic Adviser to the Australian High Commissioner,

London BELGIUM:

Viscount Alain du Pare Commercial Counselor and Minister Plenipotentiary of the

Embassv of Belgium, Washington Charles Leonard

Agricultural Attache of the Embassy of Belgium, Washington BouvIA:

Rene Ballivian Financial Counselor of the Embassy of Bolivia, Washington


BRAZIL: C. M. de Figueiredo

Minister Plenipotentiary CANADA:

L.B. Pearson Minister, Canadian Embassy, Washington

CHILE: Carlos Campbell del Campo

Commercial Counselor of the Embassy of Chile, Washington CHINA:

P. W. Tsou President of the Agricultural Association of China Senior Adviser to the t\1inistries of Food and of Agriculture

and Forestry of China, Chungking COLOMBIA:

Guillermo Eliseo Suarez Commercial Counselor of the EmbaRsy of Colombia, Wash

ington COSTA RICA:

Francisco de P. Guti6rrez Ambassador of Costa Rica, Washington

Jorge Hazcra Comme1cial Attache of the Embassy of Costa Rica, Wash

ington CUBA:

Felipe de Pazos Commercial Attache of the Embassy of Cuba, Washington

Mariano Brull Minister Counselor of the Embassy of Cuba, Washington

CZECHOSLOVAKIA: Professor Dr. Vaclav Myslivcc

Czech Technical University, Masaryk Academy and Czechoslovak Agricultural Academy, Praha

DOMINICAN REPUBLIC: • Mario E. de Moya

Minister Counselor, Embassy of the Dominican Republic, Washington

ECUADOR: S. E. Duran-Ballen

Minister Counselor of the Embassy of Ecuador, "\,\ashington (appointed July 7, 1944)

Emilio A. Maulme

EGYPT:

Commercial Counselor of the Embassy of Ecuador, Washington

Anis Azer Minister Counselor of the Royal Legation of Egypt, Wash

ington Monir Bahgat

Agricultural Attache, Royal Legation of Egypt, Wa hington EL SALVADOR:

Carlos Adalberto Alfaro First Secretary of the Embassy of El Salvador, Washington

12 FOOD AND AGRICULTURE ORGA IZATION OF UNITED -ATIONS

ETHIOPIA: Yilma Deressa

Vice Minister of Finance of Ethiopia FRENCH REPRESENTATIVE:

Andre Mayer Professor and Vice President, College de France

Christian Valensi Financial CounsC'lor of thC' French D<'legation to the United

States, ·w ashington GREECE:

Kyriakos Varvaressos Governor of tlw Bank of Grt>C'ce and Ambassador at Large· for

Financial and Economic 1fattPrs Atbanasios Sbarounis

Gen~ral Director, 11inistry of FinancC's, Athens GUATEMALA:

Francisco Linares-Arrrncb

HAITI: Second SecrC'trrry of the Embassy of GuatC'mala, Washington

Elie Garcia First Secretary of the Embassy of Haiti, Washington

HONDURAS: Julian R. Cacen•s

Ambassador of Honduras, Washington lcELA. D:

Thor Tbors

I 'DJA:

MinistC'r of lcC'land, "\Yashington

Sir Girja Shankar Bajpai Ag_ent GcnC'ral for India, Washingt-0n

Advisers:

IRAN:

S. K. Kirpalani, India Government Trad<' Commissioner, New York

Humphrey Trc·wlyan, First SC'cretary to the Agent General for India

Ali Akbar Daftarv Counselor ofthc ImpC'rial Legation of Iran, \Yashington

H. IIadjeb-Davallou

IRAQ:

First Secretary of the ImpC'rial Legation of Iran, Washington

Darwish Haidari

LIDBIUA:

Director of the Central Agricultural Experimmt Station, Baghdad

Gabriel L. Dennis SecrC'tary of State of Liberia

I ,UXl';MBOURG:

Hu~uC's Le Gnllnis ~Iinistt•r of Luxt•mhonrg, Washington


MEXICO: Rafael de la Colina

Minister Counselor of the Embassy of Mexico, Washington Vincente Sanchez Gavito

Counselor of the Embassy of Mexico, Washington NETHERLANDS:

M. P. L. Steenberghe Presidmt of the Economic, Financial and Shipping ~fission

of the Kingdom of the Netherlands L. A. H. Peters

Agricultmal AUache of the Embassy of the Kingdom of the etherlands, V{ ashington

EW ZEALAND: Walter N~sh

Minister of ~ ew Zealand, Washington A. G. B. Fisher

Counselor of the Legation of New Zealand, Washington Adviser:

B. R. Turner, Second Secretary, Legation of Ne\v Zealand, Washington

NICARAGUA: Alberto SeYilla Sacasa

Secretary of the Embassy of icaragua, Washington KoRWAY:

Anders Fjelsta<l Delegate of the Royal orwegian Government for Agricul

tural Affairs in the United States PANAMA:

Ricardo A. l\Iorales Counselor of the Embassy of Panama, Washington

PARAGUAY: Paris E . Menendez

PERU:

Director of Central Laboratory, Ministry of Agriculture, Paraguay

Juan Chavez l\1inister Counselor of the Embass.r of Peru, Washington

PHILIPPI ~E COMMONWEALTH: Joaquin ~f. Elizalde

RC'sident Commissioner of the Philippines to the United States

Urbano A. Zafra Commercial Adviser to the Resident Commissioner

Amando l\I. Dalisay Research Analyst, Philippine Commonwealth, Washington

POLAND: WiC'slaw Domaniewski

Commercial Counselor of the Embassy of Poland, Washington

UNION OF SouTII AFRICA: A. T. Brennan

Director and Drputy Brad, Union of South Africa Government Supply Mission, Washington

70838-45-3


W. C. Naude Attache of the Legation of the Union of South Africa,

Washington J. A. Siegruhn

Commercial AUache of the Legation of the Union of South Africa, Washington

UNION OF SovIE'l.' SOCIALIST REPUBLICS: P. I . Tchegoula

Chairman of the All Union Combine "Ek portkhleb", and 1Icmber of the' GovC'rnment Purchasing Commission of the Soviet Union in the United States

Adviser: B. I. Groudinko, GovC'rnment Purchasing Commission of

the Soviet Union in the United Slates

UNITED KINGDOM: Edward Twentyman

Second Secretary, Ministry of Food Advisers:

Redvers Opie, Economic Counselor of the British Embassy, vVashington

Robert Rae, Agricultural Attache of the British Embassy, Washington

P. H. Gore-Booth, First Secretary of the British Embassy, Washington

u ITED STATES OF AMERICA: Paul H. Appleby

Assistant Director of the Bureau of the Budget

URUGUAY: Juan Felipe Yriart

First Secretary of the Embassy of Uruguay, Washington. VENEZUELA:

L A. Falc6n-Bricefio Commercial Counselor of the Embassy of Venezuela, Wash

ington YUGOSLAVIA:

Branko Cubrilovich Formerly Minister of Agriculture

George Radin Special RepresC'ntative of the Yugoslav Government

THE DANISH 1IINISTER: HC'nrik de Kauffmann

l\fini ter of DC'nmark, Washington Count Benedict Ahlcfel<lt-Laurvig

Financial Counselor of the Royal Legation of Denmark J. Y. Rechendorff

Secretary of the Royal Legation of Denmark EXECUTIVE SECRETARY OF THE COMMISSION:

Howard S. Piquet

FIRST REPORT TO THE GOVERNMENTS OF THE UNITED NATIONS BY THE INTERIM COMMISSION ON FOOD AND AGRICULTURE •

I. THE INTERIM COMMISSION

A. CONSTITUTION AND TERMS OF REFERENCE

1. The Interim Commission on Food and Agriculture was established by the United ations Conference on Food and Agriculture held in May 1943 at Hot Springs, Virginia, for the purposes stated in the following recommendation: WHEREAS:

1. Freedom from want is difficult to achieve without concerted action among all like-minded nationR to expand and improve production, to increase employment, to raise levels of con umption, and to establish greater freedom in international commerce;

2. The successful carrying our of the recommendations of the Conference in the field of production, distribution, and consumption of food and other agricultural products in the post-war period will be the most important prerequisite for the achievement of freedom from want, and requires the creation by the governments and authorities here represented of a permanent organization in the field of food and ag1 iculture; therefore

The United Nations Conference on Food and Agriculture

RECOMMENDS:

1. That the governments and authorities here represented recognize and embody in a formal declaration or agreement the obligation to their respective peoples and to one another, henceforth to collaborate in raising levels of nutrition and standards of living of their peoples, and to report to one another on the progress achieved;

2. That the governments and authorities here represented establish a permanent organization in the field of food and agriculture; and

RESOLVES:

1. That in order that every practicable step may be taken to attain these and the other appropriate objectives set forth in the declaration and specific recommendations of the Conference, an Interim Commission for carrying out the recommendations of the United Kations Conference on Food and Agriculture be e tablished.

2. That each of the governments and authorities here represented be entitled to designate a representative on the Interim Commission, and that the Interim Commission be installed in Washington not later than July 15, 1943;

3. That the Interim Commibsion perform its ,-..-ork with due re{l;ard to the exigencies of the war, through such form of organization and personnel as it may deem appropriate; and formulat<' regulation~ covering itR expenditures and submit to the member governmentt, and anthoJities a budget and allocation of quota contributions;

4. That the functions of the Interim Commission be to formu late and recommend for consideration b} each member government or authority:

(a) A specific plan for a permanent organization in the field of food and agriculture;

15


(b) The formal declaration or agreement referred to in the first recommendation, in which each participant shall recognize its obligation:

(1) To raise the levels of nutrition and standards of living of its own people;

(n) To improve the efficiency of agricultural production and distribution;

(n1) To cooperate, so far as may be possible, with other nations for the achievement of these ends;

(1v) To undertake to submit periodically to the other participants, through the permanent organization, reports on the action taken and the progress achieved toward these ends;

(c) Such propo als or reports as are necessary to give effect to the recom-mendations of the Conference; •

5. That in the preparation of a plan for the permanent organization the Interim Commission give full consideration to the following:

(a) The relation of the permanent organization to, and methods of associating it with, other institutions, national as well as international, which already exist or which may hereafter be established, in the field of food and agriculture and in related scientific, economic, and other fields;

(b) Proyision for membership in the permanent organization, in due course, of governments not represented on the Interim Commission;

6. That in considering the functions and duties to be assigned to the permanent organization the Interim Commission take into account:

(a) The promotion of scientific, technological, social, and economic research;

(b) The collection and dissemination of information and provision for the exchange of services;

(c) The submission to member governments and authorities of recom-mendations for action with regard to the follo" ing:

(1) Nutrition; (11) Standards of consumption of food and other agricultural products; (111) Agricultural production, distribution, and conservation; (1v) Statistics and economic studies in the field of agriculture and food,

including the study of the relation of agriculture to world economy; (v) Education and extension work in the field of food and agriculture; (v1) Agricultural credit; (vu) Problems of agricultural population and farm labor;

7. That the Interim Commission further consider the desirability of as igning to the permanent organization functions in the field of:

(a) Development of agricultural resources and orientation of production, where necessary;

(b) Agricultural commodity arrangements; Cc) Agricultural cooperative movements; (d) Land tenure; (e) Other subjects on which recommendations have been made by the

Conference;

8. That the Interim Commission also consider the initiation of preliminary statistical investigations and research into the problems with which the permanent organization will deal;

9. That the Interim Commission be <1ecmed to have been dissolved when the permanent organization has been established;

10. That the GoYernment of the United States of America be invited to take whatever preliminary action may be necessary for the establishment of the Interim Commission after the United Nations Conference on Food and Agriculture has completed its work.

2. Delegates to the Interim Commission were designated (Appendix II), pursuant to paragraph 2 of the above Resolution, by the Governments of all the United and Associated Nations, and the Commission was convenea in "' ashington on Jul.v 15, 1943. The Commission now presents its First Report, which has the unanimous concurrence of its constituent Delegates.

FOOD AND AGRICULTURE ORGANIZATION OF UNITED NA TIO NS 17

B. EXPERT ADVISERS

3. The Commission felt itself to be in need of technical advice in regard to many of the subjects referred to it by the resolutions of the Hot Springs Conference. It therefore decided to ask certain distinguished scientists and economists conversant with problems of nutrition and agriculture to act in an advisory capacity. These experts constituted the Scientific and Economic Panels which advised the Commission on the scope, functions, and methods of operation of the permanent organization on food and agriculture. It is appropriate Lo record in the forefront of this Report the Commission's deep appreciation of their invaluable assistance. The panels were composed as follows:

ECONOMIC PANEL

Chairman: Mr. H. R. Tolley (United States), Chief, Bureau of Agricultural Economics, United States Department of Agriculture.

Professor H. F. Angus (Canada), Economics Department, University of British Columbia.

Dr. Antonin Basch (Czechoslovakia), formerly Head, Research and Economics Department, ational Bank of Czechoslovakia; Economics Department, Columbia University.

Professor J. D. Black (UHitcd States), Professor of Economics, Harvard University.

Mr. R. R. Enfield (United Kingdom), Principal Assistant Secretary, Ministry of Agriculture and Fisheries.

Professor A. G. B. Fisher ( Tew Zealand), Professor of International Economics, Royal Institute of International Affairs, London.

Dr. Alexander Loveday, Director of Economic, Financial, and Transit Department, League of Nations.

Mr. Ansgar Roscnborg, Economic, Financial, and Transit Department, League of Nations.

Professor T. W. Schultz (Unikel States), Professor of Agricultural Economics, University of Chicago.

SCIENTIFIC PANEL

Chairman: Professor J. A. Scott Wa.tson (United Kingdom), Professor of Rural Economy, Oxford University.

Dr. E. C. Auchtcr (United States), Administrator of Agricultural Research, United States Department of Agriculture.

Dr. G. S. H. Barton (Canada), Deputy :Minister of Agriculture. Dr. F. G. Boudreau (Unit('d States), Chairman, Food and Nutrition

Board, National R('s('arch Council. Dr. R. E. Buchanan (United States), Director, Agricultural Experi

ment Station and Dean of Graduate School, Iowa State College. Dr. Andre :\fayer (France), Professor and Vice President, College de

France. Professor L. A. Maynard (United States), Professor of Animal utri

tion, Cornell University. Dr. Paris E. :Menendez (Paraguay), Director of Central Laboratory,

Ministry of Agriculture. Dr. T. H. Shen (China), Vice Director, National Agricultural Research

Bureau; ~Icmber of ational Resources Commission.


Dr. R. D. Sinclair (Canada), Dean of Agriculture, University of Alberta.

Dr. :M. L. Wil on (United Statl' ), Director of Extension, l lnited States Department of Agriculture. 4. These expert ndYiscrs have contributed in large measure to the

discharge by the Commission of the duties laid upon it, by their expert and comprehensive advice on the problems rcfcrrC'd to them and by the devotion and energy which they have given, separately and in cooperation, to thC'ir voluntary task. The Commission cannot too highly commend their services or too fully recognize its own indebtedness to them. It records with sntisfact.ion that their advice on all the mattC'rs rdNred to them was unanimous.

5. The Commission has utilized the services of consultants from other organizations, national and international, to assist in certain phases of its w01k. It particularly d<'sircs to record its appreciation of thC' assistance rC'ndered by 1lr. C. Wilfred Jenks, Legal Adviser of the International Labour Offic-C', who has contribukd unstintingly of his experience and skill in the preparation of the Constitution.

II. I TRODUCTIO

6. lt is unnecessary lo the purposes of this Report to include in it any general statcmC'nt of the important considerations supporting the proposals and policiC's embodied in the Final Act of the Hot Springs Conference. It is appropriate, however, to slate briefly here the general con iderations of which the Commission has been mindful in formulating its recommendations, o far as they relate to the circumstances under which thC' recommendations are mac.le, the conditions under which effect will be given Lo them, and the general purposes they are designed to achieve.

7. In the struggl<' for food, mankind has b<'en indifferently successful. If millions have enough, more millions have too little, and many starve. This had been thought to be inevitable, but we now know that it is not. Recent discoveries and developments have made it possible under certain conditions for all men and all nations to achieve freedom from hunger, which is the first step toward freedom from want. Indeed, we can now expect to do much more than be free from hunger. The ,vay i opC'n to move toward new levels of wC'll-being which men have hitherto thought unattainable.

8. First among the developments that have made these thing possible is progress in scientific production. The natural sciences have shown us how to increase the productiveness of the land. The nature of the soil has been explored, and methods of management have been developed to maintain and incrPase its fertility. Great progress has been made in the breeding of both crops and livestock, and strains have been created that arc far more productive than their predece sors. At the same time scientists have found new and surrr wavs of combating diseases and insect and other pests that constantly menace the food supply.

9. Along with progress in tlwse fields, immense strides have been made in the dev<'lopment of tools and machines to do work formerly done by hand labor, so that it is now possible for one man to till enough land and produce enough fooJ to feed many more people than before. Equally important have been developments in handling,


processing, storing, and tran porting foods which make it, possible to overcome many of the former handicaps of season and dist,ancc.

10. The result has been to open the way for greatly increased production from the same primary resources, a more even distribution of the supply of food both geographically and over periods of time, and finally a release of large numbers of people from Lhc production of food. These people could produce other things and perform other services needed by their fellow men.

11. v\11ilc t,hesc developments have been in the making the physical nat,ure and needs of human beings have also been explored. The advances in the science of nuLrition within recent years have been comparable in importance to the earlier di coveries in bactcriology, which opened the way to control many deadly or handicapping disrases. Chemistry anq physiology have given us a vast amount of new knowledge regarding the relation of food to human well-being. v\te now know that certain diseases, which affect immense numbrrs of people, arc caused solely by failure to get enough of the right kind of food. We lmow what foods the human body needs not only to prevent these diseases but to build resistance to many others, lengthen the span of life, favor the birt,h of healthy children, and raise the power of many individuals to do physical and mental work formerly thought to be beyond their innate capacity.

12. Moreover, the 'frontiers of scientific discovery arc constantly expanding and opening opportunities for further progress.

13. Thus mankind is equipped with new lmowlcdge, the heritage of all men. A new mastery over t,hc forces that determine human well-being is possible, which men and na,tions can exercise, if thry will, to better lhe lot of the vast, majority of people. But, to put this knowledgr to full use requires forethought, and action adequate to the ends desired.

14. The modern knowledge of nutrition must be shared, in simple practical terms, among increasing numbers of people until it finally reaches all. The modern lmowledge of production must be shared among the world's farmers. Producers must be enabled to get the materials and tools, and to apply Lhe methods, necrssary to increase the world's production to the point where all can have enough food. Those rclea eel from agricuhure by its increased efficiency must be enabled to find useful work in other pursuits. Workers in cities and towns must be enabled to get the products they need from an expanding agricuHural production; that is to say, industry and other forms of production, as wrll as the domestic and foreign trad(' of all countries, must likewise expand. Each nation must, give earnest, considrration to the adoption of policies designed to ensure sufficient, food to those who, for one or another reason, arc at so grrat a disach·antagc in the economic system that they cannot obt,ain the means for rC'asonablc nutrition. Finally, research, which has already accomplished so much, must be stimulated and made even more rC'sponsivr to the nred of discovering ways of reconciling the changing numbers of the world's peoples and the quantity of things produced and di tributed to meet their rC'quirements.

15. Scientific developments have shortened the distances between countries until all are now near neighbors. Thus the discontent or the over-weening ambition of one profoundly affect all others, trifo at one place can quickly become world-wide, and cooperation i thrust upon


us if the world is to avoid being brought ultimately to the verge of ruin. 16. But these same scientific developments will enable us to achieve

many things through cooperation that were thought impossible before, and among them is freedom from want of food. No nation can hope to achieve this by depending solely on its own effort, for none can any longer insulate itsPlf from the disastrous effects of things that may be done by other nations. But in a world in which distance has shrunk and the pace of events has quickened, each nation can reinforce what others do far more readily and effectively than in the past. The pos ibilitie for good have increased as greatly as the possibilities for Pvil. We can now reasonably expect to solve the problem of freedom from want if all will act together.

17. Progre will necessarily be gradual. Men do not readily adjust traditional ways to new conditions, and there are many obstacles to be overcome. But a start can be made at once. Changes in the economic and social arrangements of nations will be needed. The redirection would not be wholly new; it is in line with an volution that has been ha tened in our time.

III. THE FOOD AND AGRICULTURE ORGA TIZATIO OF THE UNITED ATIONS

A. PURPOSES -\ND FUNC'l'WNS

18. In pursuance of paragraphs 4 (a), 5, 6, and 7 of the RC' olution quoted in paragraph 1 of thi Report, the Interim Commi sion recommend for the approval of it constituent Government the Constitution (Appendix I) of a pcrmanC'nt organization for food and agricultun', hereinaftC'r rdeITC'cl to as the "Organization."

19. The remainder of this section of this Report is devoted to an exposition, supplementing the Constitution, of the purposes and function of the permanent Organization as the Commi ion ha envisaged them, and of it structure and organization, its mrthods of working, its relationship with othC'r organizations, national and international, and the need for its C'arly C'stablishment. RefcrencC's at the ends of paragraphs are to the corresponding Articles of the Constitution.

20. Th10ughout this RC'port references to thC' purposrs, funrtions, duties, and powers of the Organization are to be interpreted as C'Xtcnding to fishrrics, marine products, forrstry, primary forestryprorlucts, and fibC'r and other non-food agricultural products (Art. XVI).

21. The purpose of the Organization as set forth in the Prcam ble to the Constitution is to promote the common welfare by furthC'ring separate and collective action by the Member nations to raise levels of nutrition and standards of living, to secure improvements in the efficiency of the production and distribution of all food and agricultural products, to better the condition of rural populations, and thus to contributC' toward an expanding world economy.

22. The> IPeans to be employed will include the promotion of research, the dissemination of knowledge, the exchange of services, and the ma.king of re>comm cndations for international and national action, in which the Organization might in some cases be directly involved, with regard to the improvement of nutrition; the production, distribution, and consumption of foods and of fibers and other agricultural


products; and the development and conservation of agricultural, forestry, and marine resources (Art. I. IV).

23. These are important and far-reaching undertakings. They should be envisaged as far as possible in their entirety, so that their interrelationships may be clearly seen. But the Organization will have to develop gradually, and it will probably be a considerable time before it will be able to cover the whole field described in this Report . It houlcl be established at the earliest practicable date since there are matters falling within its scope vd1ich call nrgently for action.

1. RESEARCH

24. One of the principal functions of the Organization will be to promote research in the fields r('lating to its work as a means of meeting the needs and helping to solve the problems of the peoples of its Member nations. Competence and pN'sistence in the search for knowledge, and fairness and courage in promoting its application, will establish a solid basis for recommendations and action ( Art. I).

25. A vast amount of knowkdge in the fields to be covered by the Organization already exists. To be more wiek'ly and effectively used, it needs to be adapted to local conditions and reexamined as conditions change. In addition, new knowledge must be sought.

26. A great diversity of research in the natural and social sciences is suggested by the range of subject matter and the solll'ces of information discussed in later paragraphs. "While continually safeguarding and fostering the freedom of inquiry necessary to scirnce, the Organization can do much to stimulate such resrarch throughout the world; suggest and initiate projects, in many of which several institutions in more than one country might cooperate: coordinate such projects whenever pos ible; anange for the use of procedurrs that would give comparable re ults; and keep research workers inforrnrd of one another's progress. The Organization should facilitate the exchange of personn<'l among institutions and the collection and exchange of impmtant biological materials-brerding stocks, for example-and in some cases lend the services of members of its own technical staff to an institution or a country. Wbeth<'r the Organization should supply equipment or give direct financial aid to research institutions is a matter of policy to be determined by th<' Conference. The question should be left for future decision whether, by arrangement with the governments primarily concerned, the Organization should rstablish research stations of its own (Art. I, XXII).

27. In sum, the Organization should lead in stimulating, promoting, and, where appropriate, conducting research focussed on world needs in food, agriculture, forestry, and fisheries. To carry out these and other functions, it will be assemble a great deal of information from all parts of the world. But it should not only gather data; it should find out and say what thry mean. a. Sources of information.

28. One of the principal sources from which thr Organization will gather information will be the periodic reports made by Member nations in accordance with Resolutions II, III, and :XV of the Hot Springs Conference. In order that these reports may serve as a basis for concerted planning and action by the Member nations it is

22 FOOD AND AGRICULTURE ORGAXIZATIOX OF UNITED NATIONS

important that they give the information needed for di-awing an accurate picture of the conditions in any country and tluoughout the world in regard to nutrition, food consumption, production, and the factors influencing them. The Organization, being charged with the responsibility of obtaining and making use of these reports, is therefore given the right to determine the lines on which they will be made and to arrange that they be furnished promptly (Art. XI).

29. The regular collection and systematic presentation of relevant statistic obtained from ::-.1cmber nations and international authorities will be fundamental; and continuity in the statistical series collected will be important to ensure accurate interpretation of current and future trends. The Organization should receive regularly all publi hC'd statistical material, and should also have access to unpublished matC'rial relevant to its work. The basic statistical data in many countries arc very imperfrct. The Organization should device effective methods for obtaining more accurate statistical information at minimum expense, and should also make the services of its technical staff available to any government needing assistance in organizing or improving national stati tical services. New methods of sampling, for example>, which ha~c recC'ntly been developed, are known and used in few countries (Art. I, XI, XII).

30. All other relevant sources of information should be used, including the results of special inquiriC's and surveys, or the work of special committees set up by the Organization; reports and other material obtained through regional and liaison offices of the Organization; information furnished by national nutrition organizations, by any agencies that may be set up under the auspicC's of the Organization, and by research institutes and scientific ocieties; and reports and other material obtained through reciprocal arrangements with other international authorities (Art. XII, XIV). b. Range of subject matter.

31. The range of subject maitC'r covered by the research, factfinding, and interpretative work of the Organization will include all the branches of the natural and social sciences relating to food, nutrition, agriculture, forestry, and fisheries. If may be useful to list some of the particularly relevant subjects as a means of sketching in broad outline the scope of the activities that would contribute to the main purpose of furthering improvements in production, distribution, consumption, and nutrition. The importance of the interrelationships of the different fields and of collaboration with other institutions should be emphasized at all times.

(i) Natura] sciences-including human nutrition in relation to health, animal nutrition, biochemistry, plant and animal genetics, plant and animal phy iology and pathology, soil chemistry and physics, entomology, mycology, bacteriology, and met('orology.

(ii) Technology-including management, selection, and breeding in relation to crops and livestock; . nimal feeding and care; soil fertilization, drainage, irrigation, and other conservation and development measures; protection of crops and livestock from natural enemies; agricultural engineering; processing, storing, and transporting food and other agricultural products.

(iii) Economic organization of agriculture-including the production and successive stages in the distribution, marketing and

I

FOOD AND AGRICULTURE ORGANIZATION OF UNITED NATIO rs 23

consumption of food and other agricultural products; the coordinated expansion of consumption and production; the efficiency of factors of production in terms of physical output and cost per unit; methods of reducing costs of production and distribution; scale of enterprise; economical use of labor and machinery; provision and use of credit; demand and prices; gross and net income in relation to output and consumption; trends tmd fluctuations in production, prices, incomes, and other factors bearing on the relation of agriculture to the general economy; domestic and international trade and other espects of national and international economy, with special reference to their bearing on food and agricultural problems.

(iv) Other social factors- including food habits and customs, the distribution of population between agriculture and industry, population movements, land tenure, consumrr and producer cooperatives, and rural organization generally; rural schools and other rural institutions; rural roads, communico.tions, and rural ('lectrification; rural housing, sanitation, and amenities.

(v) Public measmes of regulo.tion and assistance: In modern states public authoritirs legislate so extensively in regard to sto.ndards and practices, and provide aids of so many kinds in connection with the matters included in each of the preceding subparagraphs, that investigations in these fields by the Organization are too broad to be covered by any list. They would rrlate, among other matters, to special planning techniques, legislation affecting tho eradication of deficiency dis('ases, measures for improving the diets of vulnerable groups, rrgulations for control of plant and animal diseases and pests, grading and standards of market and nutritive quality, subsidies for production or consumption, commercial policies, and measures for increasing consumption by the distribution on special terms of accumulated stocks.

2. DISSEMI ATION OF KNOWLEDGE

32. The need to make useful facts about nutrition and the consumption and production of foods far more widely known is so great and so essential to progress that promoting the dissemination of knowledge is to be given equal emphasis with research. The Organization should employ various means to this end as the need arises. The development of a program of publication will be important from the beginning. Promoting education in the fields rrlating to the Organization's work will be another important activity (Art. I). a. Publications.

33. A considerable variety of publications will probably be needed, some for official or professional use, some designed to meet tho needs of particular groups of producers and consumers and those of the general public. High standards should be the aim in rvery case. Duplication of work adequately done by others should be 11,voided, and the possibility of cooperative ventures should be fully explored; the Organization might do much by this means to promote world-wide coordination of efforts-for example, in the preparation and publication of scientific abstracts (Art. XII).


34. It is not possible at this time to forecPst exactly what publications the Organization will find it useful to issue. Among them might be a periodic summary based on the reports by Member nations; a periodic world survey of the state of nutrition, consumption, and production together with an analysis of tbe determining factors, with special attention to intenelated developments and the policies of different countries; a periodic digest or review of legislation and administrative rulings relating to food, agriculture, forestry, and :fisheries; abstracts, reviews, and bibliographies of scientific literature; regular bulletins dealing with crops. production, trade, stocks, prices, and other date and their interpretation; and a journal or journals containing articles for the general reader on problems and progress in the fields covered by the Organization. It will clearly be essential to publi h an authoritative and comprehensive yearbook of international statistics (Art. I, XI). b. Education.

35. The publications of the Organization will be educational in a broad sense. It should also promote more specific educational activities in several important fields, with the central purpo e of furthering improved nutrition and adequate production and consumption on a world-wide scale (Art. I).

36. With a view to raising the standards of professional services and making them more widely available, the Organization should be prepared to assist governmental and other agencies in planning for expansion or improvement of the work of institutions of learning in the fields related to its work. It should be in a position to serve as consultant to institutions on courses of study and methods of training. It might well act as a clearinghouse of information on facilities for study and research in institutions throughout the world. It should encourage and facilitate the exchange between countries of students, teachers, and professional workers (Art. I).

37. To what extrnt, and in what ways, the Organization will be of assistance to educational institutions other than those at tho univrrsity

· or prof es ional level <·annot be forcsren 11.t presrnt. Nat ions differ widely in their cducationr.l systems, which are 1wculiarly a, matter of nationn.l concern. But while the rurvJ school system should be' one of the most important factors in improving rnral life, it is in fact iu most countries at a disadvantage in comparison with urban school systems, and in both urban and rural chools there arc great and often unrealized opportunitie for teaching young people elementary but important facts regarding foods and nutrition. Drspitr the difficulties involved, the Organization should be able to perform a useful service by advising on suitable courses of study, promoting adrquate teacher-training in approp1iatc subjects, acting in a consultative capacity, assi ting in surveys 11n<l studies to determine needed improvements, and in othrr ways (Art. I).

38. Various countrie arc interested in furthering adult education, particularly of the kind exemplified by agricultural extension, home demonstration, and similar services. Such services depend largely on local instructor and leaders who give personal counsel and assistance and demonstrate methods to hrlp producers and homemakers apply thr principles of good farming, food preparation, nutrition, and home economics, or domestic science, in their daily work and living. The


Organization should be prepared to assist governments in determining the need for these services; to promote adequate training of workers, induding opportunities for study in other countries when this would be advantageous; and to assist in other ways in widening the usefulness and improving the methods and standa1ds of such sl'rvices (Art. I).

39. The Organization will be interested in improYing the effectiveness with which adult education services could use such channels as newspapers, radio, and motion pictures to spread practical information. In addition, it should furnish authentic information for the public regarding its own activities. 'I'o what extent it should elaborate services of its own, cksigncd specifically to furnish material for the press, ra.dio, and other popular media, will depend upon the course of its development. Whatever may be done in this field should be safegua1 ded with unusual care against the risk of exploitation and misr€'presentation for purpo es of commercial or other propaganda (Art. I). c. Library and inquiry services.

40. As the work of the Organization becomes widely known, it will probably be called upon to answer a large volume of inquiries on many subjects. Furnishing adequate information in response to these inquiries will in itself be an important service in disseminating knowledge. Partly for this purpose, and also for its other work, the Organization will need an extensive library, kept fully up to date (Art. I).

3. ADVISORY FUNCTIONS

41. 1luch of the work of the Organization will be of an advisory character. This will include making recommendations ranging from a suggestion on some minor point to drawing up and submitting for approval an elaborate program of action on a complex problem; and from advice given to a single Member nat,ion or even a single institution to advice given to all Member nations (Art. I, IV).

42. The Organization should have this wide scope in its advisory functions to enable it to achieve tho objectives of the Hot Springs Conference. It is, however, a much more delicate matter to give advice on some subjects than on others. Special procedures are provided by which the Conference of th(' Organization may formulate and adopt formal recommendations to governments. In addition, a wide variety of advisory services may be developed of a less formal charackr (Art. I, IV).

43. The effectiveness of advice and recommendations depends on the qualifications of those who give them, the adequacy of their preparatory work, their understanding of variations in local conditions, and their ability to enlist the cooperation of 1frmber nations. The Organization should progressively establish its connections and build up a staff with a wide range of qualifications and experience. The Organization will thus be equipped to take the initiative in formulat~g recommendations designed to stimulate action by one or more nations or international authorities. Its initiative in making suggestions and offering advice Lo nations individually and collectively would be especially useful in cases in which coordinated action is required in several fields or by a number of countries. For a variety of reasons, a nation may feel itself inhibited from initiating a discussion of prob-


lems, the solution of which appears to demand modifications of the policies of other nations as well as of its own. In such ca es, particularly, the Organization would be in a favorable position to initiate discussions and make recommendations (Art. IV).

44. The advisory work of the Organization would in appropriate cases be done in cooperation with other international authorities in related fields (Art. XII). a. Typical cases and procedure.

45. The Organization should be ready and willing to moet requests from one or more states for advice in regard to policy or for other assistance. The extent to which the Organization's advice in regard to the problems of individual countries will be required will of course vary greatly as between countries in different stages of agricultural and economic development. But improvements resulting from sound advice given to particular countries will in the long run redound to the common benefit, and by their general as ·well as their particular effects will promote the basic pmposes of the Organization. The following might be typical cases and procedures:

(a) In some cases an international convention, in the sense of a formal agreement to be ratified by a largo numbN of nations, would be the mo t effective in trument to accomplish the desired objective. Or the Organization might, frame a model code or form of treaty as a. guide to Member nations. Either of these methods would be suitable for agreement on such matters a the standardization of terms, assaying samples, biological material of various kinds, weights and measures, container , certain trade practices, method of apprai ing the nutritive value of foods and the adequacy of diets, and measures for preventing the spread of diseases or of pests (Art. IV).

(b) In other cases the Conference would act by moans of a resolution or by adopting reports embodying proposals for action. Such a resolution or report might call for common action by the nations affected, the acceptance of common or related policies or changes in policy, or the creation of an institution for the common u e and benefit of a group of nations (Art. IV, XIV).

(c) Raising the nutritional level of the population will in many countries involve long-range programs including the expansion and reorientation of production, the building up of food processing and consumer-goods industries, the improvement of markets, and the expansion of such services as transportation and electric power. Complementary shifts in the production and trade of other countries would often be required in such cases, and outside capital and technical assistance might be needed. Tbe Organization could perform a useful function by helping to d('termine the need for such far-reaching developments, drawing up plans, coordinating action by various countries, presenting the case for loans from international credit agencies, ond fumishing advicfl and technical assistance in other ways {Art. I, IV, XII).

(d) in1ilar but ev('n mor(' difficult probl('ms occur in the case of countrie or regions in "hich such developments and improvements cannot materially relieve the poverty and malnutrition of large masses of people in a reasonable lime. In ome rPgions chronic poverty is in part the re ult of age-old traditions, high

FOOD AND AGRICULTURE ORGA:NIZATIOX OF UNITED NATIONS 27

net rates of reproduction of populations, and the lack of education, the inadequacy of roads and communication facilities, and the absence of opportuniti<'s for industrial employment. These problems are not insoluble, but they require long-continued effort and the cooperation of many agmciC's. The Organization should play a leading port in such long-term efforts. ·where famine is a rC'CUlTent risk the Organization should obtain informn,tion on probable requiremC'nts and solll'CC'S of supply, and facilitate arrangemC'nts with the governmC'nts of 1IcmbC'r nations or with appropriate inlC'rnational agC'nciC's for finding the necC'ssary men, mon<'y, n,rnl malC'rials, frC'C' or on special terms (Art. I, XU).

(C') AnothC'I' typC' of problem concerns areas whC'I'<' climatic or other factors have kd lo specialization in th<' production of one or a few C'xport products. Every practicable effort should be madC' in tllC'se areas to di-versify production, grow morC' food, and provide altC'rnativC' C'mployment. Usuall.v, howC'vC'l', the solution of tlw problem rC'quirC's Lhe enlarg<'ment of forC'ign markets for the export products of thC' area.

b. Advice and recommendotions on other problems. 46. In addition to dealing with thC' problems discussed so far, the

Organization would furnish advice and make recommC'tHlations in many other cases, some of which will be of a more or less routine nature. The initiative in making proposals might be taken by one or more :Member nations or by the Conference. Suggestions might be made to the Conference by general or special confer<'nces, by the advi ory committees, by the Executive Committee, and by the Director-General. The Executive Committee should be espC'cially well qualified to act as an intermC'diary for proposals for action to be considered by the Conference, which in turn ,Yould suhmit recomm<'ndations to governments. The Director-GN1eral would not make recommendations directly Lo a government unless it requested hi.m to do so (Art. IV, V, VI, VII).

47. Although a distinction is drawn throughout this discu sion betweC'n the initiation of proposals by governments and by the Organization, the point should not b<' overemphasized. To exercise its functions effectively, the Organization would neces arily devC'lop close working relations with governments in the course of which suggestions and advice would naturally be exchanged (Art. I).

48. The Organization will be in regular communication with governments in conn:eclion with their reports and statistical and othC'r returns. Governments will both ask for and expect to be offered suggestions for action on their part which will amplify the information supplied and mak<' it comparable for the various countries. In rC'sponse to 1 equests, the Organization might furni h expC'l't adYisers who, tog<'ther with

• local officials and technical personnel, "'ould constitute special committe<'s 01 missions authotizPcl to inve tigate and report in accordance with their terms of referenc<'. In g<'neral, such inquiries would have in view Lhe making of recommendations for action (Art. I, XI).

49. Similarly, the Organization would increa ingly haYe occasion to map out surveys and other undertakings-for example', a world agricultural census, to be repeated at intervals-to be carried out in cooperation with the governments concerned. For these surveys, too, special committees or missions made up in part of local representatives would

28 FOOD AND AGRICULTURE ORGANIZATION OF U ITED NATIONS

be effective machinery, and useful advice might be expected frequently to result. The Organization would also have regular advisory relations with national agencies such as nutrition committees and research councils (Art. I).

50. fo addition, collecting and disseminating information would in themselves involve indirect advisory work which would have considerable influence. Each nation would be given the benefit of the experience of others, objectively examined as a subject of common interest. The force of example should lead governments to find out more about conditions affecting their own people, and stimulate them to introduce measures for improvement which have succeeded elsewhere, and, equally, to guard against the repetition of mistakes.

4. FISHERIES, FORESTRY, AND NONFOOD AGRtCULTURAL PRODUCTS

a. Fisheries and marine products. 51. Fisheries furnish a considerable part of the world's food supply;

in some areas they arc more important than agriculture as a source of food. Vitamin-rich oils extracted from the livers of cod, sharks, and other fish have in recent years assumed great importance in nutrition and therapy. Fisheries also furnish important byproducts, such as fertilizer materials, protein feeds for livestock, industrial oils, leather, and various chemicals. The technical and economic problems of those engaged in fishing require largely similar treatment to the problems of those engaged in farming. Improving the production, handling, storing, processing, and di tribution of fish is vital in any concerted effort among nations to raise the nutritional lcYels and the standards of Jiving of populatioPs.

52. Few if any types of food production yield returns as quickly as docs fishing. Tliis fact will be of special significance after the war when there will be a general scarcity of animal protems. During 1939-44, as during 1914- 1 , fisheries have been substantially replenished, and at the end of the present war well-stocked fishing grounds will constitute one of the world's few reserves of foods.

53. The work of the Organization in this field would follow the same general pattern as in agriculture, including research, education, advice, and recommendation. It should examine the po sibilities for expansion of present fisherie , since in many parts of the world known marine resources could without harm be exploited much more intensively to supply food for human beings, feed for livestock, and materials for industry. It should encourage systematic exploration for virgin marine resources ancl evaluate the possibilities for their development. It shoul<l encourage the setting up of additional research laboraLorics to study biological, economic, and technical problems relat"d to the fislwry industry throughout the world (Art. I).

54. In their migrations among the waters of the world, fish have no regard for national boundaries. The conservation and wise and equitable use of fishery resources is therefore in many cases peculiarly a matter for international agreements, treatiP , and conn,ntions. It would be the duty of the Organization to help to formulate and to propose such international arrangements. It should also perform funetions in relation to credit, which will be needed for the development, expansion, and rehabilitation of many fishery enterprises,


similar to the functions suggested elsewhere in this Report in connection with agriculture (Art. I, IV).

55. As in the case of agriculture, the Organization hould take tho neces ary st<'ps for cooperation with other bodies-in particular, tho Intornalional Labour Organization, whiC'h is concerned with the social conditions of fishermen; the Council for the Exploration of the Sea (Copenhagen); the North Atlantic Council on Fishery Investigations (Ottawa); and the several bodies administering international fishC'ries (Art. XII). b. Forestry and fore ·try products.

56. Forests occupy approxi.matt-ly 22 percent of the land surface of the earth. They play so irnporlnnt a part in the conservation and building up of soil u11d water resourcC's that it is impossible to plan consenution nwasur<'s on any extPnsiYe scale ,vithout including forC'st manag<'m<'nt and frequently afforestation-in the plans. In most countries forestry and forming or grazing constitute possible alternative USC'S of much of the lnnd, and a significant part of the .forest land in many countries is owned or operated by farmers. Indeed, forests arc perennial l'rops, natural or man-made, and their products compete with or supplement other farm products for certain important uses. FarmC'rs arc among the huger users of forest products, especially for fuel, building, and equipment. For these reasons many countries include forestry as a pan of ngriculture in their governmental organization.

57. World forest supplies have been altered by the war, New supply problems have hcen created an<l new uses developed. In some countries progress in improved methods of forest managemf'nt and utilization is being made at a faster rate than ever before. Thus there are now especinlly urgent reasons to consider forestry in world terms and to take concerted action to bring about more efficient growing, processing, and distribution of fon,st produets, the balancing of production and distribution with needs on a world scale, and the prevention of disastrous overuse of forest resources in some countries while those of other countries go to waste for lack of effective demand, to the encl that the world's forest resources may make their full contribution to the needs and the well-being of the people of every nation.

58. As in the case of food and other agricultural products discussed in this Report, these objectives would be accolnplished through international cooperation in bringing all branches of science to bear upon the biologiool, technological, economic, social, and other problems involved in the production, distribution, ·and use of primary forest products; in establishing a factual basis upon which nations, individually and in concert, could build policies and programs; in helping to work out such programs; and in promoting widt'spread education and public undrrstanding of forestry problems. The Organization's work in forestry would thus closely parallel that in other fields (Art. I, IV).

59. The Commission recommends that, in accordance with the situation in each case, th<' Organization hould establish close working relations with any existing international agencies concerned with forestry (Art. XII, XIV).

30 FOOD AND AGRICULTURE ORGANIZA'l'ION OF UNITED NATIONS

c. Non-food agricultural products. 60. A considerable part of the world's agriculture is devoted to the

production of commodities other than foods. These products are of special importance becau c of the contribution they make to the money income of farmers since most of them require processing and are sold as raw materials for cash. Some of them are necessities of life; others contribute in an important measure to human health, dignity, and well-being. The Organization should accord the e products consideration commen,mratc with their importance to agriculture and to social WC'lf arc.

61. Fibers constitute one of the major groups of nonfood products. Of these some, such as cotton, wool, linen, and silk, arc consumed mainly in clothing and household goods; others, such as jute, hemp, abaca, sisal, and hC'nequen, are used in the form of bags, ropes, cords, and nC'ts. Other categories of nonfood products include the oils and fats used in paints and soaps; hides, skins, and furs used in clothing and in industry; beverages and beverage materials; and tobacco. It is characteristic of most of these products that their markets are international in scope and that consumption increases and decreases with fluctuations in general prosperity. Of many, also, production oner the world tmds in peacetime to run ahead of effective demand, with a resulting depression of the living standards of producers. At the same time many of these products are especially subject to intercommodity competition, including the incrC'asing competition of synthetic materials.

62. Exi ting information on consumption capacity and effective demand for some of these products in different countries, and on the relation of consumption levels to standards of living and levels of well-being, is meager and inadequate compared with the same information in relation to food and nutrition. In sponsoring, organizing, aiding, or conducting rcs('arch designed to develop more complete information, the Organization will have an opportunity for service to consumers and producers. While such fundamental facts are being sought, however, much can be done to increase and broaden the consumption of many important products-for example, clothing, household textiles, paints, soaps-through a general expansion of world economy, including agriculture, industry, and trade (Art. I).

63. The functions and activities of the Organization will, in the nature of the case, include nonfood as well as food products, with respect to such matters as agriculturnl organization, agricultural credit, commodity arrangements, scientific and economic research, and education (Art. I, IV).

64. The Commission recommends that, where appropriate, the Organization should establish close working relations with other public international organizations concerned with nonfood agricultural products (Art. XII).

5. AGRICULTURAL CREDIT

65. The Commi sion has given careful thought to the functions that ought to be performed by the Organization in the domain of agricultural crC'dit. It is manifest that the basic purposes of the Organization will not be achieved unless international credit for agricultural


projects is made available and effective on a considerable scale, and it follows that the promotion of a wise and liberal administration of international agricultural credit is among the major concerns of the Organization. Such an administration, indeed, is important not only to world agriculture but to world economy, and the doctrine of an expanding world economy, to which, at the Hot Springs Conference and elsewhere, the majority of governments have subscribed, is unlikely to be realized in the absence of sound policy and practice in regard to international agricultural credit. Investments directed toward the improvement of agricultural methods should bring quick returns in increased production, and this would not only be reflected in improved nutrition but also in increased international trade. Indeed, that portion of international investments which may be directed tov. ard agriculture' may bring about quicker C'ff('cts upon world economy than larger sums needed for longer term developments.

66. The Commission conceives, how('ver, that international credit and investment, whether related to agricultural or industrial development or to other purposes, would must suitably be administered by a single international authority charged with the appropriate functions in respect of all such purposes. It recommends that such an authority be established by agreement between tl1e. govcmmcnts concerned, and that adequate arrangements be made for including the provision of agricultural credit among its functions. It further recommends that the Organization, or in the event of its not being established in time the Interim Commission itself, should be rcprernnted at any international conference that may be convened for the purpose of setting up an international credit and investment authority.

67. Credit will be needed for many agricultural d<'velopm!'nts-for example, the re-equipment of agriculture, mechanization, land reclamation, irrigation, afforestation, and increased storage, processing, and marketing facilities for agricultural products. Agricultural credit should, however, be interpreted not only as covering its conventional forms but also as including credit for adjustments in other parts of the economy in the interests of agricultural reorientation and better standards of nutrition.

68. The Organization will have a direct concern with all these matters, and it is clearly appropriate, if it is to be enabled to exercise an influence in its own field commensurate with the purposes for which it is established, that it should be recognized as a complementary body to the international credit and investment authority with specific functions in regard to agricultural credit (Art. I).

69. The specific functions relating to agricultural credit which the Commission recommends should be assigned to the Organization are as follows (Arts. I, IV, XII):

(a) The Organization should participate in the management of the international credit organization through representation on its governing body, in order to provide for due consideration of agricultural interests in the determination of general internat.ional credit and investment policies.

(b) Applications for international credit for an agricultural purpose should be considered by the international credit au-

32 FOOD AND AGRICULTURE ORGAKIZATION OF UNITED NATIONS

thority only after examination by the Food and Agriculture Organization and in the light of its recommendations.

(c) In appropriate cases, and if the Food and Agriculture Organization should so recommend, the borrowing country should be required, as a condition of the loan, to avail itself to the fullest extent, in regard to the projects for which the loan is granted, of the technical services and advice of the Organization.

6. COMMODITY ARRANGEMENTS

70. Resolution II 7 (b) of the Hot Springs Conference instructed the Commission to consider the desirability of assigning to the Organization functions in the field of agricultural commodity arrangements. The Commission has recognized the important role which such arrangements can play in (a) coordinating internationally diverse or conflicting national price and marketing policies and programs; (b) eliminating excessive fluctuations in prices; (c) mitigating some of the effects of trade cycles; (d) maintaining adequate supplies for consumers; and (e) ensuring markets for producers while promoting desirable adjustments in agricultural production. Commodity arrangements for nonagricultural products have a similar role to perform, and to secure fairness of treatment, avoid confusion, and establish consistent policies, the Commission recommends to its constituent government that international commodity arrangements for both agricultural and nonagricultural products be coordinated under the supervision and direction of a single international authority. The Commission further recommends that principles governing international commodity arrangements for all classes of products should be formulated by a special international conference and that thereafter there should be established an international authority to review in the light of experience the application of the principles so formulated and to coordinate and supervise the administration of individual commodity arrangemPnts.

71. The Commission recommends that the Organizat,ion, or in the nent of its not being established in time the Interim Commission itself, should participate in the intPrnational conference which it proposes should be held to formulate the principles to which all commodity arrangements should conform. It further recommends that the Organization should be represented on the directorate of the proposed intcrnatioHal authority n,nd should be associated, where appropriate, with the working operations of that authority through mutual consultation and reference (Art. XII).

72. As in the case of international agricultural credit a1Tangcmeuts, the Orga.nizalion will have an important, though not an exclusi,<', concern in international agricultural commodity arrangements. The Organization should be entitled to propose particular commodity arrangements to the proposed international authority, or in the absence of such an authority to governments, and to suggest the provisions of the arrangements so proposed. Similarly, the Organization should be entitled to propose that any e)risting agricultural commodity arrangement should be modified or terminated (Art. IV).

73. The Organization will have a special competence and interest in rcg~r<l to such a.rrangements as they promote or hinder hotter orientation of production through agricultural adjustments and whether


tlwy may be C"ffectivt' in providing opportunities for supplying con-umption nreds from the most efficient sources of production. For

exampk, lhr Organization may well study the effects of monopolistic practicr , excessive price variations, and similar phC'nomena in order to stimulate appropriate international action for maintaining a check upon the first and for diminishing, or even for preventi.ng, the second. On its own initiative, or in response to reqtwsls rither from tho general ndministrative authority or from the individual commodity control concerned, the Organization may conduct inquiries regarding any international agricultural commodity arrangement, and should furni h to govrmments, to the international commodity authority, or to any authority dC"aling with an individual commodity arrangement, information, analyses, or advice (Art. I, IV).

7. ADML"ISTRATIVE FUKCTIONS

74. In carrying out the duties already outlined, the Organization will necessarily undertake certain administrative work.

75. In certain circumstances the Organization might perform administratiYe functions in connection with a wide rimge of international ,convrntions or agreements on such mattC"rs as those already mrntioncd. It might also, in agreement with the countries concC"rned, perform or organize SC'rvices of an international character, such as ~he control of locusts and other plaguC"s, or the srarch for and dist.ribution ,of biological materials for the control of predatory insects and noxious weeds (Art. I, IV).

76. The Organization would be free to accept and administer endowments or gifts for the furtherance of its work, being careful to ensure that the terms are not such a might caus(' C"mbarrassment to the Organization (Art. XV).

77. The Organization would be cmpowerC"d to expend, if it should so decide, part of its funds, contributed by Member nations, to establish fellowships for training expert workers or carrying out rC"search projects, to found research institutes, or to make grants-in-aid for other purposes. In such cases its funds should be usC"cl, howev('r, only for projects that have a regional or world significance and that would not be undertaken without such assistance (Art. I).

78. To the fullest po sible extent the Organization should utilize the facilitiC"s and resourC"cs of othC'r organizations, both national and int('rnational, for the achiC"vement of its purposes and in general should be cautious about undertaking the supervision or administration of executiw aO'encies in fields related to its work (Art. XII).

79. The Organization should be entitlC"d to eorn;ider any proposals that mig½it be made or itsrlf to make proposals for the distribution on special terms, to those whosC' consurr.ption is r('latively VNY low, of abnormal stocks of food or other agricultural products; and it should be empowered to assist oLher international bodi('s in admini tering such schemes. The necessity of coordinating such proposals with the policies of other bodies should be borne in mind, together with thP risk that such action might delay necessary basic C"conornic adjustment by giving producC"rs an inducement to continue production d('spitC' the lack of effective demand for their pulput (Art. IV, XII).

80. Much of the forC"going discussion assumC"s that other international authorities will be created with administrative responsibilities


in related fields, and that the Organization will promote its own purposes by maintaining close and cooperative association with these other authorities. A different situation would arise if such otherauthorities were not set up. If governments were prepared to.authorize the Organization to fill, in whole or in part, some of the gaps created by the absence of such other authorities, there would be a case for its undertaking further executive responsibilities (Art. XII, XIV).

81. In particular, the Commission has recommended that the constitutent governments establish international authorities to deal with international credit as a whole, and with commodity arrangements as a whole, including agricultural credit in the one case and agriculturalcommodity arrangements in the other. If, however, such international authorities should not be established, or if their effective operation should be unduly delayed,· the Organization would undoubtedly find itself seriously hampered in the promotion of its primary purposes. The Commission has the confident hope that this situation will not arise. If it should, the Commission conceives that it would be the duty of the Organization to represent' to governments that appropriate international credit and commodity arrangements, applying to the agricultural field alone, should be made. In that event, it would no doubt be appropriate to propose that the administrative functions involved should be performed directly by the Food and Agriculture Organization itself (Art. I, IV).

82. Collaboration with the United Nations Relief and Rehabilitation i\..dministration also has its administrative aspects, especially in relation to agricultural rehabilitation. The Organization might well have functions to perform in connection with rehabilitation work that may need to be continued beyond the life of the Relief and Rehabilitation Administration. The Constitution of the Organization permits it to assume such responsibilities at the appropriate time (A rt I, IV, XII, XIV).

8::3. The Organization may initiate or concert plans with governments, in cooperation with other appropriate international bodies, for the procurement and distribution of supplies of food and producers' goods to relieve famine resulting from floods, drought, earthquakes, or other calamities (Art. I, IV, XII).

B. CONSTITUTION

1. NATURE OF THE CONSTITUTION'

84. The Constitution is so framed as to provide for the essential powers and duties of the Organization as envisaged in Section III i\.. of this Report; to give scope for development within e»isting :provisions according to circul}.1stances; and to permit of considered amendment to meet undetermined future conditions, including more particularly the future framework of international organizations.

2. MEMBERSHIP

85. Original membership is accorded to the nations represented at the Hot Springs Conference, as and whrn the Constitution is accepted by their governments; but provision is made for the admission of

.--

FOOD AND AGRICULTURE ORGANIZA'l'ION OF UNITED NATIONS 35

other nations to membership, with full rights, duties, and obligations, by a two-thirds majority vote of the representatives of all the Member nations (Art. II).

86. In view of these provisions, acceptance of the Constitution by twenty governments is deemPd to be necessary and sufficient for its entry into force. In reaching this conclusion, the Commission has had in mind the desirability, for the reasons indicated in Section III G of this Report, of bringing the Organization into active operation at the earliPst practicable date, and also the circumstance that under present conditions of communication acceptance by the governments of several of the United Nations may be deferred for a considerable time (Art. XXI).

87. Initial membership is for a prriod of not less than five years. Because of the adverse and fluid conditions arising from the war and its aftermath, with which the Organization ·will have to contend during the early stages of its dcvelopmrnt, it is thought that five years is not too long a period for any nation to pledge its adherence and support (Art. XIX).

88. Provision is made for withdrawal of membership by any Member nation after the expiration of an initial five-year period, withdrawal being subject to fulfillment of financial obligations to the date of withdrawal (Art. XIX).

S. LIMITATIONS ON POWERS OF THE ORGANIZATION AND ON OBLIGA'l'IONS OF MEMBERS

89. Adequate work covering the entire field indicated in this Report will be only gradually achieved. Any change in functions which would involve modification of the provisions of tho Constitution requires a two-thirds majority vote of the representatives of all the Member nations, and no such modification can impose a new obligation on nny Member nation without its consent (Art. XX).

90. Tho particular obligations undertaken by Member nations, by acceptance of the Constitution, are as follows:

(a) to make specified reports to the Organization (Art. XI); (b) to contribute to the expenses of the Organization (Art.

XVIII); (c) to accord appropriate diplomatic privileges to the Organi

zation and members of its staff (Art. VIII); (<l) to respect the international character of the responsibilities

of the Organization's staff (Art.. VIII). 91. As indicated in paragraph 89 of this Report, the Constitution

specifically provides that a new obligation cannot be imposed upon any Member nation, by amendment of the Constitution, unless that obligation is formally accrptcd by that Member nation (Art. XX).

92. Subject to this restriction of the power of Member nations to impose new obligations on each other, and to the further restrict.ion that no amendment of the Constitution involving a new obligation shall take effect, oven as among l\fombor nations prepared to accept it, unless two-thirds of all the Member nations shall have accepted it, amendments may be made, and may take effect, on adoption by a two-thirds majority vote of all Member nations (Art. XX).

36 FOOD AND AGRICULTURE ORGANIZATIO~ OF UNITED ~ ATIONS

C. Am,IINISTRATIYE S 'rRUCTURE AND 1-1AN.\GEMENT

93. The succn,ss of the Organization will depend on the quality, honesty, and usefulness of its work. 1~ should be equipped to perform the wide range of duties proposed in the Final Act of the Hot Springs Conference, and should accordingly be readily adaptable to changing circumstances. The governments of the Member nations should be able promptly and effectively to determine it program of work. The work done hould be so widely known as to as ure the full backing of public opinion and be of such high quality as to command the respect of all profc sional worker . The Organization should be in a position to keep itself fully informed of the needs, policies, and practices of 11ember nations, and to draw on the advice and ervices of scientific and administrative expert throughout the world. The staff houkl be highly competent in the different fields of activity of the Organization; and its character should be genuinely international.

1. THE CONFERENCE

94. In order to assure the larg(•st measure of n•sponsible direct control to \Icmber governments, the Conference should consist of representatives of those governments. It would be advantageous if government were to adopt the practice of nominating to the Conference re ponsible ministl'rs having authority in the appropriate fields of activity, accompanied by person with special knowledgl' in matters of food , agriculture, and public health (Art. III).

2. THE EXECUTIVE. COMMITTEE

95. The Executive Committee will facilitate action in the intervals between meetings of the Conference. Its members will be nominated by and its powers specifically derived from the Conference. The Constitution empowers the Conference to delegate to the Executive Committee any powers other than those prescribed in paragraph 2 of Article II, Article IV, paragraph 1 of Article VII, Article XIII, and Article XX. Tho Commission regards it as important that the Executive Committee should be composed. of persons who, by virtue of their administrative experience or other special qualifications, can contribute to the attainment of the purpose of the Organization. Subject to this primary consideration, the membership of the Executive Committee should reflect as varied as possible an experience of the different types of agriculLural economy of the world. The Constitution provides that there shall not be more than one member of the Committee from any Member nation (Art. V).

3. STANDING ADVISORY COMMITTEES

96. In order to keep the Organization in close touch wiLh current cientific and economic thought and practice, the onference should

appoint standing committees which would have continuing responsibility to advise the Conference on the various aspects of the Organization's work. Such advisory committees should consist of persons selected on the basis of their qualifications as scientists, technical experts, or economists, or because of special experience, and may include representatives of international organizations working in related fields (Art. VI).


97. These committees should meet several times a year. They would be invited to comment on any subjects referred to them by the Conference or the Director-General and would also be entitled to initiate proposals. Their reports would be submitted to the Conference and would frequently be published.

98. It, may ultimately be found necessary to <'stablish a standing advisory committee corresponding to each main division of tho Organization. At the beginning, however, it is proposed that advisory committees should be established for nutrition, for the scientific and technical aspects of agricultural production, for economic and social questions, including agricultural cooperation and social WC'lfare, and for statistics.

4. GENERAL AND SPECIAL CONFEUENCJ<;S

90. The Commission considers it important that machinery should bC' provided whereby the Organization could be in closP touch with public opinion, receive suggestions in regard to its work, and obtain the support of rep1csentativr bodies actively concerne<l with food and agricultural questions. 'l'he Constitution provide!\ therdorc, that the Organization should convene general, technical, regional, or other special confrrcnces for the purpose of bringing together representatives of responsible' groups concrrned with the fields of activity of the Organization. A gc1wral conference might be in the nature of a forum in which prohlcms, experience, and points of view would be discussed, sugg<'stions brought forward, and recommendations made which the Organization would take into account in shaping its programs of work. Governments would see that tho delegations from thrir com1tries to such a general conforcnce wore fully representative of the interests involved; indeed, it might be possible in some countries for national confcrenc<'S to be held at which the delegations would be nominatrd. The Confrrence might itself invite representatives from international bodies. The Conference would make the pn•paratory arrangements for such confer<>nccs (Art. VI).

5. DJRECTOR-GENERAL

100. The Director-General will be the responsible head of the Organirntion. He will he responsible for selecting and organizing thP staff, and will direct it in the carrying out of the functions of the Organization, and in the execution of the policie~ ndopt<>cl by thr Conference (Art. VII. VIII).

6. STAFF

101. The staff should be competent in all of the branches of knowledge rcquirrd to ~ive a solid foundation to the work of the Organization. It should be drawn from differC'nt regionc; and, subjPct to the overriding consideration of competence, should collectivcl_v represent as many g<'ographical areas as possible'. In making initial appointments, due rC'gard should be had to tho importance of retaining freedom of action to enable the Organization to include in it sstaff, at a later date, personnel from an' as not yet libera led from enemy occupation. Members of the staff should receive their instructions exclusively from the Organization. In the past a few governments have followed tho highly undesirable practice of supplementing the

'38 FOOD AND AGRICULTURE ORGANIZATION OF UNITED NATIONS

salaries of thier nationals on the staffs of cE?rtain international institutions. Governments should refrain from offering remuneration to any of their nationals on the staff of the Organization, except for services previously rendered, uch as pensions. Senior members of the staff should receive diplomatic privileges and immunities, and other members of the staff should be accorded all the facilities and immunities accorded to non-diplomatic personnel attached to diplomatic missions, or alternatively those facilities and immunities which may hereafter be accorded to equivalent members of the staffs of other public international organizations (Art. VIII).

102. An Organization of this nature must grow and adapt itself lo changing circumstances. From one point of view, it is desirable that the Organization should move with caution. It must make its weight felt by the excellence of its work and the high standnrd of its contributions. It should play a great part in guiding policies relating to nutrition and agriculture throughout the world, but it cannot <lo this with its own staff on a big scale all at once; for a fully functioning and efficient organization cannot be built in a <lay. The Organization will have a difficult course to steer. It must, on the one hand, be in a position to take vigorous action in the critical period just after the war when conditions are fluid and before vested interests have become established. On the other hand, it must follow a policy of careful df'vclopment, involving the painstaking study of its complicated problems. Those concerned with its creation must be fully alive to these considerations. The solution may be found initially in eallin~ temporarily to the aid of the Organization experts from universities and from national organizations who ·would be unable or unwilling to devote more than a relatively brief period to international work.

103. The Organization would, therefore, be well advised to make a number of temporary appointmrnts at the outset while taking ample time to choose the permanent staff carefully and awaiting the release from war service of persons of the ability and training ne<'(kcl for its work.

7. RJ<:GIONAL A TD LIAISON OFFICES

104. To facilitate much of the work described it would be desirable for the Organization to have liaison offices in convenient centers in various parts of the world to keep in touch with conditions in a single country or a region including several countries. In some casPs it might be desirable to establish regional offices. Such partial decentralization would better enable the Organization to take full account of the diversity of conditions with which it must deal and to maintain close association with public au thoritics and scientific and other organizations whose cooperation in its work will be required (Art. X).

8. ORGANIZATION AND ME'l'HODS OF WORK

105. The Director-General will need the assistance of such officials as a treasurer, a legal adviser, and a director of personnel. The heads of divisions or departments, or ·whatever may be the titlP of the main administrative units. might constitute an administrative board responsible to the Director-General, or their collective relationship might be less rigidly defined. The Director-General would rely on the standing or special committees appointed by the Conference to advise on various aspects of the work.


106. The number or precise nature of the divisions required to handle the work cannot be determined at present. Each principal field of work might constitute a division, for example, human nutrition; the sciences and technology of agriculture, forestry, and fisheries; economic and social questions; statistics; education; and publications. Subdivisions might be made in a number of ways.

107. Arrangements for coordinating the work of the divisions, on whatever basis they may be created, will be especially important, since the problems to be dealt with in most cases demand simultaneous attack from many sides. For example, a problem of regional soil conservation, one of eradicating a deficiency disease, or one of shifting production to more-needed crops in a given area might demand the combined work and special knowledge of every division. A unit of the Organization experienced in coordinating the findings of specialists in many diverse fields might present a unified set of recommendations giving due weight to the different elements of the problem.

108. This kind of approach should characterize all the work of the Organization. It should bring every necessary skill to bear so that a given problem might be solved not only adequately but without the delays likely to result from an uncoordinated piecemeal attack.

109. A major part of the organization's work, as has been made clear in the earlier discussion, would be to define problems that should be attacked and to assist those most closely concerned in planning the necessary action and carrying it through successfully. In many cases the most suitable method would be to appoint a committee of experts, drawn in part from the staff of the Organization and in part from local or other especially qualified experts and administrators, to investigate, report, and recommend possible courses of action; in some instances such a committee would be sent out on a field mission. Making use of such tcmpora1y committees would have great advantages. It would not be possible for the Organization itself to have a staff lar~e enough to deal with all aspects of the great range of matters within its scope. The committees would provide flexible machinery and a greatly widened range of personnel to meet specific needs; they would serve to stimulate local interest and the active participation of local authorities, who would in many cases serve on the committees. Each committee would be dissolved when its work was accomplished (Art. VI).

D. RELATIONs ,v1TH o,1'HER ORGANIZATIONs

1. OTHER INTERNATIONAL BODIES

110. lt is important that international agC'ncics should pursue related courses, and that their activities should not conflict. The nature and degree of closeness of association required among international authorities will differ in difierent stages. Even when the general structure of future international organi,mtion is agreed upon and the basic relationships among authorities determined, scope must still be allowed for relationships to develop. Accordingly, the Constitution enables the Organization to enter into agreements with other public international organizations, defining the distribution of rC'sponsibilities and methods of cooperation (Art. XII).

111. The Constitution permits the Organization to fit into any future general framework of international authorities that may be agreed upon; assures freedom for it to work with other international author-

40 FOOD A D AGRICULTURE ORGANIZATION OF U ITED NATIONS

ities, pre ent or future; and in particular enables it to invite rrpresentativcs of other international authorities to participate, without the right to vote, in the meetings of the Conference (Art. III, XII, XIII).

112. There arc certain international authorities which now exist and with which the Organization should agree on provisional working relationships. Some of these arc war-time agencies while- the activities of others will Pxtend into the post-war period.

113. In the first category are such agencies as the Combined Food Board and the Middle Ea t Supply Centre. Cooperation with these i:s desirable because they will have acquired data which may later be turned over to the Organization and be> of value to it. For c>xamplc, the> recent study of the comparative levels of food consumption in various countries made by the Combined Food Board should prove of great value (Art. XII).

114. The resolutions of the Hot Springs Conference recognize that a transition will have to be effected between the concerted arrangement of the United Nations in regard to food and othc>r su pplit•R during and immediately following the war, and their policies in shaping longerterm adjustments of agricultural production and levels of food consumption.

115. For these reasons, it is felt that there should be the closest association between the Organization and agencies concerned primarily with the short-term problems of food and agriculture (Art. XII).

116. The Interim Commission intends to submit separate>ly recommendations regarding the International In titute of Agriculture.

117. The governments concerned will probably in due course consider the future organization and adaptation of the work now being done by the League of ations and its various committees and ections in connection with a general settlement of the structure of international authorities aftC'r the war. Working arrangements should meanwhile be e tablishecl between the Organization and those agencies connected with the League which are active in related fields.

11 . The resolutions of the Hot Springs Conference contemplate that the Organization should convene periodic meetings of representatives of national nutrition organizations or committees, and the proceedings would presumably be reported to the Conference. The contemplated reports by :Member governments would also presµmably include accounts of the work of these organizations, together with a statemC'nt of progress otherwise achieved in nutritional matter . It is furth<'r contemplated that the Organization would p<'riodically publish a summary of M.ember governments' reports. By a re olution adopted in 1937, the Lrngue has practically identical responsibilities, and the governments of the nations that arc members of the League were requested to furnish corresponding r<'ports. Joint technical committees might with advantage be set up, therefore, to arrange for the orderly resumption by the Organization. of activities previously clcvcloped by such other agencies (Art. VI, XI, XII).

110. There are a numbc•r of ubjects in which tl1c Organization, following the recommendations of the Hot Springs Conference, will have an int<'rcst in common with that of the International Labour Organization, and others in which their interests will be closely related. Conditions of agricultural labor and work in the field of cooperative organizations arc cases in point.

120. The International Labour Organization has adopted a numb01· of conventions and recommendations concerning agriculture, and has


appointed a committee concerned specifically with agriculture. Labor conferences of American States and the first Int('r-American Social

ecurity Conference dealt with the extension of social services to farm families; und a permanent committee on migration for settlement has been proposed under the auspice of the International Labour Organization. The Food and Agriculture Organization should agree with the appropriate authorities of the International Labour Organization on arrang('ments for cooperation (Art. XII).

2. REGIONAL AND NATIONAL ORGANIZATIONS

121 . The Organization will J1('ed the cooperation and support not only of governments aud other international authorities but also of regional and national scientific and economic institutions, both public and private, which arc concerned with food and agriculture. Experts from regional and national institutions might be appoint.eel as members of the standing advisory commiLtees of the Organization; members of the staffs and resettrch workers from these institutions should be associated .for varying periods with the work of its special committees; and the Organization should entrust tasks to these institutions and ('ngage in joint undertakings with them. It should explore the possibility of concluding arrangements with appropriate institutions whereby they would carry on work on behalf of the Organization or in association with it (Art. XII).

122. Precedents of the kind exist. For example, the Health Organization of the League of alion entrusted to the ational Institute for l\,fc,clical Research (London) the custody and distribution of international standards for many biological preparations and other related tasks; and a Conference on Rural Hygiene in the Fn,r East selected the Nutrition Research Laboratory at Conoor, India, to act as the center for res('arch in nutrition in that region.

123. There are advantages in having abstracting and other information erYiccs supplied as far as possible by institutions that are already doing outstandingly good work of this kind. The Organization should therefore seek arrangements whereby certain present information services, which are extensive and valuable, might receive wider circulation and perhaps be extended to those parts of the field which are not now covered. The Organization should explore such possibilities, for example, with the appropriate a.uthorities of the Imperial Agricultural Bureaux, the Pasteur Institutes, the Inter-American Institute of Agricultural Sciences, and national research councils or academies in various countries (Art. I, XII).

E. EXPENSES

124. Under the provisions of Articles IV and XVIII of the Constitution the Conference is empowered to approve annual budgets for each financial year after that in which the Organization is established and to determine the apportionment among Member nations of the required total contributions thereto.

12.5. In regard to both these matters, however, it would be convenient if specific proposals, relating to the year in which the Organization is established, were to be formulated in advance by the Interim Commission, both to provide the Organization with a financial basis for immediate operation and to afford the Governments of the United


Nations an indication of the measure of financial obligation involved at the outset by acceptance of the Commission's proposals.

126. The Commission has accordingly prepared provisional estimates, based on varying hypotheses, of the expenses likely to be incurred by the Organization dming the first five years of operation. For this purpose it has drawn on the experience of existing international organizations and has had the assistance of a number of their officials.

127. After careful consideration of provisional estimates so prepared the Commission recommends that the average expenditure by the Organization during the first five years should be estimated at about $5 ,000,000 per annum.

128. Considerably less than this amount is likely to be spent in the first year, however, by reason of unavoidable delays in the recruitment of the necessary expert staff and in the initial preparation of operational plans. The Commi sion, therefore, recommends that the budget of the Organization for the financial year in which the Constitution comes into force be that set forth in Annex II to the Constitution. A capital fund will be needed to meet the m;msual expenses involved in getting the new international organization started and to provide funds at the beginning of each financial year before national contributions have been fully received.

129. The Commis ion has found it difficult to devise a wholly satisfactory scale of apportionment of expenses. It has considered whether such a scale might be formulated, based on such factors as capacity to pay modified, e. g., by the desirability of maximum and minimum limits to contributions, the importance of agricultural production, national income, foreign trade, etc. If this could have been done and if world conditions were normal, such a scale might have bePn adopted bv the Conference for an indefinite period, or, at least, for the five-year period referred to above. The n01mal circumstances created by war and enemy occupation, however, and the impossibility of knowing when they will terminate, render it impossible to formulate a scale which is likely to be regarded as satisfactory except for a very short period. During the first or second year the Conference probably will wish to consider, in the light of the conditions then prevailing, the equity of the scale which the Commission now recommends. This scale, recommended for temporary use, is based upon a relationship among the Member nations growing out of that accepted by them in respect to pre-war international organizations, but adjusted as follows:

(a) the assumption of 54.5 per cent of the ullocations by the United States, the United Kingdom, the Soviet Union, and China;

(b) the scaling down of the allocations, as a measure of temporary financial relief, for those countries that are occupied by the enemy, or that have, in consequence of the war, suffered from major economic disasters; and

(c) the placing of certain countries on a uniform minimum allo-cation.

The result of (b) and (c) has been subs~antially to increase the temporary allocations to the remaining countries. When world conditions improve, the proportions allocated to these countries will have to be correspondingly reduced.

130. Accordingly, the Commission recommends that the scale set fort-h in Annex II be accepted by the governments concerned for appli~

FOOD AND AGRICULTURE ORGANIZATION OF UNITED NATIONS 43'

cation during the :financial year in which the Constitution comes into force and have so provided in Article XXV of the Constitution. In devising this scale for application in respect of the first year, the Commission has adhered to the view that in an international organization of this character no one nation should contribute more than twenty-five per cent or less than one-twentieth of one per cent of the total expenses. It has also provided that each Member nation may deduct from its payment to the Organization the amount contributed by it toward the expenses of the Interim Commission (Art. XXV).

F. MISCELLANEOUS

1. LEGAL STATUS

131. The Constitution gives th<' Organization the capacity of a legal pC'rson to perform any le~al act appropriate to its purpose which is not beyond the powers granted to it by the Constitution (Art. XV).

132. The Organization is further given the immunities and privileges customarily accorded by Member nations to each other, aod as a corollary of the bestowal of these immunities, the Conference is required to make provision for the adjudication by an administrative tribunal of disputes with its staff, which in the absence of the Organization's immunity from suit would be the subject of ordinary legal process (Art. XV).

2. INTERPRETA'rION OF CONSTITUTION

133. Provision is made in the Constitution for the reference to an appropriate international court of any question or dispute concerning interpretation of the Constitution, in such manner as may be provided by rules to be adopted by the Conference (Art. XVII).

3. LANGUAGES

134. The Constitution leaves the question of official languages to be determined by the Conference. Pending such determination, it is provided that the business of the Organizntion shall be conducted in English (Art. XXIII).

G. NEED FOR EARLY ACTION

135. The Commission has given earnest consideration to the question whether the Organization should be brought into being at an early date, or whether its establishment should be deferred until after the war.

136. There arc undoubtedly considerations in favor of the latter alternative. During the war, and probably for a considerable period thereafter, it will be impossible' for the Organization to recruit all of the highly qualified personnel essential to full operation. It is a matter of the greatest importance that the Organization should not begin its work without the inspiration and direction of m<'n of the highest caliber and competence in their fields. The success of the Organization will dC'pC'nd on the quality, honesty, and usefulness of its work, and on the extent to which, by its work, it can make its disinterested authority and influence felt. A false start would mean a handicap from the beginning.


137. During the war, also, many of the governments and other bodies with which the Organization would work will be so preoccupied with other matters as to be unable to give it complete cooperation.

13 . These arc valid considerations to a realistic view; but a realistic view calls for deeper analysis. In the period immediately following the cessation of hostilities there will be many serious problems in nutrition, food and agriculture, in many parts of the world, calling urgently for solution. This perio<l will be characterized by condition of fluidity particularly favorable to the adoption of sound and thoroughgoing measures to meet these problems. There will be both need and opportunity for the kind of international advice and influence which it is the purpose of the Organization to provide. It would be lamentable if none were to be provided. lucked if this unique opportunity to realize some of the high purposes of the Hot Springs Conference were to be lo t and the fluidity of the immediate post-war period were to be allowed to become set and rigid with the growth of vested interests, it might prove impossihle, for many years to come, to give effect to the purposes of the United Nations as expressed in the Final Act of that Conference. To delay the beginning would be to delay the whole program.

139. Personnel must be assembled; cooperative relationships must be established with organization and governments; problems of nutrition and of the production and distribution of foods and other products must be clearly defined and studied, and their relative urgency must he deLermincd; a considerable amount of information mu t be collected and analyzed. In sum, a good deal of preliminary work will be needed to make the Organization a going concern, ready to discharge its responsibilities.

140. These considerations greatly outweigh the argument against starting at this time. The Commission believes the main difficnltyassemhling an adequate staff- mm be overcome by developing a car<'fully selected nucleus of permanent personnel aided by a group of competent experts employed on a temporary basis-in other words, loaned by government and institutions. This might be desirable in any event; under present conditions it is the most practical procedure.

141. In th<' light of these considerations and because it is mindful of the dangers of a return to national policies of self-sufficiency, the Commission urges its constituent governmcnls to take, with a minimum of delay, the action required to enable thP Organization to be brought into effective operation, on a nucleus basis if necc sary, at the earliest practicable date. The sooner it is established, the sooner ,vill it be able t,o bi ing to bear upon post-war problems of reconstruction the disintere ted, international, and instructed advice and influence the provision of which is the essential purpose of the Organization.

142. The considered view of the Commission is that, whatPver the difficultie , the Organization should be established as soon as possibk,, and that government in a position to do so should make every con tribu tion in their power, by relea ing suitable personnel and otherwise, towards making it an effective and authorit,ative nucleus for dealing with bot,h immediate and longer-term problems of adjustment in food and agriculture. The Commis ion so recommends.

For the United Nations Interim Commission on Foods and Agriculture:

L.B. PEARSON, Chairman. 0

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UNITED NATIONS RELIEF AND REHABILITATION ADMINISTRATION, 1946

HEARINGS BEFORE TilE

SUBCOMMITTEE OJ? THE

COMMITTEE ON APPROPRIATIONS UNITED STATES SENATE

SEVENTY-NINTH CONGRESS FIRST SESSION

ON

( H. J. Res. 266 A JOINT RESOLUTION MAKI G AN ADDITIONAL APPRO

PRIATIO r FOR THE UNITED NATIONS lRELIEF AND REHABILl fATION ADl\fINISTRATION

Printed for the use of the Committee on Appropriations

UNITED STATES

GOVERNMENT rRI ' TING OFFIClil

7!, 54 WASHINGTOX : 1945

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SUBCO1L\1ITTEE OF THE COMMITTEE ON APPROPRIATIONS

KENNETH MCKELLAR, Tennessee, Ohafrma1~

CARTER GLASS, Virginia C. WAYLAND BROOKS, Illinois CARL HAYDEN, Arizona STYLES BRIDGES, New Hampshire MILLARD E. TYDINGS, Maryland CHAN GURNEY, South Dakota RICH.\RD B. RUSSELL, Georgia JOSEPH H. BALL, Minnesota JOIIN H. OVERTON, Loulslana HOMER FERGUSON, Michigan ELMER THOMAS, Oklahoma ------PAT McCARRAN, Nevada JOSEPH C. O'MAHONEY, Wyoming JOIIN H. BANKHEAD, Alabama

EVERARD H. SMITH, oze;.k II

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UNITED NATIONS RELIEF AND REHABILITATION ADMINISTRATION, 1946

FRIDAY, NOVEMBER 16, 1945

UNITED S-r.\TE SE.'ATE, SUBCOMMITTEE OF THE CO)Il\:ClTTEE ON APPROPRIATIONS,

lV ashington, D. 0. The subcommittee met at 10: 30 a. m., Hon. Kenneth l\foKellar

( chairman of the subcommittee) presiding. Present: Senators McKellnr ( chairman of the subcommittee), Hay

den, Russel1, Overton, Thomas, and Ball. Senator J\fcKELLAR ( chairman of the subcommittee). The sub

committee will come to order, and House Joint Re olution 266 is before u ·, to appropriate $550,000,000 for Ul..,.RRA. l\1r. Clayton, ,ve shall now hear from you concerning this bill.

STATEMENT OF HON. WILLIAM L. CLAYTON, ASSISTANT SECRETARY OF STATE, ACCOMPANIED BY JOHN H. FERGUSON, SPECIAL ASSISTANT TO THE ASSISTANT SECRETARY; DONALD S. GILp ATRIC, CHIEF, WAR AREAS ECONOMIC DIVISION; A. H. FELLER, GENERAL COUNSEL, UNRRA; DAVID WEINTRAUB, CHIEF, BUREAU OF SUPPLIES, UNRRA; AND SAMUEL T. PARELMAN, ASSISTANT TO DEPUTY FOREIGN LIQUIDATION COMMISSIONER

TOTAL FUNDS MADE AVAILABLE AND ADDITIONAL Al\IOUN'l' REQUESTED

Mr. CLAYTON. Mr. Chairman and gentlemen, I appear before you this morning for the State Department to voice our warm approval nnd advocacy of this Resolution 266. ~\_s vou know. some time ago the Congress authorized a total of $1,350:ooo,OO0 for UNRRA, of which there has been appropriated $450,000,000 and authority given to FEA to make avaiJable $:350,000,000 from lend-lease funds, making a total that was made available to UNRRA of 00,000,000 out of $1,350,000,000. The object of this resolution is to appropriate the remaining $550,000,000.

I shall just say in passing that Governor Lehman is appearing this morning before the House Foreign Affairs Committee in connection with a new bill asking for an additional authorization of $1,3501000,000, and he will be available to your committee later on if you wish to question him regarding some of the aspects of the administration of UNRRA.

PREVIOUS APPROPRIA'l'ION ENTIRJ~LY COMl\UTTED

I should like to point out, Mr. Chairman, that there is an extreme urgency for prompt action in connection with this resolution which is

1

2 U RRA, 1946

before you this morning. UNRRA has entirely committed the $800,-000,000 which has been available to them, and they have been hard put to keep functioning in a proper way so that there would be no lapse in the continuity of the procurement and delivery of supplies abroad on program which they have already agreed upon.

'l'RANSFER FROM SURPLUS PURCHASE ACCOUN'l' WITH WAR DEPARTMENT

That is perhaps best evidenced by the fact that I was informed on yesterday that UNRRA had had to request formally and urgently • the State Department's approval of transferrino- $50,000,000 from the UNRRA surplus purcha e account with the ,'var Department as a temporary and reimbur able credit to the Department of Ao-ricul-ture in order to make available to UNRRA allocations of foo~stuffs by that Department. The e allocations wou kl be lo t to the relief pipe line if this transfer is not made immediately and I therefore propose to support it for the State Department with all the agencies concerned.

I am informing you of this proposed action because it is merely a modification of the plans whieh had been made for the purchase of Army urplus by U~ rRRA. Out of the $850.000,000 which has been made aYailable by the Congress from lend-lease funds as a charge again tour contribution to NRRA, a total of '13!),000,000 has been earmarked with the ,Yar Department for the payment to them of Army surpluses abroad, military surpluses-trucks and things of that kind-which UNRRA needed and which the ,Var Department had indicated that they could upply. So this $150,000,000 has been set a~ide for that pmpose. It has dewloped that the War Department could not make these snrplu!-eS available to U~ TRRA as quickly as "-as expected, and we havt' resorted now to that fund to recover 850,000,000 in order that essential foodstuffs and supplies could be procured and paid for and . o that rNRRA would not lo. ·e the allocation that liaYe been made to them of those articles.

SYSTE)I or DIRTRlBUTIOX

Senator MciuLL.\R. ::\Ir. Seeretary, let me ask yon this question: Doe UNRRA buy the food ancl other supplies ancl giYe them directly to the recipients, or do yon simply furniRh the food or monC'y, or whatever is necessary, to the seYeral governments? • \\'hat plai1 ha; b0 en adopted?

Mr. CLAYTOX. U.i.:TRRA proenres and ships the supplies to the recipient country, and on arriYal in the port the usual plan is to turn them owr to the gowrnment of that country, and that gowrnment <H'ganizt's the distribution of the :,;npplies an~l doe~ in fact distribute them. That is largely the case. UNRRA has done some of the transportation work inYolYed by furnishing trucks, ancl so on, for that · purpose.

I should explain, Mr. Chairman, that U~ TRR~\ has a mission in each one of these countries that i located there permanently and it is their duty to follow the di tribution of these supplies and t~ e, that they are properly distributed.

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NRRA, 1946 3

PERCENT.\GlJ OF • ND uSED FOR UPPLIES

Senator McluLLAR. Could you state about what percent of the supplies of-not of the supplie , but what J.)ercent of the appropriation actually goes in upplies and actna lly 1s usecl by the recipients of those supplies?

Mr. CL.\YTON. It all goes in supplies except a very small amount which is u eel for administration. "\Ve notecl on yesterday in my testimony before the House Foreign Affairs Committee that the total of administrative and distribution expenses which UNRRA bears is only about 2½ percent of their expenditures, which seems to be a very mall amount.

Senator McKELL,\R. T,Yo and one-half percent?

Al\C0UXT FOR .\DJHJNibTIUTIYE AND 0PEH\TIN0 }~XPENSES

Mr. CLAYTON. Yes, sir. They estimate that out of the billion eighthundred-and- ome-odd million, which is the total of their first program, they ,Yill have about $16,000,000 of administrative expen e and a total of about ~24,000,000 of mission operating expense, making a total_ of $40,000,000, which is about 2½ percent of the total expenditure.

Senator OVERTON. That includes both personnel and distribution? 1\fr. CLAYTON. Yes, sir. That is the total of the administrative

expenses. Senator OvERTON. That is rather remarkable. Mr. CL.\YTON. It really is. Senator OrnRTON. ·what I have heard of UNRRA is that it spends

a large portion of it funds in the employment of mrnecessary per·onnel.

Dl\'l::RSC0N OF HUPPLIES FROM THEIR PROPER USE

Senator McKEI,L.\R. You see those statements in the paper, an.cl that i why I am asking what is actually done with it. Now, the charge has also been made that UNRRA upp1ies have been used by certain governments, I won't mention the names of the governments-for other purposes. Have you found anything of that ort?

Mr. CLAYTOX. There is no doubt about it, that in some of these countries some small portion of the supplies have bee~1 diverted from their proper use. There is no question about that. That almost always happens in every great relief undertaking that I have ever heard anything about or know anything about. So far as we haYe been able to ascertain, that is a Yery small proportion in the case of UNRRA and is not enough to detract greatly from -the e:ffecti veness of the operation or the enterprise as a whole.

8enator ~foKELL.\R. Could you form an estimate of about what percent? '

Mr. CL.\YTON. I think it would be wry difficult to do, Mr. Chairman, but what ,Ye haYe clone in the State Department is this: We get these rumors and we get these reports that these supplies are being diverted to the black market in such arnl such a country, or that the authorities in such and such a country have used the supplies to send to their favored political adherents, and so on, and we inve tigate those reports to the best of our ability, and the 1. NRRA missions investigate

4 l'NRRA, 1946

them and we have found that-with ome exceptions, becau-;e those thing have happened occa;;ionnJly-L-they are the great exception rather than the rule.

Senator )fcKELL.\R. ,vhere yon fincl. for in. tance, that a government-let u call i.t governme11t B-has done, that, and that government is still in existence, do you still furnish that goYernment with the . upplies?.

Mr. CLAYTON. Mr. Chairman. it is usually some petty official, somebody way down the line; it isn't something that is done by the central <YOYernment. but it is somebody way down the line, and I think, so far a ·we haYe been able to oh~erYe. that it is of a nature that you certainly cannot say that it is a policy of any goYernment of a recipient country to do anything of that kind.

Senator :\IcKr.LLAn. All right. ;;ir; go ahead.

ILIXSTR.\TIO, ·s OF rR<mXT --mm }'OR .\DDITIOX.\L FUXDH

Mr. Cr..\YTOX. I spoke of the need, of the great urgency here of getting this appropriation quickly. and I gave as an im:tance that we were transforring or arrangin~ to transfer $30,000.000 of this $159,-000,000 which ha:; been set asioe to purchase "\rmy surpluses; we are transferring that amount to the Department of "\gricnlture to pay for the neces ary food. In addition to that, some time ago, not very lon<Y a<Yo, in anothrr situation in which UXRRA found that they were going to haYe to find some money somehov.- or else lose an allocation of food. it was arranged that certain procurement programs which PXRR"\. had with the Treasmy £or trucks arnl tractors and things of that kind would be help up, and they wouldn't make the contracts, anc1 ,'.'50,000,000 thus released was trtmsferred from Treasury Procurement to the Department of Agriculture in order to pay for essential food.

I just mention these things to .illustrate how important it is to get prompt action on this measure.

B.\SIS OF OBJECTIO, ' TO FREE PRESS .\:\IEXD::\IENT

There is one other matter. Mr. Chairman, that I 1-;hould li.ke to refer to, and that is that when this hill was up in the House certain amendments were added to it. We feel that it is really unfortunate that these amendments were added to the bill, added to the measure, but we do not feel we can seriously object to any of them at this time .. except the one relating to the free access of American raclio and press representatives to the news in foreign countries. Now, I am sure that no one will misunderstand my position and that of the Depart-ment regarding a free press. ,,~ e are negotiating with governments all over the world on this question all the time, and "·e have had a certain measure of succe s. but we do seriously object to the relief needs of these countries being used as a vehicle to force goYernments into the adoption of certain mea ures that thny may be resi. ting.

Senator McKi;LL.\R. The amendment which you speak of 1s the amendment under the title (B) on line, H on page 3. You gentlemen all find that.

Mr. CLAYTOK. Yes, sir. Senator McKELL.m. You think that is unnecessary?

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U RRA, 1946 5

EFFECT OF AMENDMENT

Mr. CLAYTOX. It is not only unnecessary, l\fr. Chairman; in our view it is really vicious. The people in these countries, and there are millions of them who are right on the starvation line, are not in position at this time to have very much influence with their central governments on the policies that those governments may adopt, and it does not seem to us appropriate that the Congress of the United States, which has authorized this money, should, in making the money available, adopt a measme of this kind ·which in effect would say that unless the governments of the. e starving peoples should adopt some of our ideas about the way matters should be run in their country, why, we will let these people starve. We ju t don't think that this is an appropriate way to achieve our political aims.

As I said a moment ago, we in the State Department are negotiating on matters of this kind all the time, and "·e do feel we haYe had some success in achieYing our objectives. We do not think that a, vehicle of this kind should be used for that purpose. "'\Ve have always objected to the idea that UNRRA would be administered in any way to :further any political aims of anybody. "'\Ve have always obJected that there should be any preference or di. crimination made on grounds of race or creed or politics, and we have fought that battle pretty hard on several occasions, and it seems to us that to insert here this free-press amendment is in the nature of doing, ourselves,. the very thing that , .. rn have been fighting so hard. So that we do hope tbat you will not adopt that amendment.

Senator 0YERTON. I unclerstancl the purpose of it, just from reading it, is really that the press may give information to the people here in the United States as to "·hat is being done with UNRRA provisions and UNRRA relief, and is confined simply to that one purpose.

Mr. CLAYTON. Yes, sir. But, Senator Overton, it means this : that we say to the recipient government , "If you don't let our press and radio people freely travel over your country and observe these things and report, then we will not give you the supplies." Now, I don't know. They may in some cases agree to that, and in other cases, not, but my point i that if the suffering people-the people who are starvin<Y in these countries-it seems to me if they are worthy, as human bein~s, of relief, that we should give them relief regardless of whether the1r government believe in a :free pres or not.

CHAUGES 01<' MIS('SE .\ND llUSE OF FUNDS

Senator RussELL. But without regard to that, Mr. Secretary, the free-press element, there have been charged that the UNRRA supplies were being used for political purposes m their distribution now. I t seemed to me that this was designed to counteract that misuse or abuse of the funds.

Mr. CurroN. Just before you came in, Senator, we were discussing that.

Senator Rus ELL. I am sorry I lfUS late. Mr. CLAYTON . .And there haYe been such charges, and I stated that

we had investigated them. "\Ve had found that in some cases some of these supplies had reached black markets, and in some few cases perhaps officials way down the line hacl used them to further their own political aims, but that that was the great exception and not the rule.

6 UNRRA, 1946

DISTRIBUTION OF SUPPLIES OBSERVED BY '.IIISSIONS IN' EACH COCNTRY RECEIVING AID

Senator Ru SELL. Is there a uniform system of handling U:NRRA in all of the countries?

Mr. CLAYTON. UNRRA has the same type of agreement with every country that recei\'es aid from UNRRA, and that provides that UNRRA may have-and they do in fact have-missions in each one of these countries, and that, those missions are to be given every opportunity to observe the vrny in which these supplies are distributed, and they do in fact so ob erve. That is what they are there for.

Senator RussELL. ·who selects the personnel that is used? Mr. CLAYTON. UNRRA. The UNRRA Aclmini tration.

enator RusSELL. Perhaps this woulcl be off the record. enator McKELL.\R ( chairman of the ubcommittee). Take it off.

( A discussion followed off the record.) enator Res ELL. "\Ve shall go back to the record.

Mr. FELLER. May I add one thing to that. In the entire Polish mission there is only one Russian employee-in the entire mission.

Senator RussELL. How lono- has that been the case? Mr. FELLER. As a matter of fact, it was always the case. There was,

for a period, I think, of 8 weeks, one of our Russian officials as head of the mission for the purpose of negotiating the agreement. He then left and was succeeded bv a Canadian. The econd man in the mis ion is an American named Clifford \Vil on, of Iowa; he i a specialist in agriculture. Beyond that there are Americans in the mission, there are a number of local Polish employees, but there i only one Rus ian, actually only one Russian on the mission and there never was more.

Senator RussELL. That is a little at variance with the information I had.

How are the supplies actually handled? Give us-just using Poland as an illustration, when UNRRA--

enator McKELL,\R. Dolou want this to go on the record? enator RussELL. Yes; want this to go on the record.

SY 'l'E:ll OF DI, 'l'R!BU'J'ION Jo'0LL0WED WITHIN A COUNTRY

When VXRR.A ship , npplie. into Poland, tho e supplies are not actually di tributecl by the mission, are they?

Mr. CL.\YTON. That is correct; they are not actually· distributed by the mission. As I under tancl it, they are turned over to the Polish Government, and that i true in all of these countries.

Senator RussELL. Is that clone at the national lenl, 01· are they tumecl over to the mayor. of the cities or the proYincial governors or whateyer officials there arP?

Mr. CLAYTON. Senator, I would like if someone :from PNNRA would answer questions abont tlJP administration, because obviously I can't follow in detail the administration. I am interested in polic;y questions, and I do follow those questions very carefully, bnt I don t get wry much into the details of the operation, and someone from U ... ~RRA could answer more accurately than I on these <h•tails. But the agreement is between L ... ~RR.\. and the central government of Poland and the other countrie,;; with ,,hieh they operate, and that provides in detail as to how the supplies are to be delivered and to be distributPCl.

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U RRA, 1946 7

Obviously, in these countries UXRRA wouldn't be able to organize and operate a system 0£ distribution; it is just too big a problem. In other words, we do have to turn the supplies over to the local government and let them distribute them. 0£ course, the UNRRA missions observe the distribution.

Mr. FELLER. May I just answer, since Mr. Claytqp has pointed out that he is not familiar with the details? In the spring 0£ rnH, we were making our plans-UNRRA was making its plans-for relie£ activities in Greece ancl Yugoslavia ancl Albania. ,ve were then working in conjunction with our military and with the British military. General Royce, who ,va · in charge 0£ the American military machine in Cairo making preparation for the Balkan., aid that, i£ di tribution was to be undertaken by the military and U.l.TRRA, it would require 11,000 men and 1,000 officers to handle the distribtuion.

Now, that is just an indication 0£ the enormous cost that it would have been to the taxpayers 0£ this country aml the other countries 0£ the United Nations whieh are furnishing funds to UNRRA, i£ we had undertaken the distribution ourselves. It is a very expensive job. It means that you have to control yonr truck drivers. It means you have to have warehousemen. It means a perfectly gigantic apparatus. For that reason the ·eNRR"\. council had Yotecl, wav hack in .At]anic City, that, in general. distribution should be controlled by the government and should be the responsibility 0£ the government.

Now, we, in effect, then, turn the supplies oYer to the government, but the government is required by our agreemC'nts to prepare plans a to how the supplies are to be distributed, the channels 0£ distribution, the allocation by regions, the prices at which they are to be sold i£ they are to be sold. ome are given away to indigent people. Some are sold to people ,vho can afford to pay for them.

DISPOSITION MADE OF FUXDS FilOl\I SALE OF SUPPLIES

Senator RusSELL. VVhere do the fund go; into the treasury 0£ the goYernment, or do they come back to 1 NRRA?

:Mr. FELLER. The local currency which is cqllected goes into a fund which is to be used for two purposes. First 0£ all the ~overnment must pay all the local expenses 0£ UNRRA. They pay tnat portion 0£ the salaries of our employee which are expended in that country; they pay for our rent, for our messing facilities, and so on. Secondly, the government is required by the agreement to utilize all the balance 0£ the proceeds 0£ sale for relie£ and rehabilitation projects inside the country. The idea is that when we put a dollar 0£ American money into that country we hope that whatever else that dollar brings in terms 0£ local curency-Greek drachmas or whatever the currency 0£ the country is-will go £urther to rehabilitate the country. So what the governments do is, they draw up projects £or things like sanitation, draining the swamps (which is a good cause in Greece, in order to avoid malaria), for the taking care 0£ orphans for the taking care 0£ displaced persons, and for other projects which ~erve a relief oi: rehabilitation purpo e. They report to us what they mtend to do with that, and we keep a record 0£ the extent to which they have utilized the currency which has been received from the sale 0£ the supplies for that purpo e.

8 UNRRA, 1946

PROCEEDS FRO::\I SALES ARE S:M:.\LL

It so happens that these countries have such a large number of indigent people that the actual proceeds are very small, much smaller than we had anticipated. In Greece, for example, the number of indigents is ver_y much larger than anyone thought whe11 we first started, so that most of the supplies have to be given away; an<l there is very little return.

HOW PER ONNEL COSTS ARE PARTLY PAID BY COUNTRY RECEIYING AID

Senator RussELL. I didn't understand your statement about the government ·where ~RRA was operating.paying the salaries of the employees of U~ TRRA. I thought they were paid from the general funds that are rnadP available by all other countries.

l\Ir. FELLER. One of the reasons for the low administrative and operating personnel expenses, is this: that when we send an American into Greece. we will say, he gets in dollars while he is in Greece that part of his salary which he ,rnnts to go to his family here. Any part of his salary that he expends in Greece to buy foocl or to rent a room in a hotel he gets in Greek ClllTt'ncy, an<l that Greek currency is furni hed by the Greek Government out of the procee<ls of these sales. In other words, if you worked for UNRRA and you were getting $150 a month, if you said. "I want $50 a month to go to my family; I want to spend a hundred dollars in Greece," you would not get a hundred dollars in dollars; you would get a hundred dollars in drachmas, and you would spend it there.

Mr. CLArro. •. Senator, may I just say that I think you "·ill agree at once that that is a proper arrangement, and it arises from another very proper arrangement, as I see it and have alway,, seen it, anrl that is that whereYer people who reeeive snpplies in these countries are able to pay, where they hav local currency-and that is the only kind they have, of course-that they should not be treated as paupers or indigents. but that they shoulcl really pay for the relief that they get. The difficulty about his relief problem from the standpoint of a country as a " ·hole. like Gree"ce, is not always that lier people have no money. They_have their local n~one:v, as yot) will understand. but they haven·t the kmd of money that 1s necessary m order to buy the snpplies abroad and transport them to Greece. It takes dollars to clo that. o that UNRRA furnishes the clollars with "·hich to buy the supplies, buys the supplies, transports them to tlw country; and tlwn. when they aet there and into the process of distribution, whocYPr has local cnrr:e;cy of the COUll~ry with which to pay ought to pay. Ha Ying paid and that mo~1ey haYmg accumulated to the govemment of the conntr_v, it seems entirely proper to me that the proceeds shoul<l be used in the manner in which ;\Ir. Ft>ller has indicated.

Senator Rrs,-ELL. Oh, I have no quarrel ,Yith that; I think it. is a Yery sound reason.

I,XTEXT TO WHICH AD::IIIXISTR.\Tl\"E EXPEXSES ARE PAID IX LOC.\L CCHHEXCY

Senator B\LL. Mr. Feller, can you aive ns some estimate of how much of your administratiYe expense ~f UNRRA has been paicl in local currency?

•

UNRRA, 1946 9

Mr. FELLER. I am sony, Senator. "\Ve haYe tried to get that information, but, as you realize, it means getting it from a11 sorts of places all over the world, and I don't believe we could give you any sort of an estimate which would hold up at this time.

Senator BALL. Is it a substantial part? I mean, does it equal-Mr. FELLER. It is a substantial part. I will give you one example.

For instance, the largest block of personnel'that ,re have are the people who are taking care of di placed persons in Germany. "\Ve have about 8,000 employees. Now, about 5,000 of those employees are in Germany. Of comse, they have to actually handle these camps. Now, of those 5,000 employees at least-well, a very large number, far and away the majority of them, are not Americans. For example, we have 1,500 French employees who are operating in the disp]acedpersons camps. Now, they get no dollar at all; we don't spend a dollar on any of those people. They are paid in French francs in part, which are made available very largely by the French Gowrnment, or they are paid in German marks which we get as oecupation money an<l which is charged off against German reparations.

\Ye have a large number of British employees in that same operation. The number is 1,0!IO. They get no dollars nt all. They get paid partly in sterling and partl_y in marks.

Kow, the number of Americans--Senator BALL. I n't this stedin~ that is paid to them, though,

charged against Britain's contribution account? Mr. FELLER. Thai is right. Senator BALL. So that., is part of your administrative e,xpenses? Mr. F1,LLER. Xo. Well, that is charged against the British operat

ing contribution. Sena tor BALL. Yes. Mr. FELLER. '.The flO percent-the British Government pays 10 per

cent-rather, pays its administrative expense , which are the combmed fund, in dollars. These people are operating employees. They are people like doctors and nurses and other W<'lfare workers. ...:row, to give, you some iclea, out of the total of -:1-,952 personnel in the displacedpersons operation 6-:1-2 are Americans, and my guess \"rnuld be that at the Yery most half of their salaries are paicl in dollars. Now, the re ult is that a relatively small amount of dollars goes into that clisplaced-pen;ons operation. Quite a good deal of i,;terling does, ho,Yever .

DISTL -cTIOX BETWEEN AD~UXISTR.\Tl\'E AXD OPER.\'l'IXG EXPR. -sES

Senator B.\LT,. 80 the figure of $14,000,000 for aclministratiYe expense actually represents a minor fraction of what is actually spent on adltlinistration.

Mr. FELLER. l1nder the reg11lations of the Comicil there is a distinct ion mad<' brtwcen a<lministratiYe expenses and operating personnel. For e.·ample, take the case of a doctor. "\'\'hen a doctor goes out to actnally handle a project in the field, to clear a swamp, for instance, to preve,nt malaria, or actually clirec-ts an operation uch as "'e haYe in Greece, where we are flitting DDT owr the swamps,

under the regulations established by the Council that i. an operating charge. Administration has to clo with the people in the adminis-

10 UNRRA, 1946

trative offices (in Washington nnd London and Sydney, and other offices) which arc cngao-ed in administration rather than operations.

CO:\IPARISO ... ' OF AD:\IIXISTR.\TIVE AND OPERATING COSTS

Senator B.\LL. How does this operating cost compare to your administratiw costs? Can vou estimate?

Mr. CLAYTON. $24,000,000 for mission operating expenses and sixteen-mi1lion-odd for administraliYe expenses.

Senator B.\LL. Doe that $2-:1:,000,000, then, include what they are paid in local cmTE·ncie. a well?

1\Ir. FELLER. Xo; it does not. It i , ho,rnYer, in United States dollar equivalents--

Senator BALL. That is what I hacl in mind. Mr. FELun. :;\Jay I make clear that, ·while it does not include what

they arc paid in local currencies, it does include what they are paid in sterling ancl other currencies of contributing countries.

Senator Il.\LL. Ye . I see it. Mr. FELIXR. Yes. Swator ll.\LL. lt is what they are p,lid in U~TRRA funds. Mr. FELLER. That j right. Senator B.\LL. But it i probable that ,Yhat they are actually paid

i double, then.

LOCATION .\XD ,\D)IL ' ISTilATION OF DISPL.\CED·PERSONS CAIIIPS

Senator R"GSSELL. Mr. Feller, where are these di placed-persons camp nrincipally? 'Where are they located?

Mr. FELLER. 'l~hey arc located in Germany-the yery largest numbe~ far and away .

.::ienator RussELL. I wns under the impre, sion that the Army has been handling the displaced-persons camps there. "\Ye saw a statement from 1\Ir. Harrison in which he ca. tigated the Army for its method of operation of all those camps, in the papers here just within the pa, t few weeks.

1. Mr. FELLER. The situation is this, Senator. The Army, as the occu-pying power, as urned. respon. ibility for these displaced-persons camps. They then called. on us and said, "Now, you have the skills which are neces ary. You can get the people who are necessary to run camp of this kind. "\Vill yon furnish us with personnel, with teams of workers to run these camp ?"

We started furnishing them-they asked for a very large number. In fact, they asked for many more than it turned out they needed. They asked for 750 teams of 13 people each, and that was scaled down, and in their c timate they asked for too many. ,Ve furnished them, gradually, in stages, those personnel until we reached this level of about 5,000. There are now about 400 camps. It i my understanding that at this time all of those camps, or virtually all-there may be a few left-Yirtually all of tho e camps are arlministered by UNRRA personnel. We have about-well, it depends on the size of the camp, but I would ay on an average of about a dozen people in one of these camp . Some of them are very large.

~enator McKELL.rn. That is in Germany? Mr. FELLER. Yes.

J.

UNRRA, 1946 11

rOLICY FOR JIAXDLTN"G CA:;\IPS FIXED IlY W.\R DEP.\RT~IENT

Senator RussELL. Who fixes the policy 1 Does U .. TRR.A fi~ the policy for handling those camps, or does_ the 'V: ar Departmen~ d_o _it~ .

Mr. FELLER. The \Var Department, still havmg the ~·es1:011s1b1l~tr, lS still fixing the policy. The UNRRA_is _in th~re at this time ass1stmg the Army. ,ve are now under negobahon w1th tl~e .\rmy for a ~omplete transfer of responsibility in accor<lan~e ,nth General ~~s~nhower's general view that thi sort of operation should be a c1V1lrnn responsibility.

C.\.Il' ()O:.\DL\ .'DERS

Senator B,\LL. Are the camp commanders still Army officers? Mr. FELLER. No, no. The camp commanders are now UNRR.\.

people. Senator BALL. They are now UNRRA people i Mr. FRLLER. They are now UNRR.\ people. Senator BALL. But they follow directives issued by them, under

their policies, do they not ( l\Ir. FELLER. That is right.

PROGRESS IN RET"URNIXG DIFWL.\CED PERSO. -s TO TIIF.TR HO:.\IES

Senator RussELL. \Vhat progress is being made in getting the e people, displaced persons, back to their homes t

Mr. FELLER. Mr. Clayton is very familiar ,Yith that. Mr. Cr,AYTON. Senator, in the beginning, when Germany surren

dered, there were 6,000,000 of these displaced persons in Germany, and at our council meeting in London the Army people came and reported on the progress of repatriating them. In the first 4 months after Germany surrendered, the Army had repatriated 4-,000,000 of these people, which is a perfectly phenomenal job, it seems to me. \Ve &'ot them bark home at the rate of a million a month. How they ever cti<l it I don't know, but they <lid. And they were being repatriated at that time at the rate of abm1t :2,\000 a <lay. I judge that the total must be down now to under a million and a half, probably. Do you know the total at the present time?

:Mr. FELLER. The total at the present time is between a million and a million and a half. And may I say that the rate of repatriation is sub tantially slower now because of the winter, very largely.

POLICY RESPECTING TilOSE WHO DO NOT WISH TO RETURN HOME

Senator BALL. Haven't you quite a few of them, too, who do not want to go back to where they came from?

Mr. FELLER. Yes; we have. We have quite a few who don't want to go back, and at the Council ~ession in London Ir. Clayton proposed a re olution which was adopted, under which UNRRA would take care of them for a temporary period, for-I don't think we put a date in, but we said we would review it after 6 months.

Mr. CLAYTON. \Ve will review it after 6 months. That is right. Senator RussELL. I aw some of that, and it was one of the most

fantastic sights I have ever laid my eyes on. Here wa::; one stream

I ,

J2 UNRRA, 1946

of displaced people coming out of Germany and another stream of Germans on the other side of the road going to their home. The Army did do a wonderful job.

QUE TION AS TO UNIFOR:.\I POLICY IN RETURNING DISPLACED PERSONS TO THEIR HOMES

However, they didn't apply a uniform policy in handling these displaced persons, did they 1

Mr. CLAYTON. How do you mean, Senator? Senator RussELL. I mean, for example, if a man was a Russian it

didn't make any difference how vigorously he objected to being sent back to Ru sia, he was sent back by force of arms.

Mr. CLAYTON. I don't . o understand, Senator. That may be, but I know that the question that we debated a great length at London was just that, as to whether UNRRA should get an agreement with the country of which a displaced person was a citizen regarding their care during the period in which they were awaiting repatriation, if that person objected to returning to his country; and, as :.Mr. Feller has said, we won on th~t point. "\Ve worked that matter out on the basis of UXRRA continuing the care of these person pending repatriation, whether they wanted to return or whether they didn't want to return, for a reasonable length of time, and v.-e determined that the matter should be reviewed at the end of 6 months; but so far as I know, I don't think-I a1n sure that U RRA has not been foroing these people to go back home.

Senator RmsELL. Oh, no. I didn't say UNRRA was, but I was told of instance after instance where these people had committed suicide when they would try to put them on trains, onto ships, to start them back. I have heard it all over France and in England. I had men who claimed to have been eyewitnesses who saw it.

Mr. CLAYTON. You mean while the Army was handling it 1 Senator Ru SELL. Yes. Mr. CLAYTON. I don't know about that; Senator. Senator HAYDEN. Wa it not a question, Senator Russell, of whether

a man had been a oldier or not, or was there a distinction made in that respect?

Senator RussELL. I didn't know it was soldiers. I don't know about that, but I know they didn't--

Senator HAYDEN. You can very readily see that there would be cases, as an example, where a government would say, "This man is a deserter from our army. We had him in our service, and he ran away. We want him back to punish him as a deserter. He committed a crime, the crime of desertion." On the other hand, a civilian citizen of that country who merely happened to be caught abroad and put in a con<:entration camp by the Germans would be in a different status.

Senator RussELL. That is pos ible, but I did hear the story from any number of sources.

Senator BALL. I heard the tory that a lot of people displaced in eastern Europe would run away from these camps rather than get on trains to go back.

►

UNRRA, 1946 13

EXTENT OF UNRR .. \ .. -\ID GIYEN TO FIL\NCE

Senator Mcl{ELL .. \R. Mr. Secretary, to what extent are we furnishing relief to France 1 The reason I ask you the question is that I saw in the paper the other day the statement that France today was more pro, perous than she has been in many, many years.

Mr. CLAYTON. Mr. Chairman, France has never applied for UNRRA uid. In fact, I question very much if France could establish eligibility :Cor UNRRA aid under the rnles under which it is administered.

Senator :MclCELL.\R. So no "C:NRRA aid i going to France~ Mr. CL.\YTON .. It may be that a million dollars-was there some

thing like that, a ~mn11 sum "·hith went over there, Mr. Felled Mr. FELLER. There is no,Y no aid, no supplies going to France at

all, and that amount of supplies were put in during the last winter for the partis::ularly devastated areas in Normandy. I don't think it was as much as a million dollars.

Senator- McKELLAR. I saw in the paper the other <lay, in a dispatch from Paris, that France in its history has never been any more prosperous than it is today, and I knew one thing or the other must be true: either the newspaperman "·as wrong, or that if we were contributing to France we were doing a wrong to ourselves. ·

:Mr. CL .. \YTON. Mr. Chairman, there is no relief by l NRRA to Frnnce because France has not requested it; and, as I . aid a moment ago, I question very much whether she could make her elf eligible e,·en if she did reque ·t it.

enator McKELLAR. ·why "·as a million dollars given to her, as you just said 1

Mr. CLAYTO-X. There were some supplies sent in there as an emer-gency matter very early after the invasion in ormandy, in the devastated areas there were something had to be done quickly, as I understand it. It was a relatively small amount. France is contributing a great deal more than tl1at to the administration of UNRRA, the administrative expense of UNRRA.

EXTENT OF UNRRA PROGRAM IN FRANCE, BELGIUM, AND LUXEMBURG

Senator McKELL,\R. I see that in the :fourth report on the operations of UNRRA, and I think the statement had better go in here. [Reading:]

FRANCE, BELGIUM, AND LUXEMBURG

The UNRRA emergenc:v program for these countries consists of relief supplies for the war victims whose homes and household goods have been destroyed and help to the allied and statele,s people in these countries. By June 30, 1945, 313 tons of supplies had been sent to these countries under this program. In addition, substantial quantities of used clothing had been turned over to France and Belgium-Luxemburg. From a first used clothing drive France had received 1,000,000 pounds, and Belgium•Luxemberg 330,000 pounds. From the secc·eived 1,000,000 pounds, and Belgium•Luxemburg 330,000 pounds. From tl.Je second drive, 7,400,000 pounds haw already beE>n !lll()('ated to France, and 3,000,000 gian Government to aicl victims of the deadly V-1 flying bomb attacks upon Antwerp and displaced Belgians rE>turning home from forced labor in Germany.

More than 2,000 nationals of France, Belgium, and Luxemburg had been employed by UNRRA for cli placed persons "·ork in Germany. In addition, 200 physicians were released from the French Army for work with UNRRA.

Then, those three countries might be dismissed from this proposal except as to the help that they may give, might they not 1

14 U RRA, 1946

CONTRIBUTION~ TO ,\IDCTXTSTR.\Tl\"E EXI>EXSES llY FR.\XCE, BELGIUM,

.\XO THE NETHERLANDS

l\Ir. CL.\YTOX. That is right, )Ir. Chairman, and they have never applied for relief, and in our opinion they neYer will. The used clothing which is referred to in the statement you reacl "·as contributed by the American people; it was not purchased by U 1TRRA. France has contributed $700,000 toward the aclministrntiYe expenses of UNRRA. Belgium has contributed $175,000 and the Netherlands $~62,:iO0. There wa;; some wry small emergency relief i1wolved there. but nothing of any suhstantia 1 nature, ancl it is not expected that any of these fonds that you are asked to appropriate now will be required for rE,lief in those cmmtries.

Senator )IcKm,L.\R. I am glad to hear that. ..

REQUIRE:\IE. ·Ts TO EST.\BL18l l ELIGIBILITY FOR RELIEF

Mr. CL.\YTOX. In order to be eligible for relief a country must show that it has not suflicient fumls in foreign exchange to provide the relief itself. ,Yell, neither France, Belgium, nor Hollancl could make or woulcl attempt to make any uch showing, in my opinion.

enator ::\IcKELL.rn. I see. 'enator H.\YDE.T. )Ir. Chairman, pardon me. I wanted to ask

about the text of the bill when you gentle1pen get through.

HANDLING 01•' COST OF :FOOD USED IN DISPLACED-PERSONS C.DIPS

Senator BALL. Mr. ecretary, does UNRRA pay for the food that goes into these displaced-persons camps, or does the Army take care of it?

l\fr. CL.\YTox. "Te passed a resolution in London to the effect that the oceupying armies must pay for expenses of that kind, for the reason that it is contemplated that in the end Germany will reimburse us for those expenses. As soon as she gets a ufiicient amount of stuff to export, it is expected ,ve shall get those co. ts out of Germany, and ,Ye felt that the ~\.rmy was in nmch better po ition to attend to that than UNRRA ,vould be, for the simple r ason that in all probability when an opportunity does present itself to recover tho. e funds it will be some time in the future, maybe a couple of years, and by that time U:NRRA will have finished its work and probably will be dis olvecl.

Senator B.\LL. ,vhen I was over there, they were using stocks of food that they had found in Germany to feed these people and to ~ feed prisoners on.

Mr. CL.\YTON. To that extent it is paid by the German economy now.

U E OFF NOS FROM ALE OF SUPPLIES TO PAY LOCAL DI TRIBUTION

EXPENSES

Senator BALL. Can you tell us whether these local funds that they get when they do sell UNRRA supplies are also used to pay the local expenses of distributi_on in that country?

.Mr. F'ELLER. Yes, sir.

U RRA, 1946

Senator BALL. Is that tnw? ~Ir. FELLER. That is right. Senator BALL. Is that a fir t claim or second-~Ir. FELLER. Second claim.

15

Senator BALL. After they have paid the U:NRRA mi ion? 1\Ir. FELLER. Second claim. First claim, they have got to pay the

1 NRR.A mission expense.

S.\FEGUARDS AC:AlNf:.T 1\1ISUSE AND .\BUSE OF UPPLIES

Senator BALL. I see. As I recall, the UNRRA agreement itself required that any nation or any government whose people were receiving this aid must give the U~'RRA people the rights of completely free inspection; and there were certain afeguards in those agreements, in the -master agreement itself, against use of the supplies for political purposes or diverting them into the black market or that sort of thing. Ts that right~

Mr. FELLER. There were. A resolution of UNRRA-several resolution, as a matter of fact, state the fundamental principle that there should be no di1::crimination in the distribution of supplies because of race, religion, or political belief. There is no provision in the basic UNRRA agreement, or as a matter of fact in the 1 :NRRA resolutions, with respect to the free admission o{ UNRRA personnel to observe; but the Director General, :Mr. Lehman, insisted that that be placed in every agreement that we have with recipient countries, and eyery agreement that we have so far negotiated makes that provision.

Senator BALL. I thought that was in the ma, Ler agreement that we passed in the Senate, but it wasn't?

Mr. FELLER. Ir o, it was not. It was not. Senator BALL. It is in our own agreements with the recipient coun-

tries? Mr. FELLER. It i in our own agreements, in very clear language.

Very clear language.

EN1'-0RCINO .\GREEMKXTH FOR FI:EE AD~lll:i ION OF UNilH.\ PERSONNEL

enator B.\LL. One more question: Have you had any trouble anywhere in enforcing that agreement, in that connection, in getting your people in and geltting them freedom of movement to see what is going on 1

Mr. FELLER. At the present time, we have no indication o-f any trouble whatever. In the early days of our operation in Yugoslavia, just a.fter the country was liberated-and as a matter of fact it was still in the process of liberation-we had various difficulties in getting c,ur people around in that country. The government found it difficult to get them acess to all parts of the country. Transportation was very difficult, the country was very upset, and much of the rumors that arose to the effect that governments were preventing UNRRA from observing came out of that situation. At this time and for some months past we have had no report, not even a small detail of a report, that anyone has been hampered. Our mission in Poland has had free access, without any hindrance whatever, in Government cars and

79254-45--2

16 F RRA, 19-16

Government planes, to go anywhere they want in Poland and see anything and check the operation.

Senator BALL. There has been no other incident even like that in Yugoslavia?

:Mr. FELLER. There have been no incidents whatever. There has been no incident of any kind in Poland. There has never been any question about it.

, Y TEM USED IN FOLLOWING THROUGH ON DISTRIBUTION OF SUPPLIES

Senator R SSELL. Ju t how do you follow those supplies +-hrough ~ What is the actual operation that takes place~ How doe the mission follow them through?

Mr. FELLER. The actual operation begins, at the outset, before any supplies are distributed, in effect, except-well, perhaps a few might <'Orne in before these plans are evolved. The Government prepares a plan which shows in general how they are going to distribute the f'npplies, at what price they are going to be sold, ~he allocat~on. by regions and by general classes of consumers, the kmd of rat10nmg rnntrol they are going to have on it, the safeguards they have against diversion for the black market.

They are required to discuss that plan with the UNRRA mission, and in actual effect the 1.: NRR..:\. mission exercises a great deal of influence on the plan. It its down "-ith the goYernment official , and the)' go oYer whether or not this is a fair distribution or whether it is an efficient distribution. Then the go,·ernment handles the supplies as they arrive in the port. It runs the trucks, and it runs the warehouses and makes the withdrawals from the warehouses.

UNRRA personnel, in the first place, advise with re pect to the operntion. For example, in Greece there was some difficulty in getting a satisfactory, operation of the trucks, and there was, as you can well imagine, a tendency for the drivers to kind of loaf, use up gasoline, and so on. UNRRA therefore insisted that the Government put in a very rigorous kind of control over the way in which the trucks were being operated. Congressman Herter has a very interesting account of that. He was there himself and saw it, and as a result the operation improved very much.

Now, then, we send out observers. We have them stationed in various parts of the country and also at the capital. We send out observers who make regular trips. They check in the warehouses, they check in the main distribution depots, they make spot checks all the way down, in terms of retail stores, and may talk to actual consumers. Where there is any complaint they go right to the spot.

INVESTIGATION OF COMPLAINTS

Let me give you an example of where there was a complaint. There was a rumor to the effect that in lovakia there was discrimination against Jews in the distribution of UNRRA supplies.

Senator Rus ELL. Against Jews? Mr. FELLER. Against Jews in Slovakia. We sent a man in there.

He inve tigated the thing very thoroughly. He spoke to every official; he spoke to the local people; he spoke to people who had been in the stores. He went through the whole apparatus. He reported back,

UNRRA, 19-16 17

after a very exhaustive iuve tiaation, with a very elaborate report. that there had in fact been no discrimination; but in the process he made people ,ery much aware of the fact that they must themselves see to it that none of these rumors get started; and in consequence he made certain recommendations on which they tightened up the way they handle the thing in that particular area, and that ,ms just a relatively small town in the country.

In Yugoslavia we send our people aronncl on a regular round. There have been a lot of rumors out of Yugoslavia, a great many. They are in con::;tant contact with the people who do t.hi sort of thing, and they are constantly making reports to the mission, to the mission chief. These reports are then sent on to us, and very frequently we will a::;k £or spot report. . As a matt.er of fact, we have followed up every rumor, no matter how fantastic.

AMENDMENTS .\DOP'l'ED BY HOUSE

Senator H ,\YDEX. Mr. Chairman, I wanted t.o ask, if I could, just along thi line, whether these provisions contained in the House bill, to which HJ?parent ly the State Department does not object, are in conformity with what is done. It starts out here on page 2:

(A) the Presitlent bas rec!'h"C(l from the Director G!'nernl of tlw United Nations RE>lief and Rehabilitation Administl'ation a <'Ql'tification to the efl'ect that the furnishing b~' suc•h a<lmi11istration of reli!'f and rehabilitalion supplies and sen-icE>s, in the case of SU('h country, will be made ouly under agreements between Unitetl Nations Relief and Rehabilitation Administration and such country or other suitable arrangements prm·icling:

(1) 'l'hat all trade agreE>ments and all barter agreE>ment of such country with other nations, togethc>r with satisfactory informal ion on all exports from, and imports into, such country, whether for goYE>nJmental or private account, will be made available to United Nations Relief and Rehabilitation Administration.

(2) That such country shall supply accredited United Nations Relief and Rehabilitation Administration personnel with all necessary facilities, credentials, documents, and safe conduct in canying out the objectives of the United Nations Relief and Rehabilitation Administration agreement, including all necessary inspections and investigations.

And then (3), which was adopted in the House: That the administration, if it <letermines such a course to be desirable, will

be permitted. during the period of its operations in such country, to retain title to all motor transport equipment supplied by th!' administration. and will also be permitted to route such equipme1,t and to direct the ues of llw fuel and lubricants supplied by the administration.

NO\v, the State Department has no objection t.o those, because they are in line with what it was already doing? Do I understand that?

STATE DEPARTMENT'S POSITION ON HOUSE AMENDJ\1EN'l'S

Mr. CLAYTON. Mr. Chairman, I said that we felt that it would be better if there were no amendments at all, because these are administrative matters, and we are seeing to it that the UNRRA Administration does all thing · that is properly should and can do in these matters, and it seems to us it would be better not to in ert in this legislation amendments that relate to the actual administration of UNRRA, because we are only one of many countries that are contributing to UNRRA. If we put ideas of our own about, adminis-

...

,

18 U RRA, 1946

jstration in legislation appropriating fund , other countries will probably think that they hould do or can do the same. So that we are likely to get a situation that wm make aclmini tration very difficult. So that a a matter of principle we prefer there hould be no amendments of this kind in the appropriation bill, but I dicl say that we could not seriously object at this time to any except the one relating to the press.

CONDITIONS HAVE NOT BEEN ATTACHED BY OTHER COUNTRIES IN APPROPRL\TING FUNDS

Senator BALL. I want to know ,vhether any other country has attached such con.litions like these to its appropriation; for instance, Australia or the United Kingdom .

.Mr. CLAYTON. I don't think any country has. They have simply appropriated the money and left the administration of UNRRA to the authorities in UNRRA that are responsible for it.

HOUSE AMENDllfENT FIXING TERJ\IINATION D.\TES OF UNRRA AID

Senator HAYDEN. I didn't read the (B), because that is the part the Department doe object to. Now I want to ask one other question. Up at the forepart of the bill it says:

Proi;ided, That no relief or rehabilitation supplies procur d out of funds heretofore or herein appropriated shall be shipped to any country except in the Far East after December 31, 1046, and in the case of any tounti-y in the Far East after Marth 31, 1947.

Now, what is the effect of that restriction on relief?

TERMINATION DATES PREVIOUSLY FIXED BY UNRIU COUNCIL

l\fr. CLAYTON. That has already been decided as an administrative matter by UXRRA. The Council in London passed a resolution to that effect, and every country is on notice that UNRRA will finish shipment to Europe at the end of next year and to the Far East at the encl of the first quarter of 1947.

Senator HAYDEN. So that the enactment of that is merely a repetition of what you have already agreed to?

Mr. CL.\YTON. That is right; yes, sir.

FflEEDOl\1 OF 'l'IIE PRESS Al\IENOl\IEX'l'

Senator HAYDEN. Then, the amendment that disturbs the Department is the one relating to freedom of the pre s, so to speak?

l\Ir. CLAYTON. Yes, ir. It distnrbs us very seriou ly. Senator Ru ELL. Are you through, Senator Hayden 1

enator HAYDEN. Yes.

TOTAL CONTRIBUTIONS TO UNRRA BY PARTICIPATING COUNTRIES

Senator Ru SELL. Have you furni heel for the record, Mr. Clayton, a tatement of the amount of funds that have been actually contributed by all the -participating countries?

•

• U RRA, 1946 19

::\Ir. CLAYTON. Not for this record; no, sir. "Te ha Ye it here, though. There is a total of a billion-eight-hundred-and-eighty-three-millionodcl dollars which has been authorized by various countries to be made twailable to UNRRA. There has been paid or made aYailable a total of a billion-two-hunclrecl-and-eighty-fiYe-million-odd, leaving still to be made aYailable five-hundred-and-ninety-seven-million-odd, of which the United State has to make available $550,000,000. So that of the total to be made :wailable nearly all of it, or the great bulk of it, is due from the United States.

FHEIOHT .\ND W .\JU-:IIOCSL TG COSTS

Senator McKELT,AH. ~Ir. Secretary, let me ask this: The UXRRA "·hen it takes supplies into a country, of colll'. e, pays the freight to the port of entry to that country, and then does it rent warehouses and pay for those ·warehouses in the country to be supplied, ancl does it pay for the handling of the supplies in that country, and does it pay for the distribution of the supplies by truck or train or otherwise to the various people in that country?

M:r. CLAYTON. Mr. Chairman, I ,rnuld like to ask Mr. Feller to answer that.

Mr. FELLER. 1To, sir. Mr. CL.\YTON. He can ans"·er it more accurately than I can. l\Ir. F1,LLER. No, sir. ,Ye pay the freight to the port; that's all we

pay. Senator :,:cKELL.\ll. You don't pay any "·arehou ing? You don't

pay for any truck ? Mr. FELLER. "\Vell, we do--

USE OF TRUCKS TN THANSPORTING SUl'l'LIES

1wtor l\IcKELLAH. Th trucks haYe come in h re, and something is in one of these amendment about trucks.

Mr. FE1.v·n. ,Yell, we supply some of the trucks. Senator l\ld(i-:r,r,.\R. NmY, what is there about the trucks? Mr. FELLJ<~R. "\Ve supply trucks where a country ha no means of

transportation to get the supplies around, but we don't pay the alaries of drivers. ,Ve don't pay for the warehouses. ,Ve don't pay for :freight on the railroads.

Senator McKELL.\R. Do you pay for the gasoline that runs the trucks~ ·

Mr. F1-:LLER. ·where a country has a deficiency in petroleum products we may supply petroleum for the general relief needs of the country, but that is not necessarily related to the trucks which go in there. Some countries don't need any petroleum because they have been getting it from other ource , and we send in none. ome countries need it very badly, and we may send in a certain amount. Incidentally, it is very hard to get.

UNRRA EXPENDITURES IN GERl\IANY

Senator McKET,LAR. I should like also to put in the record-I don't suppose you have it with you-to put in the record how much we have

• 20 U TRRA, 1946

expended for relief and 1ehabilitation to Germany since she has surrendered.

Mr. CL,\Y'I'ON. Have you that figure availablP, l\lr. FPller? Mr. FELLER. No, sir. You un<ler::;tan<l, of cour::;e, t,hat li ~RR.A. has

expended nothing except for the salaries of its personnel who are handling displaced persons, because UNRR.A has no authority to extend any relief to the Germans and has no intention of extending any such relief.

Senator -MCKELLAR. "\Vlrnt has been clone? I u11derstood you to testify a while ago that you had taken over 1:;ome of the duties of the Army in distributing supplie::;, and what I want to know is ho"· much hrs been expended by you.

Mr. FELLER. For di ·placed per::;ons? e11ator :McKELL.m. It doe. n't make any difference whether it i for

the Army or anyone else. . . l\Ir. FELLER. For displaced per ons? Senator l\fcKELL,\R. That might be exclusiYely American money

and not UNRRA money; is that right 1 Mr. FELLER. The only job that \Ye are taking: over from the Army in

Germany is the administration of the camps which have these displaced persons who are not Germans. They are slave labor. They are people who were put in concf'ntration camps. who werf' brought in there by the German . "\Ve do not ourselves have any authority to fumisli relief to Germans, the German population, and Jf that is being done then it is being done b~, the military forces, and I would have no information on it, although :Mr. Clayton might be able to get that.

(The information reque,;tecl apepars on pp. 5 59.)

EXPJ<cNDITURES FOP. t--ANIT.\TlON AND FOR RElfAIULTTATION OF ('(DIM Nl'.l'IE

Senator McKELL.\R. I am going to ask Mr. Clayton about another feature of it in just a minute, but I would like to ask you thi1:;: ·what amount has been expended for the carrying out of cleaning up cesspools and other unhealthy places and rehabilitating localities, ancl things of that sort, that you spoke of a \Yhile ago? How much has been spent on that? Could you get figures and put them in the rf'cord?

l\fr. FELLER. Yes; we could get the figures and put them in the record.

(The information requested appears on p. 45.) SE'nator 1fcKELL.\R. It seems to me that the principal purpo::;e ought

to be the relief of people who nre hungry. That is what UNRRA was intended to be, as I recall it; not to build up a country, but to le£ them build up their country themselves, ancl we would furnish relief.

Mr. FELLER. That is quit€' correct. Senator. That is quite correct. lso, in addition to just keeping people alive, we want to make sure

ihat these people are able to produce their own relief supplies ju t as quickly as p o.· ·iLle, so that m ,' shouldn't lrnYe to carry tliem on our hands all the time.

'I'Yl'E OF 1:-l !"ELTER F NISIIED

~enator ~frK:2LL.rn. Do you fnrnish houses? Mr. FELLER. No, no. "\Ye do furnish emergency shelter by sending

in some lumber and some nail;;. They build their own houses. Now, you mentioned the case--

U 'RRA, 1946 21

EXPENDITURE FOR Lr:l\1BER AND NAILS

Senator McKEI..LAR. To what extent clo we furni8h lumber and ua ils?

Mr. FELLER. \Ve would be very gla<l lo put that in. Senator McKF.LLAR. \Youl<l you put the figures in the record 1 Mr. FELLER. \Ve will be very glad to put them in. Senator McKELLAR. Yes. (The information rcqnestNl appears on p. 4G.) Mr. FELT,ER. I would like to giYe one special illu tration. \Ve have

also the job of preventing epidemics, and I will give you a special, iipecifir case as to how that opern.te .

Senator McKELLAR. Is that provided in the act? Mr. FELLER. That is provided.

ILT,US'l'RNI'ION OF SXNITATION WORK U.\RlUED O, T IN OREECF,

I will show you how that is clone in a specific case, in the case of Greece. Greece is infested with malaria. Malaria comes from the swamps. Now, what we do i. , we provide this DDT powder, and we have brought in a number of small Piper Cubs, planes equipped with dusting apparatus to dust the DDT on these swamps to kill the malaria-bearing mosquitoes, and we furnished a number of doctors who are specialist in malarial control.

:row, in addition to that, of course, there is a lot of labor in filling in the swamps. Yon have to have people draining them, and so on. Now, that is all paid for by the Greek Government. We don't pay for any local ln,bor. They do the work. Well, we furnish-·-

Senator McK1u,LAR. °"Te furnish the airplanes i Mr. FELLER. Airphrnes and the DDT and a few doctors who will

tell them how to clo it. But we don't pay to clean out those swampst in terms o-f hiring people or anything o-f that sort. That is what the Greek Government is supposed to do, and does.

POLICY RESPECTING 'J'IIOSE WHO DO :N"O'l' WI II TO HETl:cRN 1101\lE

Senator McKEl,L.\R. Now, Mr. Secretary, I wanted to ask you about the people that I belieYe you are allowing, under an agreement that you made in London, to remain -for G months in Germany to make up their minds as to whether they want to go back home or whether they want to continue to live in Germany. I suppose they are largely French. I imagine they are. I don't know.

l\fr. CLAYTON. No, sir. They are Poles. Senator BALL. Poles, more than likely. , enator McKELLAR. Poles, are they? Mr. CLAYTO:N". Pole and Russians and Czechs, and so on. Senator )1clCELL.rn. Yes, sir. 'I'he cause of my question was that

I ::::aw in the paper-sometime during the war that the Germans had enslnve<l some G,000,000 Frenchmen, I believe it was, or some yery large number, at any rate, and they were very a1L·ious to get out; but what I want to know now is, now what do we do? Are we just leaving those people in detention camps and paying all their expenses, and how much does that cost per man?

22 UNRRA, 1946

l\Ir. CL.\YTOX. UXRRA isn't paying those expenses, Mr. Chairma!1, and the situation i this: That at the time Germany surrendered m

lay it "·as found that there were a total of about G,000,000 of theie per· ons who had been brought in there, a great many of them against their will, and had been used as a kind of laYe labor. Some came willingly, because they got--

Senator ::\fcKELL,\R. From countries, for instance, like Hungary and Austria?

l\Ir. CL.\YTOX. Yes, sir; and Poland. Senator ::\lcKELL.\R. And perhaps Czechoslornkia? Mr. CL,\YTOX. Poland, Czechoslornkia. and Yugoslavia. Senator ::\fcKELL\R. ~\.nd Yugoslavia, and cn'll R11llla11in an<l Bul-

garia? l\Ir. CLAYTOX. Yes, sir. Senator ::\IcKELL.\R. And some from Poland and--Mr. CL.\YTO. ·. They came from all those countries ancl from France,

Holland, and Belgimi1. Most. of the French and the Belµ:inns and the Dutch haye been repatriated beC'ause obviously it is very l'asy: They are contiguous countries, ancl they were people who wante<l to go back home.

Now, "·ith the others the question <lid arise with sollle of them that they didn't mrnt to go back homl'. Some hadn't made up their mill(ls, allCl you have to recognize that these people had been through a terrible experience and they were upset emotionally and in ewry way. and it was felt that they should not be forced to say right now, today or tomor-row, wlwther they would go back or not. .\nyway, I he ~\.nny had its hands :full in taking the people back who wanted to go bad,. and that has been a perfectly stupendous job. So that with some of the people who were not sure the_y wanted to go back an<l some that ,wre pretty sure they didn't ,rnnL to go bade here aro,;e a problem of ,Yhat to do with them. .

Now, either they had to be taken care of in camps or they had to be forced to go back or turned loose on the community to f'hift for themselves. Now, the .Army was faced with that job up to the time that U TRRA took OYer. And the Army. I think wi ely, decided that it was best not to just make these people go whether they wanted to go or not. It i best not to turn them loose on the community. becau e if you turned enough of them loose you ,Yould haYe an elern _nt there which might contribute to disorder, and the Army is trying to keep order. That is what they are there for, to keep the country in order and keep the thing going, as well as they could. So that it was decided that ,...-hen it i · turned oYer to UNRRA, in accordance with the resolution which was passed in London, that UNRRA would be permitted to go ahead and to care for these person , to see that they are fed and cared for, to keep them in these camp for a reasonable length of time until they make up their minds whether they want to go back or not.

• -r:~IBER IX GF.R:)I.\XY :-;TILL TO BF. RF.P.\TRI.\TF.D

Se~ator l\fcKELLAR. How many of them are there, and could you furnish a list of how many there are, the number of them~

Mr. CLAYTOX. In fact, I understand that the total of people remaining to be repatriated is about a million and a quarter now. A great

•

U1TRRA, 1946 23

many of these people arc what we call stateles persons. ,vhen you get through you are going to have some hundreds of thousands of them.

Senator McKELLAR. Many of them will be stateless persons as long as we keep them going, anyway, I am quite sure.

Mr. CLAYTON. Of course, we emphasized, Mr. Chairman, in the discussions of the matter in London, that UXRRA is not an organization that is supposed indefinitely to take care of. these people and :feed them-eYerybody understands that, and that.. 1s well agreed, but that it woul,<l not be wise to say to a man or his :family, "AH right; if you are not ready to go back to your connt ry tomorrow, your food stops. You don't get any breakfast tomorro"' morning or any lunch or any dinner." It was deemed wise not to take that strong attitude with them because, as I say, they had been through a pr tty terrible experience. Many of them were upset. They didn't know about conditions back home. They wanted a little time to hear from relatives and friends who had returned, ns to what the conditions were, and we :felt that it was sensible to give them a reasonable length of time in which to make up their minds. So that we agreed--

Senator :McKm,LAR. That may be all right, but clon't extend that time too long. I'll tell you, tlw:v will be there on your hands as long as you take cnre of them.

EXPEXSl·} 01•' :\[ \IXT.\L'L'(l l'E()l'Ll·'. lX ('.\:\Il'S

Mr. CL.\YTON. I ,voulcl like to make this clear, Mr. Chairman, that FKRRA is not paying the expense of keeping them, and also we-

enator McKELL.\R. ,v1rnt expense do we pay? Mr. CLAYTON. Only the expen es of the administratiYe personnel

the personnel that are in charge of the camps. ,ve have about 4,000 people there, UNRRA hn8, who are looking after these camps and after these duties.

nator McKELL.\R. Who feeds them and clothes them? Mr. CLAYTOX. "\Yell, they are :fed from the cornmlmity-in other

words, from these stocks of :food that were found-and to the extent that they can, they buy with marks-which are furnished by Germany-they buy with marks tho food that they can get in the community, wgetables and other items. For ,vhatever has to be imported in the way of flour and things of that kind, obviously the American Army has to put up the money, but we expect in the encl to recover that money from the German economy, nncl we haYe a first charge on exports :from Germany to pay that money back.

Senator McK1,LL.\H. Thank you. sir. I hnYe to go, and Senator Hayden will take my place here, but I think we hncl better make an arrangement as to ,vhen we shall meet again. I do not think it is possible to meet this afternoon because we may be called upon to bring up tho appropriations bill in the Senate, and tomorrow is Saturday, and \Ye would have difficulty about getting a quorum, so I think we had better adjourn until Monday when you adjourn, Senator Hayden.

SPnator HAYOEN. All right. SPnator 11cKELL.\R. Is that satisfactory to the committee 1 ::\fr. CLAYTON. Yes, sir.

24 UNRRA, 1946

Pnator )Iclu;u,_\R. ~\.nd it is satisfactory to you gentlemen 1 Senator R\LL. Yes, sir. ( At thi. point Senator Hayden a ·sumed the chair.)

on,;cc.-srox OF CIODSE .D1EXD::\IEXTS

S<'nator BALI,. Af' I undl'rstand, these (1), (2), and (3) proviso are pretty much in line with ,vhat you are now doing in your agreements; is that right?

Mr. FELLER. ·well, .J. To. 2 is in our agreements right now. , enator B_\LL. Yes.

. )fr. Fn,u~u. X o. 3 we never provided for in the agreement. That 1 sue neYer arose.

~enator BALL. It is pennissin anyhow. Mr. FELLER. It is permissive. ~To. 1 is not in our agreements. But,

of course, part of the diffieulty is getting adequate statistics out of count1·ies which do not haYe fine departments of commerce and statistical boards, and so on, and we "·ill do the be8t we can under it i:f it is enacted.

FRI::E PRESS ,\::\IEND::\IEXT

COUXT!UE:-; STILL l\I.\INTAIXIN(, CJ:XSORSillP

.Senator ll.\LL. Xow. as to (B) there, which countrip:,; that are on your liist here-Albania, Czechoslovakia, G1·eece, Italy, Poland, Yugoslavia, and China-which ,;Lill maintain censorship and who limit the movement,; of foreign correspondents/

Mr. CLAYTON. I belie;-e that by diplomatic negotiations we have got arrangements for our newspaper people and radio people to go into all of these countries at the present time. I am sure that they do have to conform to some regulations of the local authorities .

._.,enator R\LL. Well, it is still censorship? Mr. CuYToN. I beg pardon 1 Senator BALL. Isn't there ,;till censor hip? l\fr. CLAYTON. Oh, yes : there are forms of local censorship. Senator B .\LL. In Poland ancl China and YugoslaYia? Mr. CL.\YTo,-. I think in-yes; in all three of those countries.

enator B.\LL. How a.bout Greece and Czechoslovakia and Albania? Mr. CLAYTOX. I think that there is local censorship in all 0£ them,

although I am not positive, Senator Ball. en a.tor BALL. If there is any in Italy it i our own, I suppose?

Mr. CLAY'.l'ON. Yes. I don't think there is any in Italy.

HANDLING OF PURCHASES

Senator THOMAS. Mr. Chairman, I want to ask a. question, if I may. Senator HAYDEN (presiding). Yes, certainly, Senator Thomas. Senator THOMAS. \Yho makes the purchases? In oth('r words, who

supe1Tises the spending of this money in the making of purchases t Mr. CL.\YTON. The programs, Senator Thomas, of u_rRR.\. are

submitted to the committee called the CPntral Committee, which is a kind of executive conunittPe of the Council, which meets regularly. The Council meets only once a year.

U.i:TRRA, 1946 25

MEMBERSHIP OF COUNCIL

.. enator TnoMAS. Who make up thi Council 1 Mr. CLAYTON. It is made up of representatives from the member

governments. of representatives from each of the nations that form UNRRA, whether they contribute to the operating an<l administrative expenses·or administrative expenses only. There are certain nations-48 of them I believe it is now-who belong to UNRRA.

Senator TmnrAs. This :foreign group called the Council does not have control of the penclino- of our money ,,holly, do they, because--

FUNCTiox OF COUNCIL

Mr. CL.\YTOX. They do not have control of the spending of our contribution. The Council is the directing agency o-f UNRRA". It is a kind of board of directors of U1:rRR.\.., and, as I say, they meet only once a year usunlly, and they make the policies. They form the policies to guide UNRRA.. ,vhen they are not in session the policies and so on are supervised by this Central Committee, to whom a program of operations is subrnmitted :for approval.

Senator Tnmus. Now, using another illustration, there was created at Quebec last "eek an organization known as the Food and Agriculturnl Orgai1ization.

Mr. CLAYTON". Yes. sir. Senator Tno:H.\S. The law proYides that ,-..e shall appropriate acer

tain amount of money for the support of that Organization. For example, n('xt year the law proYides that we can appropriate, if we see fit, $1,250,000, and this money is to be placed with the Organization under the Director General, and when the money is turned over to the Director General then he spends that any way he sees fit-governed, of conrse, by an executive committee o-f, say, 15 men. That is wlmt is provided now.

Exn;NT (W ('0 'Il!OL OYER SPE:\"l>lNO OF FU'\"DS CONTIUllUTEI> llY UNITED STA.TES

Now, what I want to know is this: Whether or not we turn our money over to thi , executive committee or this Council, and the Council then has full jurisdiction in making allocations and making expenditures, or does the United States representative on that Organization have control o.f the spending of our money1

Mr. CLAYTOX. No, Senator. The money is not turned over to the UNRRA. The policies with respect to programs are fixed by the Council, of which the United States is a member, and, obviously, since this is a United Nations organization, the United States couldn't very well exercise any greater authority in connection with the programs than its vote in the Council or the Central Committee would giYe it. Just like any board of directors of a corporation, we are a member of the board; we are a member of the Executive Committee. The Executive Committee meets here in Washington, where the headquarters of UNRRA are maintained, and we have, we think, a very great influence in the fixing of these policies.

Senator THmL\S. From that answer I get the impres ion that this Organization goes into markets of the world and buys commodities that are needed, on the lowest and best bid.

26 UNRRA, 1946

l'EHCENTAGEl OF UNITED STATES CONTRIBUTION SPENT IN THIS COUNTRY

Mr. CLAYTON. Of course, Senator, the money is supposed to be spent-in fact, at least 90 percent of our contribution has to be spent and is spent-in this country. A small amount, 10 percent, was allowed to be spent elsewhere. for the rea on that oftentime the supplies that UNRRA might need cannot be obtained here.

Senator Tno:uAs. I haYe no objection to that. Mr. CLAYTON. Yes, sir; that is the rule; 90 percent of it i!::i spent

here, and nearly 10 percent, I think, is spent elsewhere. Senator Rc-ssELL. It is provided in the law, iim't it, the authoriza

tion? Didn't that provide--Mr. FELLER. It is not in the law. It is in the resolution of the Cen

tral Organization.

FUNDS US!;;o TO BUY SUPPLn_:g ON l'ROOHAMS i ·1x1m BY UNHRA

Mt·. CLAYTON. And the money is not actually turned over to U JRRA. Supplies are bought with it for progrnms that UNRRA fixe, , and the supplies are turned over to UNRRA. That is the way it operates.

Senator TrrOl\fA . Your last statement clarifies in my mind the point that I wanted to bring out. If this money was used by an organization over which we had no control, save one representative vote, then that money could be u eel in buying commodities from low-producingcost countries to the disadvantage of the higher standard of production that we provide and enjoy in this country.

l\fr. CLAYTON. Yes. enator Tuol\I.\S. That is the point I wanted to be ure about.

Mr. CLAYTON. Yes. Well, the spirit and indeed the rule about it all, enator, is that each country's contribution shall be in the form of supplies from that country, and in fact 90 percent of our money is spent right here.

AMENDl\IENT TO BE PROPO ED RELATING TO PURClL\SE OF FARl\I PRODUCTS

Senator Tuo:'\I.\S. I am yery glad to get that information, and there is only one question further, l\Ir. Chairman, and that is, I hope that the supplies purchased in this country will be purchased not on the basis of bargaining downward the sellers, because farmers produce these products in the main, because these are food products, and if they are lumber they are a forestry product, which is an agricultural product, after all. This organization in Quebec comprises three features; I.hat is, farm products, and farm products mean forestry products, and fishery products; so the forestry is intended to cover hon, es, and the fi hery and agricultural products in the m~in are _int'tmdecl to cover food; and, inasmuch as everybody else 1s sharrng in the 1 NRRA, I am going to offer an amendment to thi. bill to just insure that the farmer ha 11 not be cliscredited or discriminated against.

l\Ir. CLAYTON. Senator, I think I can assure you that that is not necessary, because all procurement in this country for U RRA is made by United States G°'~ernment agencies, and the Department of Agricnltnre . buys all the food and the farm products that the

UNRRA, 1946 27

UNRRA requires. UNRRA doesn't buy it . U~RRA present requisitions to us, and, if we approve, ,rn give the order to the Department of Agriculture.

Senator Tno:uAs. This amendment I am going to suggest will be directed at the Department of Agriculture, because I am not at all sati ·fied that all the agencies in the Department of Agriculture are in full sympathy with the producer of these products, and it is for their guidance that I want this amendment considered.

llOl.':sE PROYISION ON UTILIZING SURPLUS AGRICULTURAL COl\Il\IODI'l'IES

Senator H AYDEN. L ei me ask you in that connection about this language that the H ouse adopted. Proridcd furthe1·, '!'bat, insofar as 1io,;sihle and vracticable, agricultural commoditie' determined b.,· the Secretar)' of Agriculture to be in surplu supply shall be utilized in tilling United Nations R Plief and Rehabilitation A<lmi11istrn· tion rE'(]ni~itions for food and ,rgr('ultnrnl commodities.

Senator Tno11us. I am for thnt proYision, but that is entirely be::;ide the question that I haYe in mind.

Senator HAYDEN. That is what I was trying lo find out about. I clon't understand exactly what it means.

Supposing, for example, that e JRRA wanted some sugar, and :-;ugnr isn't surplus. Does thi · Ilouse provision allow the 'ecretary of Agriculture to say, '·"\,Ye haven't any sugar, but we can giYe you some rnolasse,..; or something else"?

::\lr. CLAY'l'OX. I don't think so, Senator Hayden. Senator 1-IAYDlsN. Corn sirup or something? Mr. CL,\YTO -. As a matter of fact, under war proeedul'es U.NRRA

was a claimant for these things through the FEA and had to go to the Combined Food Board for al locations of food such a sugar; and

. when those things were allocated, why, then the Department of Agt'ieulture attended to the purchasing of the commodity. This is still the ease ,yith respect to items in short supply.

Senator H .\YDEN. If tl,at is the ,Yay it was done, then I do not see where this language suggested by the !louse committee adds anything or takes anything away from "·hat has been done before.

l\Ir. CL.\YTON. l think you are exact l:v right. I do not think it either adds to or take::; away anything, and it more or less--

Senator Tno:u \S. It is a mere gesture and means nothing to me. )Ir. CL.\YTON. It is more or less innocuous. I don't see that it adds

anything.

PURPOSE OT' A!\U,XD?IH,NT TO BE l'IW P d SED m,LATI. ·o T O l'FRClL\Sls 01' l'.\Rl\I

l'RODUCTS

Senator H .\YDEX. How could we impron that . .._ enatol' Thomas ? S:mator TH <DL\S. I will submit the anwndment. I " ·ill let you

di:,;cuss it in the committee. I want the farmer to get the benefit of full parity price ' . Now most things are aboye parity, so my amendment " ·on't have anything to do with them. There are only a few c-ommoclities-one is wheat-for whieh the farmer is not gett'ing full parity prices. Another is oats, another eggs. There are three that I expect you buy in one form or another, and I ·want this Organization to pay for these commodities a price that vl'ill giYe 1he farmer~

28 UNRRA, 1946

pro<lucer of those commoditie a full parity price, an<l there are not many o:f them, but they are not getting it now. To the extent that the farmer are selling their goofls to your Organization below parity, to that extent they are contributing out of their pocket to the support of these foreign people. They /)ay their part of the taxes to raise the fund , which y,.u use, and i they are not getting a full parity price, as the law directs in two places, why, they are compelled under our system to pay not only their taxes to buy commo<litie , but they are compelled to sell their commo<litie at a price below the standard fixed bv the law; so that they are paying out of their pocket, in reduced prices, 'funds to upport the people in foreign lands.

That is all I am trying to protect. Mr. CL.\YTOX. Of course, Senator, it is for the Congress to decide

what they will do about it. Senator Tuo::11As. Congre. s has decided already, in hrn laws, but,

unfortunately, some agents of our Government pay no attention to '\\hat Congress doe , or pay little attention to what Congress does.

Mr. CLAYTON. I would just point out that UNRRA probably doesn't buy 1 percent of the production of any one of tho1,e three commodities.

Senator Trro::1us. It is immaterial to me what they buy. I want it stated in the law, or at lea t I want the Congress to consider-this committee to con ider ,vhat I think ought to be done. and the committee will pass on it, of cour e.

EFFECT OF A::IIE~D::IIE."T TO REQUIRC PAl~EXT OF PARITY l'RICES WITII UNRRA FUNDS

Mr. CLAYTOX. Yes, sir; that is right. I was just thinking that it would be a kind of discrimination against UNRRA to single it out, because the American people themselves wouldn't be paying those prices. If those commodities are elling now below parity, what I understand you would seek to attain would be to make UNRRA pay parity when other people, for the other 90 percent or 95 percent, "·oulcl be buying those commodities at the market price.

Senator Tno~us. The farmers are not organized. They cannot protect themselves, and if the Congress doesn't do it for them, why, they are at a di advantage.

Now, here is the statistical summary put out by the Bureau of Agricultural Economics under date of October 14, which is now just 1 month ago. At that time, the parity price of wheat was $1.54 a bushel, but the farmers are getting $1.45. There is 9 cents a bushel less than ~he parity price. Now t~e law, in t"'.o laws, in the Agricultural AdJustment Act of 1938 and m the extens10n of the OP A of 19-:l:5, provides that they shall have parity prices, and the President is directed in the law to see to it that they do get pariy prices, but for some reason they do not. I, for my part, speaking as one Member, am goin()' to make another effort to see that they do get parity prices on thos~ products sold to be consumed by foreigners.

Senator HAYDEN (presiding). Are there any further questions~

PERCENTAGE OF UNRRA FU1'."DS CONTRIBUTED BY UNITED STATES

. Senator RussELL. Yes, sir. I have one or two other questions. Mr. Secretary, we contribute about 75 percent of the total funds for

UNRRA, do we not i

UNRRA, 1946

l\fr. CLAYTON. I believe it is about 72, Senator. Senator R-c-ssELT,. Yes, sir. "\,Vell, 72. Mr. CLAYTON. Yes, sir. Senator Russm,L. More than 70, ,,e will say. Mr. CLAYTON. Yes, sir.

29

ALLOWING CREDIT OX UNRRA OBLIGATIONS FOR SUPPLIES FURNISHED BY

ARl\IY

Senator Rm,SELT,. Of course, that is clone on the basis that we are the richest Nation on earth and have more money than anybody else. I sometimes rather doubt that we haye; I think we fool ourselYes. But I am uot quarreling about that now, but I merely state that as a

~ , preface to the suggestion that I think has considerable merit: Has any effort been made to get credit on our obligation to PNRR~\.. for the supplies that ha Ye been fumished to the Army? They are all paid for from the same source. The American taxpayer pays for them, and I just wondered if we got any credit for all this food that we were buying out of the Army funds, which come from the same pocket as the UNRRA appropriations. .

Mr. CL.\YTON. Senator Russell, to begin with, referring to your first remark, the basis, as you probably know, of our contributions to UNRRA is 1 percent of the national income--

Senator RG~SELL. One percent of the national income; yes. l\lr; CLAYTON. For the year ending June 30, 19-:1:3, and that has been

the basis that has been used. Now, I understand you to refer to the use of Army urpluses in

connection with UNRRA relief. Senator Rus~mLL. Displaced persons, under your present set-up, are

the responsibility of UNRRA, or will be? Mr. CLAYTON. Yes, sir. Senator Russi,~LL. Tho e people were largely feel for a long time,

and I think still are being fed, with United States Army supplies. Mr. CLAYTON. Only to a certain extent, Senator Rus ell. As I said

a moment ago, whateYer upplies they can buy in Germany with mark , of course, come out of the German economy, and they do get vegetables and local produce often in the country and pay for it with the marks that are issued there by the control authorities; and, therefore, to that extent the cost comes out of the German economy now, and the remainder of the cost--

FIRST CIIARGE AGAINST EXPORTS TO PAY FOR NECESSARY IMPORTS

Senator RussELL. Yes ; I understood your testimony that if and when we ever decide to relax our controls in Germany and let them export some commodities, and if they ever make any money out of it, why, this will be paid, but I am not too hopeful that we shall eventually realize on all these expen es from Germany--

Mr. CLAYTON. Well I am not entirely hopeful, either. Senator RussELL. Now under the terms of the Potsdam agreement. Mr. CLAYTON. I am not too hopeful, either, but I do think there is

a fair chance of getting a good deal of this money back. They are exporting coal now in a considerable amount, and in time they will

30 UNRRA, 1946

be exportino- other thing., and il is the expectation-it is the understanding, a · a matter of fact, that there hall be a first charge on these exports o:f an amount sufficient to pay :for neces nry imports.

Senator RussELL. Is that a pnrt of our agreement with our allies1 Mr. CLAYTON. Yes, sir; it is a part of the agreement that we reached

at Pots<lam. enator R SSELL. It ha been written out j fr . CLAYTON. Yes, sir; it has all been spelled out and agreed, and

ihe Allied Control Council has charge of enforcing it; so that when exports can be resumed from Germany we shall have a first charge on those export for the e amounts and occupation co ts, and so on.

ALLOWIKG CREDIT FOR S PPLIES FURNISHED BY ARMY

Senator RussELL. ·what is the objection of the State Department to permitting the e upplies to be credited to our contribution to UNRRA? They all come from the same source-originally the same source, the Treasury of the United States.

M:r. CL\YTON. The matter of charging expenses involved in conllection with the Army's responsibilities to our UNRRA contribution has never been presented to us. Senator Russell. I don't know that any objection has ever been voiced. I never heard the suggestion made until this moment. It "·oukl, of course, reduce the amount available :for PNRRA's programs.

Senator RussELL. I wonlcl eertainly haYe thought that some of our

f)eople who are dealing with our allies and with the intemational probems would han considered it, because in my opinion it will run into

perhaps hunclrecls of millions of dollars. Mr. CLAYTON. I hardly think so, although it is po sible. But I

would just like to say that the care of these displaced penmns is very definitely an Army responsibility. Of course, we only had a part of them in our zone. The British had some, and the French hacl some, nnd the Rus ians had ome. I don't. know. I haven't at hand at the moment the exact fifrure of how many there are in our zone, but the care of the e people 1s a definite charge on the Army, and they have to care for them, and as one means of preventing civil unrest, and that sort of thing.

enator RC"SSELL. I took cognizanee of that. I wa not in accord ,\ ith Senntor :\IcKellar':-; suggestion that yon ought to turn these people looi-e right away. I would be pE'rfectly willing to give them a year instead of 6 months to m:tke l!P their mind. Bnt here you have your part of the expense that 1s bemg borne by UNRRA, to which we are the largest contributor. Another part is being borne by the Army, to which w·e are the sole contributor, ancl it does seem to me that if it is going for thE' same purpose wE' would l>e fully justified in SE'<'king some ereclit for the appropriations that go from this same committee for the Army, that go for the same purpose.

Mr. CL.\rrox. It is a suggestion. as I . ay, "·hich I hadn't heard rnacle up until this time, ancl it is something that I would like to think about. I think it would be WI')' difficult to handle it because, for one thing. the programs whieh haYe alreauy been tentatively agreed upon for U:N"RIL\.. relief "ill take eYery dollar of the appro-

•

..

UNRRA, 1946 31

priation that we ask you here to make, aside from the displacedpersons care.

PROGRAMS FOR WHICH ADDITIONAL FUNDS WILL BE USED

In other words, the programs in Italy and in Poland and Czechoslovakia and Yugoslavia and Greece, and so on, will absorb the entire amount that we are asking to be appropriated here; and al o, if we can't get a new authorization and appropriation to match those of England and Canada and others, who have alredy committed theirs, we shall not be able to complete the job.

ADDITIONAL FUNDS WILL CONTINUE UNRRA SUPPLIES UNTIL EARLY SPRING, 1946

Senator RussELL. It will all fold up the 1st of July 1946 ~ Mr. CLAYTON. Lon<Y before then. Senator Rus ELL. Oh, it would i Mr. CLAYTON. Yes, sir. Senator Rus ELL. You means even if we appropriate $550,000,000 ~ Mr. CLAYTON. Yes, sir; even after appropriating $550,000,000.

That will give only enough money to continue the supplies to the countries of destination, the recipient countries, early in the spring. In the case of many items, the period would be even shorter.

QUESTION AS TO NEW COUNTRIES FOR UNRRA OPERATIONS

Senator RusSELL. Now, do you propose out of this appropriation to undertake any operations in any countries where you are not operating now i

Mr. CLAYTON. "\Vell, we have undertaken a program in Austria and Korea and Formosa. There are limitations, and so forth, on these programs. They are countries where-

Senator RussELL. In where i Austria~ Mr. CLAYTO:N. Austria, Korea, and Formosa. (At this point Senator McKellar, the chairman of the subcom

mittee, resumed the chair.) Senator J\foKELLAR. Has Korea been badly damaged by the war 1

I thought it was outside of the war operations. Mr. CLAYTON. o, sir. Korea, of cour e, has been a part of Japan,

as you know, and is very near to Japan. I understand there has been considerable damage there, and there is great suffering for lack ol food.

Senator Tno:r.us. Off the record, Mr. Clayton, because it wouldn't be proper to put it on the record.

(A discussion followed off the record.) Senator RussELL. J\fr. Chairman-if you will pardon me, J\fr. Sec

retary-I see no reason why this should not go on the record. It is generally a matter of public knowledge.

Senator T.rIOl\IAS. I did not know that all this was in existence. I£ I had, I would have had it all on the record. I thought I was getting; information that was not advisable for us to put out.

79254--45-3

32 UNRRA, 1946

ADDITIONAL AUTIIORIZATION BEING REQUESTED

Senator RussELL. We will save ourselves from action by the Congress for another appropriation of 72-

Senator McKELLAR. Let it go on the record. Senator RusSELL. Of the next year's total operations of UNRRA,

just as we have in the J?ast. Mr. CLAYTON. Yes, sir. We are asking for an additional-UNRRA

is asking for an additional 1 percent of our national incomeSenator RussELL. That is right.

PRESENT UNRRA PROGRAM

Mr. CLAYTON. As of June 30, 19.J:3, which is $1,350,000,000. Now, to recapitulate and get it on the record, in answer to Senator

Thomas' question, the present UNRRA program involves the expenditure of a total of $1,850,000,000. That is the present program. Let us call that the first phase, phase 1, of their operations. Of that amount the United States has promised $1,350,000,000. Of the $1,350,000,000 the Congre, s has made available $800,000,000. We are now asking you here today to appropriate the remaining $550,000,000.

Jow, when that is done, then that total of $1, 50,000,000 will be all in, practically speaking, and will be available and will be committed. At the latest, that will carry UNRRA np to the early spring in respect of supplies arriving in these countries where they are needed; but the pomt is that, if the job is to be finished, a new appropriation, a new authorization and appropriation, must be made promptly unless the pipe line is to run out in the next few months. That is very important. This pipe line is, at best, about 3 months long. In other words, to get supplies into these countries on the 1st day of April, they have to be committed, they almost have to be contracted for, by the 1st of January in order to get them ready and get them shipped and get them there.

AMOUNT INVOLVED IN SECOND PHASE OF UNRRA PROGRAM

:row, phase 2, Senator Thomas, is expected to involve the expenditure of another $1, 50,000,000, and the proportion of appropriations by the different contributing countries will be the ame as before. And, as I said a moment ago, in London in August Great Britain agreed to hers, and the Canadians agreed to theirs, so that those amounts are available if we authorize and appropriate our additional $1,350,000,-000. That will make a total of UNRRA expenditure, phase 1 and phase 2, of $3,700,000,000, and that will carry UNRRA to the end of next tear in Europe and to the end of the first quarter of 1947 in the Far Ea t; and UNRRA, by resolution, at the Council in London, stated that the UNRRA program will be finished at that time. Everybody agreed to it, and the Council passed that resolution.

Senator Tool\IAS. You are speaking now about the calendar year or the fiscal year 1

Mr. CLAYTON. The calendar year '46. I

UNRRA, 1946 33

Senator THOMAS. That is the information I wanted to get :from you.

Mr. CLAYTON. Ye . Senator THOMAS. But I wa n't sure, and I did not know that it had

been given such thorough consideration as you have outlined. Mr. CLAYTO . This information in this form has not been given be

fore, o far as I am a ware. Senator THOMA . That is the reason I sugge ted in my question I

did not know about it. Mr. CLAYTOX. Yes; that is right. Senator RossELL. You suggest to have us exactly duplicate what we

have already done in the original UNRRA Act? Mr. CLAYTON. Yes, sir; that is right.

OPERATIONS IN ITALY

Senator RusSELL. Mr. Secretary, how extensive have been the operation of UNRRA in Italy? I was nuder the impression when the original act v.-as up that it wa stated time and again that none of the funds wonld be expended for the benefit of our enemies in the war.

Mr. CLAYTON. The UNRRA charter or constitution or what-haveyou-I don't know the proper name of it--provides that none of the funds are to be expended for the benefit of ex-enemy countries; but at Montreal last September at the Council meeting a resolution was adopted which authorized UNRRA to spend up to $50,000,000 in Italy for the relief of mothers and expectant mothers and small children-or children-a,nd that program is being caried out at the present time.

Senator MoKELLAR. Is that authorized by the UNRRA Act? Mr. CLAYTON. It is authorized by the UNRRA Council. Senator MoKELLAR. I know, but the Government in this country,

Mr. Secretary, is based upon a document, the Constitution of the United States, and under that Constitution money that is appropriated by the Congre s ha to be expended, not by a council, but it has to be expended by the agency set up for the purposes set out in the act. Now, I don't believe that Council, however great a council it may be, takes precedence over the Congress of the United States. It has no right to repeal the law, and unless that is provided in there we are simply violating the law.

Mr. CLAYTON. I assure you, Senator, that there has been no violation of the law whatever in this matter. It is--

Senator McKELLAR. Then, let us see the act, and you may find out.

RENDERING OF AID IN ENEMY COUNTRIES

Senator RusSELL. I am probably confused as to what was stated and what was in the act, but if it was not in the act certainly some documents that purported to be official in character were read.on the floor of the Senn.te to the effect that none of the funds would be expended in any enemy country.

Senator McKELLAR. Let's see. Let's look at it for a moment. Senator RussELL. Underst.'lnd, I don't doubt the need. I have

seen it with my own eyes, and I believe that even the flintiest hearted

•

34 U RRA, 1946

man that ever lived would feel compassion, to go through Germany or Italy, either one, now. Bad as I thought I despised those people, I couldn't go there and see those bombed-out cities in the miserable conditions that obtain without feeling some compassion for them.

Mr. CLAYTON. It is pretty terrible, Senator Russell. The status of Italy, I think you will admit, was altered to some extent when she became a cobelligerent.

8enator RussELL. Unfortunately, didn't you have some kind of an agreement that was submitted to the Congress along with this original UNRRA act between all of the Allied Powers?

Mr. CLAYTON. I only got into this UNRRA business for the State Department at the time I was appointed by the President in June as the United State delegate to the UNRRA council, and I was very busy at that time getting ready for the economic aspects of the Potsdam Conference, and I •went to Pot dam and was very busy there, of course; I really didn't get into U RRA until I got to London; and what took place in the beginning of this matter, and the introduction of the bill in Congress here and the hearings, and so on, I am not personally familiar with.

Senator Rus ELL. ,v asn't there an original agreement somewheresome such thing in it?

Mr. FERGUSON. Mr. Clayton, perhaps I can explain that . Mr. CLAYTON. Yes. Will you let Mr. Ferguson of the Department

tell you? He is more familiar with that than I am.

SECTION 4 OF ACT APPROVING UNRRA AGREEMENT

Senator BALL. In ection 4 of the act which approved the UNRRA agreement it says this:

In expressing its approval of this joint resolution, it is the recommendation of Congress that insofar as funds and facilities permit, any area, except within en my territory and while occupied by the enemy, important to the military operation of the United Nations which is striken b~· famine or disease may be included in the benefits to be made available through the United Nations Relief and Rehabilitation Administration.

U E OF FUNDS IN ENEMY COUNTRIES

I would say that that was a specific authorization, that if they found that it was important to the military operations of the United Sates to avoid famine in Italy, they could moYe in with a limited program; don't you?

Senator Rus ELL. Yes; I would interpret it that way too. I should have prepared myself more fully before this hearing, because I was certainly confident that it was stated in the course of debate that none of these funds would be expended in enemy countries.

Senator BALL. I think there was a resolution--Mr. CLAY'.roN. In orde,r to make it regular so far as UNRRA was

concerned-this had no reference to the act passed by our Congress-but in order to make it regular so far as XRRA was concerned, they had to adopt a special resolution at the Montreal meeting of UNRRA, of the Council, in September of last year, and that resolution was adopted, and it is in accordance with that resolution that this pro<Tram has been carried out. They have spent something less than $50,000,-000 in Italy for that purpose.

UNRRA, 1946 35

Senator fcKELLAR. I wi h 0

you would have-I am unable to put my finger on it, but it struck me that Senator Russell was correct that there was a provision in here that made it apply solely to nations that were not at war with us.

Senator RrssELL. That is my recollection. Senator 1\foKELLAR. That was my recollection. ·we may be mis

taken about it, but I wish you would have your lawyer look it up and see "·hether it is, because if it isn't you gentlemen should come before the Congress, not before some counc:J. ·

Mr. CLAYTON. Certainly. Senator 1\-IcKELLAR. They have no right to legislate in the matter. Mr. CLAYTON. Yes, Certainly. Mr. Chairman, with your permission I would 1ikc to a k Mr. John

Ferguson of 'the Department of Stale, who is a lawyer, to clear this matter up.

Senator l\fcKELL.\R. All right, sir; we shall be very glad to. Mr. CLAYTON. He is thoroughly familiar with that and can do it. ~enator McKELT,AR. What part of the act? Mr. FERGUSON. Senator l\fcKellar, in the original authorization act,

in the first paragraph, you find that there is authorized to be appropriated $1,350,000,000 for our participation in the work of U RR.A "established by an agreement concluded by the United Na lions and associated governments on November 9, 19,1::3, reading as follows:". And then the entire agreement is set forth. There is nothing in the agreement which prevents UNRRA from operating in Italy. There was a resolution at the first UNRRA council session which announced that UNRRA was not going to operate in enemy areas. That resolution was not part of the ori§crinal authorization act and was not affected by the Jegi lation; and, as enator Ball has pointed out, in the legislation itself there is section 4 which clearly expresses the intent of Congress that where it was found to be militarily desirable or necessary to go into any area, even an ex-enemy area, after it had been freed from enemy domination, UNRRA could undertake a program.

DETERMINATION OF "l\CILITARY NECESSITY''

Senator RussELL. \Vho was to determine whether it was militarily necessary? The military authorities or UNRRA?

Mr. FERGUSON. No; I think that was to be the judgment of the UNRRA Council after consultation with the military authorities.

Senator RussELL. You mean the UNRRA Council was going to decide whether it was militarily desirable 1

Mr. FERGUSON. Yes; in conJ 1mction with the military authorities. One of the particular things that was in contemplation here was the po sibility of doing ome work, if necessary, to relieve famine in India and parts of the Far East which were not actually battlefields, which had not even been occupied by the Japanese. I think that UNRRA would never make such a decision without consultation with the military authorities. They have never done so in the past. In fact, they are required to get the Judgment of the military authorities.

36 UNRRA, 1946

SMALL BEGINNING OF PROGRAM IN CERTAIN COUNTRIES TO BE MADE WITH ADDITION AL FUNDS

Senator RusSELL. I believe you stated, Mr. Secretary, that this 550,-000,000 would only be expended in countries ,vhere you are now operating.

Mr. CLAYTON. I think, Senator Russell, that it is intended to make a small beginning in these new areas, but not to commit these fonds to any substantial degree, but in order to get the supplies going it is going to be necessary for them to get these programs started.

NEW COUNTRIB FOR UNRRA OPERATION UNDER ADDITIONAL AUTIIORIZATION

Senator RusSELL. How about the $1,350,000,000 authorization that is now under consideration in the House? Does that c6ntemplate operations in any countries where yon are not now operating~

Mr. CLAYTON. Yes, sir. The administration of UNRRA has tentatively fixed on certain programs in Austria and Korea and Formosa. They don't involve a great deal of money.

enator Ru ELL. I thought that wa out of the $550,000,000. Mr. CLAYTON. No, sir; not to any large extent. A I said a moment

ago, there will be very little of the $550,000,000 that will be spent in those areas or in any areas where UNRRA is not now operating, because UNRRA does not have the money to spend. This money will be needed in areas where they have programs now in operation, but they may start in a small way-out of this $550,000,000, they may start in a small way to get ome of these programs started, but not in any substantial amounts.

Senator Ru SELL. So then the new program will only add Korea and Austria?

Mr. CLAYTON. And Formosa. · Senator RussELL. And Formosa. Mr. CLAYTON. And also a much larger program in Italy, which was

decided upon at the Council meeting in Lon<'lon in August. I should like, if you will permit me, to explain a little about this

Italian program.

OPERATION OF UNRR.\ IN FOR]\[OSA

Senator Ru ELL. Yes; I will be glad to have you do it. I did want to find out, though, just on what basi it was determined to operate in Formosa. I thought that Formosa had been Japanese country for a great many years. .

enator McKELLAR. Smee 1895. Mr. CLAYTON. About that time. It "Was declared in the Cairo meet

ing, which was attended by President Roosevelt and Prime Minister Churchill and I think a repre entative of the Chinese Government-

Mr. GILPATRIC. I believe Chiang Kai-shek. Senator R SSELL. Yes; Chiang Kai-shek was there. And they said

Korea and Formosa would be returned to China. Mr. CLAYTON. Yes, sir; to the United Nations. It was declared

there that an attempt would be made to bring Formosa and Korea into the United ations, as I understand it, and I suppose--

UNRRA, 1946

Senator RussELL. I thought it was a part of China; right 1 Mr. CLAYTON. I didn't think so.

37

Senator RusSELL. Your Koreans, of course, were promi ed independence, but I thought.Formosa was to be returned to China.

Mr. GILPATRIC. That is quite right with respect to Korea. Senator RussELL. Of course, we all said they would get back Man

churia. I don't know which part of China we meant would get it back, but we agreed that it be restored to China.

Mr. CLAYTON. Anyway, it was felt that the e two countries-although they had been a_ part of J al?an for a _long time, they origi1~ally were not, and it was believed from mformat10n that had been received that the need for relief there was very urgent, just as it is in China, and that some small programs there, in view of the liberation of those sections, should be undertaken. Not a great deal of money would be spent.

EXTR.\CT FROM AGREEMENT ON RENDERING AID TO AREAS UNDER CONTROL OF UNl'l'ED NATIONS

Senator McKELLAR. Let me call your attention again to the agreement, in which we provide, in article I of the agreement, under section 2 (a), this is the authority-To plan, coordinate, 'administe1·, or arrange for the administration of measures for the relief of victims of war in any area under the control of any of the United Nations through the provision of food, fuel, clothing, shelter, and other basic necessities, medical and other essential services; and to facilitate in such areas, so far as necessary to the 'adequate pl'Ovision of relief, the production and transportation of these articles and the furnishing of these services. The form of activities of the Administration within the territory of a member government wherein that government exercises administrative authority and the responsibility to be assumed by the member government for carrying out measures planned by the Administration therein shall be determined after consultation with and with the consent of the member government.

It would look as if this act was intended to apply only to the member governments of the associated nations that fought this war.

OPERATING UNRRA IN EX-ENEMY TERRITORY

Mr. FERGU ON. Senator, in the first resolution which, as Senator Ru sell pointed out, or Senator Ball, had already been adopted by the time t.he act was passed by Congress ( the authorization act), the problem of operations in ex-enemy areas was covered, and it was said that in case it wa decided that U:&°RRA should undertake any op~rations in an ex-enemy area, that would require Council authorization. That is preci ely what was done in Montreal when the limited program for relief was undertaken by the UNRRA Council, and since then the supplies have moved under that limited program.

Senator Mclu:LLAR. But your agreement which the Congress passed limits it, if I understand t110 language, to the member nations. It is perfectly plain, can't possibly be misunderstood, if you read from page 37:

To plan, coordinate, administer, or arrange for the administration of measures for relief of victims of war in any area under the control of any of the United Nations • • •.

'

38 U RRA, 1946

1\-Ir. FERGU ON. O:f course, Italy was clearly under the control o:f the United Nations when that was--

Senator McKELLAR. When we captured it, that was so, but it was never intended in this act, in my judgment, to prepare for the people that we were fighting. We had very different notions about them at the time.

Senator RussELL. I hadn't checked up on my recollection, but evidently this resolution that Mr. Ferguson read had been adopted by the UNRRA Council before the bill was submitted in the Congress.

Mr. FERGUSON. That is correct. Senator RussELL. Someone probably read the resolution-Mr. FERGUSON. That's right. Senator Rus ELL. When the que tion arose as to whether or not

enemy countries could be aidecl, but the argument led U RRA to reverse its own position, o they then later decided it was desirable to go into Italy and amended the original resolution.

Senator McKELLAR. I uppose Germany and Japan-then you will have to furnish relief for those countries. Why should Italy be the only one, if you want to be fair about it? We have to be fair about it. I think what you ought to do is to come before Congress and get the authority.

l\Ir. CLAY'rON. ,ven, Mr. Chairman--Senator McKELLAR. I think you had better prepare such an amend

ment to your bill over in the House. It is a good deal better, when you are a king appropriations-and I am sure you, Mr. Clayton, will agree with me, because you have plenty of sense-it is a great deal better, wl1en you are asklng appropriations, to haYe the authority for the use of those appropriations; not only a great deal better, but that is the only legal and constitutional ·way to do it.

Mr. CL.\YTON. We certainly want to do it in the proper way, and I believe we have.

Senator 1\foKELL.\R. Will you look into it? Mr. CLAYTON. We certainly will, Senator. 1Ve will incleed.

CU TODY OF FUNDS APPROPRIATED BY UNITED TATI~S FOR UNRRA

Senator Tuol\L\S. Mr. Chairman, there is one point there that I am not still clear on. I asked :Mr. Clayton a while ago who expended the funds we appropriate, and I got the impression from his statement that the actual allocation of funds was made by the council, but I find on page 29 of the Fourth Report to Congress--

Senator McKELLAR. ,vait 1 minute. Twenty-nine~ enator THOMAS. On page 29.

Senator McKELLAR. Ye , sir. Senator Tnol\IAS. The :following, and I quote: By Executive order, the Pre ident ve ted In the Administrator of the Foreign

Economic Administrntion the responsibility for the expencliture of the funds appropriated for U~"'RRA and the provision of supplies and services.

And down a little further: As indicated there, the large t amount was transferred to finance purchases of

commoclities outside the United States in connection with the UNRRA program of relief and rehabilitation.

ow I would like to know whether or not the FEA Director actually did this, or did he delegate the power to someone i

UNRRA, 1946 39

Mr. CLAYTON. Senator Thomas, the working out of the programs of operation of UNRRA is done by their Council-by the Administration with the approval of the Council of UNRRA. The actual expenditure of the American contribution is done by the-has been done by the FEA in this country, just as the paper you read indicates.

Senator TnoMAS. Now, who, what official, has acted for the FEA? Mr. CLAYTON. I don't know who particularly has acted. Senator Tno:\IAS. Someone is down there. Mr. PARELl\IAN. Mr. Secretary, perhaps I can clarify that point, if I

may. The appropriations, in being made to UNRRA, were actually put in the custody of the Foreign Economic Administration under authority granted by the President. Since FEA went out of existence, the State Department has taken over that particular function. Under the procedures established, the Administrator of the Foreign Economic Administration from time to time allocated these funds to the various procuring agencies of the United States Government: For agricultural supplies, the Department of Agriculture; for miscellaneous supplies, such as medical supplies, to Treasury Procurement. Requisitions were received from the UNRRA organization by FEA and were screened in FEA and then transmitted to these procuring agencies, to be purchased out of the funds earlier allocated to those agencies.· So that the custody of the funds on behalf of the United States Government has been in the Foreign Economic Administration.

Senator THOMAS. Where are they now, at this moment? Mr. PARELMAN. Since FEA went out of existence the State Depart

ment has taken over that authority under the Executive. Senator TnoMAS. What official of the State Department has super

vision? Mr. CLAYTON. It is in my part of the Department, Senator Thomas. Senator Tnol\IAS. And you, Mr. Clayton, have charge of this mat-

ter--Mr. CLAYTON. Yes, sir. Senator TrroMAS. That was :formerly supervised by the FEA 1 Mr. CLAYTON. That is right. It has just come over to us in the past

2 or 3 weeks.

TYPES OF FOOD TUFF$ REQUISITIONED'BY UNRRA

Senator TnoMA . On page 25 of this same publication I find chart 3, which is very interesting. It hows that the largest percentage of our contribution and the largest percentage of the supplies used and purchased by the UNRRA were spent for fats, oils, and other foods, 28 percent. The next largest amount was for grains and cereals, 24 percent. The third largest amount was for vegetables and fruits, 21 percent. The fourth largest amount was for eggs and dairy products, 15 percent. And the next for sugar and related products, 8 percent. And the next was for fish, 3 percent, and meats, 1 percent. Now, I haven't added those several percentages, but those must total le s than 100 percent, because there must be administration in there; is that correct~

Mr. CLAYTON. Senator Thomas, the division by broad categories is shown on page 52 here of this--

Mr. FERauso . He doesn't have that book before him.

40 UNRRA, 1946

Mr. CLAYTON. Oh, you haven't this book. Would you mind saying ju t what is the point that you ha Ye in mind now 1

Senator Trro:uA . I just came across this chart. Mr. CLAYTON. Can you tell me, please, what page that is on 1 Senator Tuo111As. That is on page 25. Senator RussELL. Page 25. Mr. CLAYTON. Thank you, 25; yes, sir. Senator Tuo111A . There must be another qt1antity there of money

not expended for food but expended for administration. Mr. SMITII. It adds up to 100. S enator McKELLAR. Oh, they take the whole. It adds up to 100

because they just take-they don't count administration in there. Senator RussELL. That is only dealing in that chart with one type

of relief. Senator McKELLAR. It is a difl'erent type. Senator Ru ELL. Mr. Clayton, is there anyone here who js familiar

with the purchases that have been made up until now by UNRRA in this country?

Mr. 'WEINTRAUB. Yes.

AGRICULTURAL REHABILITATION SUPPLms AND INDUSTRIAL REIIABILITATION SUPPLIBS

Senator Ru SELL. I would like to get some information on just what is embraced within the items "agricultural rehabilitation supplies" and "industrial rehabilitation supplies." I assume that the former would include mules and cows and hogs and seed.

Mr. WEL-TR.iCB. And agricultural equipment. Senator Ru SELL. Trucks and tractors. Mr. WEINTRAUB. Tractors. Senator RussELL. Tractors, plows. Mr. '\VEINTR.\UB. Appurtenances. Senator RussELL. Fertilizer. Mr. \YEINTRAUB. Fertilizer, agricultural tools. Mr. PARELlIAN. If you turn to page 59 in your House hearings, Mr.

Ru. ell, you will find a ·complete break-down of that; 58 and 59 both. Mr. '\VEINTRAUB. 58 and 5!) has that break-down, and then on

130--1\fr. GILPATRIC. 137 and 8. Mr. WEINTRAUB. 137 and 138 has even more detail. Senator RussELL. That includes the agricultural rehabilitation;

yes. Mr. GILPATRIC. The previous pages. Senator Tno111As. I would like to know what percent of our con

tribution has been expended for things cataloged on pages 137 and 138.

EXPENDITURES ON AGRICULTURAL REHABILITATION SUPPLIES AND INDUSTRIAL REHABILITATION SUPPLIES

Senator RussELL. That shows in the House r<'port, Senator, a very large snm, $43,000,000, has been pent on agricultural rehabilitation supplies, and it is proposed t.o spend forty million and a half, is the appropriation we are considering now; $71,000,000 has been spent £or industrial rehabilitation supplies and $80,000,000 is proposed.

UNRRA, 1940 41

DIFFICULTY IN RECONCILING PURCHASE OF CERTAIN ITEMS WITH A RELIEF PROGRAM

Now, it is a little difficult to reconcile some of these items with a strictly relief program. I see here where you shipped out considerable wiring devices and electric lamps, 2 tons of electric lamps to Greece, and 1 to Poland, and 1 to Yugoslavia. They had no lighting fixtures in their homes. Was that the ai1swer for that?

Mr. vVEINTRAUB. Very largely that matrrial had to go into these assembly centers for di placed persons that had to be et up in Italy, also in Greece.

enator RusSELL. How did it happen that UNRRA bought those, and not the War Department? We have just been told that the "\Var Department was running all these displaced-persons camps.

Mr. FERGUSON. That is true in Germany. Mr. CLAYTON. That is in Germany, Senator Russell, and there is

very little expenditure or vel'y little problem of caring for displaced persons outside, of Germany. There has been some in Italy, but it ha not been very substantial.

Senator RussELL. This is Greece. Mr. CLAYTON. Yes; in Greece also.

ELECTRIC LAMPS

Senator Russell. Where yon say 2 tons of electric lamps. That a considerable number of electric lamps; 1 ton to Poland, l\fr. vV1nNTRAUB. There have been a very great number of Greek

citizens who were displaced; burned villages, and so on. Senator RusSELL. A displaced person has no house. vVhere is he

going to us those electric lamps~ Mr. WEINTRAUB. ,vell, shelters have had to be, provided. Emer

gency shelters had to be put up to house many of the people in burnedout villages, and some of these devices had to go in to supply light.

PLUMBING FIXTURES

Senator RussELL . .All those plumbing fixtures here now? Mr. WETNTR.\.UB. That is for the same purpose. Senator RussELL. Just for the buildings? Mr. WEINTRAUB. That is right. Senator RussELL. You have only shipped 43 tons, and 42 tons of

those went to Yugoslavia. Do you mean there are that many displaced-persons camps in Yugoslavia to need 42 tons of plumbing fixtures~ ·

Mr. vVEIN'I'RAUB. That isn't a very large tonnage, Mr. Senator. onator RussELL. It sounds considerable to me, for a country like

Yugoslavia. Mr. Wm:KTRAUB. Not in there--Senator RusSELL. I didn't know they had the displaced-persons

problem there that they had in Germany. Mr. "\VEINTRAUB. Those are not displaced l?ersons from foreign

countries, but people who were bombed out of the1r homes, whose homes were destroyed, and they had to be put up in temporary shelters.

Senator TrroMAS. There is one question on page 137 that I would like to ask.

42 UNRRA, 1946

Senator RussELL. There are a lot of people in this country who have no plumbing.

SOURCE OF TRUCKS FURNISHED YARLOUS COUNTRIES

Senator TnoMAS. This shows that we furnished over 15,000 trucks to the following countries: Albania, 131; Czechoslovakia, 4,737; Greece, 3,669; Italy, 229 · Poland, 3,927; Yugoslavia, 4,901; and the

NRRA operations, 30. kow, here is my question: ·were those trucks purchased on the open market as new trucks, or were they taken over from the Army or military authorities? -

Mi'. CLAYTON. They got them from the Army whenever they could, Senator, but they couldn't get many from the Army until recently. The Army wouldn't let them have them, so they had to buy some on the open market, and those trucks were one of the most essential things that U RRA furnished, becau e in many of the e countries the transportation facilities had been almost completely destroyed, and they had to depend upon trucks for moving food to the places where it was needed.

DIFFICULTY IN RECONCILI~·a PURCHASE OF CERTAIN lTEM WITH A RELIEF PROGRAM

SHIPMENT OF COPPER TO POLAND

Senator RussFLL. "Why was it nece sary to ship 1,230 tons of copper to Poland? What was the particular demand for it?.

Mr. CLAYTON. I am not familiar with that item. Do you know what that was, Mr. Weintraub.

Mr. WEINTRAUB. Yes. I don't know specifically, but I am sure that the general answer applie . That would be in order to reestabli h the communications within Poland, and repair other public utilities.

Senator McKELLAR. "\Vell, are we going to do that? Mr. 1VEINTRAUB. To repair with copper-Senator McKELLAR. The object of this-Mr. WEINTRAUB. To repair with copper-Senator ~foKELL.\R. Just a moment. Mr. WEIN1.'RAUB. I am sorry. Senator McKELLAR. Are we going to do that? The object of this

so-called charity i to put up telephone poles and establish communications and build trunk lines and things of that sort?

Mr. CLAYTON. I assure you-·-Senator McKELLAR. If it is that, why, I think we ought to call a

halt. We can't. I think such expenditures are unauthorized by any agreement that we have made about furnishing relief. Where i this thing going to stop?

Mr. CLAYTON. I assure you, Senator McKellar, that it is not UNRRA's function or intention to do general reconstruction work. 1VhereYer they have sent these relatively small shipments of things like plumbing or copper or thi11g of that kind, it has been where it was felt that it was neces ary t0 do some repair work or do some emergency work in connection with the distribution of supplies and--

UNRRA, 1946 43

PURCIIASE OF STEEL PLATES AND PIPE

Senator McKELLAR. Now look at this: Steel plates, sheets, and bars, Czechoslovakia, 36; Greece, 1,385 or 5,585. I can't tell which it is. And then there is steel pipe to Greece, 1,448. It is rather difficult for an ordinary man to understand how you connect steel plate and pipes and copper wires and fixtures with charity. This 1s a charitable thing. This was for the relief of human suffering. It was not to build up these countries at all.

Mr. CLAYTON. That is right, Senator McKellar. Senator McK:ELLAR. If you want to apply the same principle to

Japan and Germany and Italy, why, we shall be restoring those countries very shortly, and I do not think we ought to do that. Those countries brought on this war. They started this fight. They ouo-ht to restore their own.

Mr. c"LAYTON. Senator McKellar, I assure you that there is no intention of undertaking any relief programs in Germany or Japan whatever, and I would fight to the last ditch against it. So far as UNRRA is concerned now, none of this--

OTIIER ITEMS PURCHASED

Senator McKELLAR. If we rehabilitate them, why heaven-look here. Let us ju t read some more down here. Steel pipe, large quantities. Steel tubing, wire. Door bolts and strikes. I don't know what strikes are in that connection. Let's see. Why, door bolts and strikes, nails, tacks, staples, chain, bolts, nuts, screws, pipe fittings, glass product , miscellaneous glass products, pottery basic products, asphalt products. I suppo e that is for building roads. Abrasive basic products. I don't know what that is. Graphite and carbon basic products, rubber. Here we are; we have been short on rubber, so short on rubber we can hardly get it, and yet we are furn1shing rubber-fabricated material.

Lead ingots, babbitt metal, tin ingots, brass ingots, aluminum ingots. Zinc plate, refined. Nickel hot and ingots. Bronze ingots. Solder. POL, whatever that is. Coal. I can see where coal might keep people warm. That is different.

Telecommunication equipment. Road-repair equipment. Station-ary machine-repair shops.

I doubt if this is contemplated at all. I think you all have misconstrueLl the act. Instead of being an act £or relief o:f these poor people, you probably construed it to mean that we will restore these people not only with food and clothing but with prosperity and that we will build them up and make a great country out of them, a great--

Mr. CLAYTON. Senator--Senator McKELLAR. Now, that was not the intention. We can't do

that, gentlemen. We just can't do that. • Mr. CLAYTON. I agree with you a hundred percent, Senator McKel

lar, and I assure you that has not been done. In order to make the record clear--

Senator Mclu:LLAR. I am just reading from this report, in the House report here.

44 UNRRA, 1946

EXTRACT RELATING TO REHABILITATION FRO~I ACT APPROVING UNRRA AGREEMENT

Mr. CLAYTON. Yes, sir. In order to make the record clear on the subject, I would like to quote from the original joint resolution of the Congress authorizing this $1,350,000,000.

Senator McKELLAR. Yes, sir. I wish you would. Mr. CLAYTON. I refer to section 7 of the resolution, which read::; as

follows: In adopting this joint resolution the Congress does so with the following

reservation : That it is understood that the provision in paragraph 11 of resolution num

bered 12 adopted at the first se sion of the Council, referred to in section 3 of this joint re olution and reading "The task of rehabilitation must not be considered as the beginning of reconstruction-it is coterminous with relief," contemplates that rehabilitation means and i confined only to such activities as are nece sary to relief.

I just quote that to show that the Congre s was made aware and di<l have in mind that a certain amount of rehabilitation would be necessary i:f relief were to be made effective, and I believe that the UNRRA administration has applied this test to whatever industrial rehabilitation has been undertaken.

TOTAL AMOUNT SPENT FOR INDUSTRIAL REIIABILITATION SUPPLIES

The total amount which has been expended under the general designation of "Industrial rehabilitation supplies," out of the $800,000,000 which has been appropriated by the Congress, is $61,140,000, which is about 7½ percent of the total$ 00.000,000 appropriated.

enator Tnmus. Mr. Clayton, let me a k you a:r:iother question. Senator McKELLAR. Surely, but let me make this statement before

you do, if you will. We shall meet again on Monday morning, Mr. Clerk, at 10 : 30.

Mr. CLAYTON. 10: 30? Senator McluLI,AR. Will that be satisfactory to you? Mr. CLAYTON. Yes, sir. Senator McKELLAR. Mr. Clayton, before Senator Thomas asks his

question may I ask you this : Will you be good enough to look through this report of the House so far as plumbing fixtures and thin.gs like that are concerned, and let us see? We don't want to do anything but relief. We have cut down. It has been a year, G months after the war stopped over there. Now Senator Thomas want to ask you a question.

PRICES PAID FOR INDUSTRIAL AND AGRICULTURAL REIIABILITATION SUPPLIES

Senator Trro~us. Mr. Clayton, I happen to be chairman of the Senate Committee on Agriculture, and it naturally falls to the lot of my committee to lQok after the interest:;; of a vast number of farmers, some 25,000,000 or more. I find in the House hearing, pages 137 and 138, where the United States has furni heel the nations abroad over 15,000 gross long tons of tractors, over 15,000 gross long tons of trucks, and over 6,000 gross long tons of railway cars.

UNRRA, 1946 45

Now my question is this: Is there any doubt in your mind but what the makers of these tractors, trucks, and cars received, when they sold them, cost production plus a reasonable profit?

Mr. CLAYTON. No, Senator; I don't doubt it. Senator THOMAS. Is there any doubt in your mind that the trans

portation systems that transported the e articles from the place of purchase to their destination-is there any doubt in your mind but what they received the cost of production plus a reasonable profit?

Mr. CLAYTON. No, sir; I have no doubt that they did. Senator THOMAS. I have no doubt about it, and I assure you there is

no doubt about it. Mr. CLAYTON. No, sir; I think there is none. Senator TrroMAS. That is the foundation, Mr. Chairman, for the

amendment that I am going to offer sometime during the consideration of the bill.

Senator McKELLAR. Mr. Clayton, this is off the record. ( A discussion followed off the record.) Senator TrroMAS. Mr. Chairman, Mr. Clayton has not been in

charge of this organization until very recently, and knowing him as I do, I have every confidence that from then on, if it has been bad in the past, it will be very well scrutinized.

Mr. CLAYTON. Thank you very much, sir. (The :fo11owing was presented for the record:)

HEALTH AND SANITATION PROJECYrS

(Seep. 20)

The United Nntions Relief nnd RPhabilitation Administration does not by its<>lf operate projPCtR for the rleaning of cesspools and such type of sanitation projects. It does, however, assii,:t member nations to estnblish health and sanitation projects, has provided mPdicnl nnd technicnl assistnnce in the development and su11ervision of such projects and has furnished supplie.. Fo1· example, in Ital~• UNRRA has ai:.siste<l in the reduction of mnlaria through providing DDT and through technical assistunce in helping the Italian Government dust swump areas. Similar projects have been developed in Greece. In China, for example, UNRRA physicians helped Chinese public-health officials in combating and eliminating an inripient cholera f'pidemic. The UnitPd States Public Health SPrvice has made available to UNRRA mnny doctors who nrf' helping the war-devastatf'd nations rPstore a minimum of public health and s'lnitation work.

In addition, U~RRA has furnished large quantities of health and medical supplies for use in hospitals, camps, and other centers.

Shipments of health and medical swpplie.~ to liberated areas, through Sept. 30, 1945

[In gross long tons and thousands or United Statrs dollars!

Country Tons Landed value

(1) (2) (3)

Total------------------------------------------------------------------·-· 11,315 17,548

Albania.. . . _____ _______ ·---------·-----·--------------- -------------------·- 134 232 Czechoslovakia. _____ . __ .. _____ ._ .. __ . ______ -- -- ___ -- -- -- . _. _ -- . _ -- -- --- . - . ----- _ 1, 92,5 3.024 OrN•ce .. _. ________ ···---------- -------······-·--- ----· ----------------------· I , 245 2.093 Italy _________ ... _. ___ . __ ... _. _______ -- -- -- -- - . -- - . ·- - -- . -- - . -- - . - . --- ---- - -- - . - . 1,341 ), 207 Yugoslavia. ___ .. ___ . _. ____ ... _____________ . - _. ___ . _ .. __ --- ... - . ___ -·-- _____ . _. _. 3.086 4,701 Poland ._ _ _. __ . _. _. _. _________ . _. _____ . ___ . ______________ . ____ . ___ .• __________ _ 3,353 6.817 U RRA operations ------· ----------------------- ----- -------------------------China._._._._ .. ___ ._. _____ . ___ . ___ -- -- - . - . -- - . - . ___ . ------ ---- -- -- - . -- - . --- . -- . -

37 86 194 388

46 UNRRA, 1941}

COMMITME TS FOB SilELTEB l\1ATEBIALS

(See pp. 20-21)

As of November 15 there were commitments for material to be used in shelter , as follows:

United United States Kingdom

Greece... . .............. . . ...... . .......................................... . ... $1, 693, 000 $720,000 Albania.. . ...... .... .......... ..... . ............... . .......... . . . ............... 142, 700 80, 000 Yugoslavia...... .. . ..... ...... ..... . ............ . ....... .. ...................... 664,000 1,000,000 Czechoslovakia. . . ...... . .. . . .... . ..... . .............. .. ....... .. ...... . ....... . 223, !CO I, 000, 000 Poland......... . . .... ....... .. ........... . . ............. . ..... .. . .... . .......... 267,000 !, 200,000

1----1----Total....................... . .. . . ....... . ........... . ... .. . . .... . ... . .. . . .. 2, 891.600 4,000,000

The commodities include such items as roofing paper, nuts and bolts, rough hardware such as hinges, spikes, screws, metal lath, ome strnctural steel, window glass and glass substitutes, lumber, and small quantities of pipe, and household electrical fittings ( conduit, wire, S\\'i t('hes, etc.).

In adclition to the above, an amount of approximately $2,000,000 has been committed for hand tools, such as hammers, screw drivers, saws, chisels, etc. , thus bringing the over·all committed total to $8,891,600. The hand tools will be of invaluable assistance in the utilization, not only of the material supplied but of indigenous material and in the repair of existing dwellings,

(Whereupon, at 1 : 05 p. m., an adjournment was taken until Monday, November 19, 1945, at 10 : 30 a. m. This meeting was subsequently postponed until Tuesday, ovember .::-0, 1945, at 10 : 30 a. m.)

UNITED NATIONS RELIEF .A.ND REII.A.BILIT.A.TION ADMINISTRATION, 1946

TUESDAY, NOVEMBER 20, 1945

UNITED STATES SENATE, , SUBCOl\BIITrEE OF TllE Col\11\IITTEE ON APPROPRIATIONS,

Washington, D. 0. The subcommittee met at 10 : 30 a. m., Hon. Kenneth McKellar

( chairman o:f the subcommittee) presiding. Present: Senators McKellar (presiding), Hayden, Tydings, Thomas,

McCarran, and Ball. Senator McKELLAR. The subcommittee will come to order. We are

considering House Joint Resolution 266, to appropriate $550,000,000 :forUNRRA.

Mr. Secretary, have you anything :further to say? I reckon we shall have some members o:f the committee here in a minute. Have you anything :further that you wish to say?

STATEMENT OF HON. WILLIAM L. CLAYTON, ASSISTANT SECRETARY OF STATE, ACCOMPANIED BY DONALD S. GILPATRIC, CHIEF, WAR AREAS ECONOMIC DIVISION, STATE DEPARTMENT, AND SAMUEL T. PARELMAN, ASSISTANT TO DEPUTY FOREIGN LIQUIDATION COMMISSIONER

PROPRIETY OF USE OF UNRRA FUNDS IN ITALY

Mr. CLAYTON. Mr. Chairman, I should like to revert to the question as to the propriety o:f the expenditure of UNRRA :funds for assistance in Italy. · Senator McKELLAR. Yes, sir.

LETTER FROM UNDER SECRETARY ACIIESON

Mr. CLAYTON. We discussed the matter with Mr. Acheson, Under Secretary o:f State, who was the United States delegate on the U RRA Council at the time that action was taken in Montreal in September 1944.

Senator MCKELLAR. Yes. Mt. CLAYTON. And he has written a letter to you on this subject,

which is intended to explain and clarify the situation. With your permission I should like to read it--

Senator Mclu:LLAR. I wish you would. 79254-45-4 47

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