If the directors of the other 86 programs in the Nation had the privilege, as I have had this morning, of appearing before you, they, too, would have feature stories, as we call them in rehabilitation, perhaps more appealing than those I have just presented to you.

Although the growth and expansion of the vocational rehabilitation program during the past 6 years has been dramatic and impressive we who administer the program in the States are keenly aware of the fact that we have not yet attained what we, along with the Federal Security Administrator, believe to be the minimum program, namely, to rehabilitate the 250,000 men and women who become disabled hrough illness or injury every year so that they can be restored to the most nearly normal life and work of which they are individually capable.

Mr. Michael J. Shortley, director of the Office of Vocational Rehabilitation, in his testimony before the subcommittee on aid to the physically handicapped (79th Cong.), specifically pointed out that the present vocational rehabilitation act, as amended, provides the necessary framework for a sound, basic program which would make possible the rehabilitation of about 80 percent of the disabled without the establishment of additional specialized facilities. Our first urgent and immediate need, therefore, is adequate financial support of our already established program of services to the disabled. The appropriations by the Congress for the fiscal year in which we are now operating is from 20 to 25 percent below that necessary to carry out the State-Federal program at the level to which it has already developed. Failure to finance adequately this basic program necessitates a reduction in personnel and services and retards the rate at which the program could and should progress toward the achievement of the goal of providing necessary rehabilitation services to our disabled men and women. This reduction of the program is particularly disturbing at this time when the demand for services on the part of the disabled is accelerating at a rapid rate.

The second area in which program needs are acute is appropriate legislative authority to establish the necessary rehabilitation centers and facilities and the employment opportunities for the severely disabled, who constitute upwards of 20 percent of our disabled population. It has long been recognized that this portion of the disabled require special medical, psychiatric, and therapeutic facilities. Further, there is the need for special employment and training facilities to furnish conditioning for all of the mentally and physically handicapped. Legislative authority necessary to meet realistically the needs of the severely disabled and to remove such limitations as exist in the current program are contained in H. R. 5370, H. R. 5577, and H. R. 5485. The provisions of H. R. 5370 and the identical bill, H. R. 5485 differ from H. R. 5577 only to a relatively minor extent. We believe that your committee as a result of careful study will reconcile these differences. The States' vocational rehabilitation council is in complete accord with the basic provisions of these three legislative proposals, and urges that they receive your favorable consideration. Thank you very much.

Mr. KELLEY. Are there any questions? If not, we thank you very much, Mr. Sherer.

The next witness is Dr. Kessler.

STATEMENT OF DR. HENRY H. KESSLER, NEWARK, N. J.

Dr. KESSLER. Mr. Chairman and members of the committee, my name is Henry H. Kessler of Newark, N. J. I am an orthopedic surgeon. I should like the privilege of submitting a written statement to the committee, but at this time I should like to emphasize the remarks made by previous speakers with respect to the importance of establishing rehabilitation centers.

Mr. KELLEY. Without objection, such statement will be received for the record and included therein.

Dr. KESSLER. Thank you.

(The statement above referred to is as follows:)

STATEMENT OF DR. HENRY H. KESSLER, DIRECTOR OF THE KESSLER INSTITUTE FOR REHABILITATION

Mr. Chairman and members of the committee, my name is Henry H. Kessler. I am an orthopedic surgeon practicing at 53 Lincoln Park, Newark, N. J. I am president of the National Council on Rehabilitation, an organization of 50 national private agencies interested in the rehabilitation of the physically handicapped. I am also president of the International Society for the Welfare of Cripples. This is an organization of national societies in different countries interested in the welfare of the crippled and disabled throughout the world. I might add that I am the medical director of the Kessler Institute for Rehabilitation at West Orange, N. J., a nonprofit institution devoted to the treatment, education, and research in the field of rehabilitation. For 22 years, from 1919 to 1941, I served as assistant medical director and medical director of the New Jersey Rehabilitation Commission terminating my connection immediately after Pearl Harbor to enter the service of the United States Navy, where I served for 5 years during World War II.

For 30 years I have been actively engaged in the rehabilitation of the physically handicapped. During this period I had an unusual opportunity to observe and study the problems of the disabled in this country and to witness their agonies and triumphs as they struggled valiantly yet patiently until the force of circumstance tipped the balance in their favor. I have furthermore had an opportunity to observe and study the Federal-State rehabilitation program with its victories and failures over this same period. This record was indeed a victory over the prejudices and apathy of the public; a victory over the confusion, the pessimism, and despair of the physically handicapped; a victory in demonstrating, however fragmentarily, the practicability of the social measures for the utilization of manpower.

It was a failure however in the relatively small number rehabilitated, in that it had broken only the outer defenses of tradition, cherished infamies, calumnies, and prejudices. It was a failure in its limited objectives. The restoration of the crippled and disabled from war and peace had been carried out on a piecemeal basis. The potential industrial and military value of the handicapped were given too little consideration. The methods employed were cast in the mold of nineteenth century paternalism. Maximum success was considered achieved when the crippled or disabled were returned to their former status. This meant frequently returning them to a state of ignorance, illiteracy, or lack of vocational skill.

The year 1943 was the turning point. Congress displayed great wisdom and foresight in correcting these shortcomings by an expansion of the program that changed the entire connotation of rehabilitation. Rehabilitation assumed its proper position as a creative process in which the remaining physical and mental capacities of the physically handicapped are utilized and developed to the highest efficiency. Its objective became accepted as an organized and systematic method by which the physical, mental and vocational powers of the individual are improved to the point where he can compete with equal opportunity with the so called nonhandicapped.

In accepting this responsibility provided by Congress, the Office of Vocational Rehabilitation of the Federal Security Agency pressed every issue and explored every avenue of help. It seized the opportunity to develop a constructive program developing techniques and pursuing the roads of general and special edu

cation of the patient, the public and the technical and professional personnel in the methods of adapting the handicapped to productive earning capacity. It stimulated the States and the communities to accept their local responsibility in the welfare of the handicapped. Here in the final analysis is the true test of any rehabilitation efforts. Government can furnish grants in aid, counseling, standards, good planning, broad educational and promotional help, but in the final analysis the success of any program must depend on the interest and attitudes of the community. It is for this reason that I would urge your committee to avoid the mistake of excessive centralization of control of this program. Federalization of this activity by too great a concentration of authority and initiative in Washington would destroy the initative and effectiveness of the program on a local level.

May I remind the committee that long before Government assumed its present role, the relief and rehabilitation of the physically handicapped was a fundamental concern of private charity and philanthropy. As Government has taken over more of these functions many of these agencies have disbanded. However, a great many still remain although perhaps modified in both structure and purpose. Many new organizations on local and national levels have been formed. Some of these organizations still continue their work of relief and rehabilitation, but the majority have confined themselves to special types of services. One cannot overlook the continued interest and financial support of large fraternal organizations like the Elks and the Shriners in the field of handicapped children.

The work of these private agencies is exceedingly important, one might say almost indispensable, since there are and always will be serious limitations to governmental service. Changing administrations in Government bring new policies and personnel, interrupt continuity of services, and seriously modify budgets. In the field of experiment, demonstration, and research, the private agency operates to a greater advantage than Government which is reluctant or unable because of legal restrictions or limited budgets to undertake investigation in special projects that bring solutions to the many problems of dealing with the disabled. The Government, therefore, cannot do the whole job. It must be supplemented by the work of the private agencies.

For many years an increasing number of private agencies have been established to promote the cause of the physically handicapped. These organizations represent the interest of all categories of disability, including epilepsy, heart disease, the blind, the hard of hearing, the amputee, multiple sclerosis, cerebral palsy, and poliomyelitis. Since a national program of rehabilitation must consider the combined actions of private and public agencies, these voluntary organizations should be encouraged and supported.

Mr. Chairman, other witnesses have already fully described the need for expanded services for the handicapped and I wish, therefore, to merely add my voice to their recommendations. There is one field in which I have had special experience and knowledge and I feel justified in emphasizing this feature of rehabilitation services. This is the field of rehabilitation centers. The time will come when every community will have a rehabilitation center. Just as every progressive community boasts of meeting its local needs with a police station, firehouse, and hospital, so it must add the rehabilitation center. This center fills a need that cannot be met by existing institutions. Hospitals are too crowded and too expensive to carry out rehabilitation work. Furthermore, the whole orientation of the rehabilitation center is away from illness and treatment and directed toward increasing working and earning capacity. Perhaps an illustration will be of value.

A 30-year-old coal miner, the father of a 9-year-old girl sustained a fractured spine and complete paralysis of both lower extremities below the waist. He developed such extensive bed sores that it was necessary to amputate both legs close to his hips. He also developed stones in both ureters which were unsuccessfully operated on leaving him with a draining abdominal urinary fistula.

Today this young man despite his paraplegia, bed sores, urinary fistula, and bilateral high thigh amputation walks with the aid of artificial limbs, all wounds healed, his fistula closed, and the stones removed from both ureters. Team work did this. The neurosurgeon, the urological surgeon, the orthopedic surgeon, the plastic surgeon all worked togeher. This is the basic principle in the treatment of the severely disabled. But of further significance is the fact that special facilities were provided in a rehabilitation center for the adaption of this miner to the routine pursuits of life. Surgery is not enough for the amputee. The surgeon must work cooperatively with the limb maker, the physical therapist,

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the occupational therapist, the vocational counselor, and the training officer. All their energies must be directed toward a fixed program including complete psychological and physical restoration of the patient, his vocational guidance and training and his final placement in work consistent with his capacities This integrated program which forms the basis of rehabilitation can well be applied to all sick and injured, and should replace the old concept of cure. A man is not cured unless he reaches his maximum physical, mental, vocational, and social usefullness. The rehabilitation center provides not only the facili ties but the professional and social climate to effect these results.

Mr. Chairman, I have mentioned in my opening that my experience in rehabilitation covered not only the civilian disabled but also the war disabled. It was my privilege to have served in the Navy during World War II for 5 years. During that period the casualties of the war in the Pacific were brought to the United States Naval Hospital at Mare Island, Calif., where a comprehensive and integrated program of rehabilitation was established for amputees and otherwise disabled. It was a stimulating opportunity for me to bring to the war disabled the benefits of the lessons I had learned in the management of the civilian disabled the previous 22 years.

I do not believe that the Congress or the general public or the veterans themselves are aware of the fact that they have been the beneficiaries of the progressive technical developments and the organized methods employed in the rehabilitation of the civilian disabled during the period between World Wars I and II. In the pursuit of this development the Office of Vocational Rehabilitation has been most zealous in carrying out its aims and purposes, limited only by appropriations and congressional policy. The further expansion of the func tions of the rehabilitation program will assure not only the civilian disabled of additional service but indirectly the veteran and war disabled will profit by it as well. These aims and purposes are included in H. R. 5370 and the administration bill 5577, which I am happy to endorse.

Mr. Chairman, one of the deep disappointments of World War II was the discovery of the low state of national physical fitness. It came as a distinct shock to the Nation to learn that despite its standard of living, 40 percent of its selectees for military service were rejected because they could not meet the standard physical requirements. What was more, despite the screening out of those with emotional disorders the highest rate of discharges from the armed services were from neuropsychiatric causes.

The first reaction to this discovery was a feeling of frustration. Would we be able to fulfill the requirements of military service with able-bodies men? The second reaction was one of self-reproach. What had we failed to do? For years we had boasted, not only of our huge resources, but also of the advantages of our way of life, our dedication to sports and athletics, our low morbidity and mortality rates. When we examined the fruits of our labors, we found them shot through with decay and disease. Our ability to meet the great national emergency of war by adequate manpower was seriously questioned.

We met the problem in our usual pragmatic way by selecting our so-called physically fit for military duty and relegating the unfit, the 4-F's, to a position alongside the women (who have traditionally been considered as physically inferior) and the superannuated, to man the defense factories and carry on the battle of production. The record of production achieved by these apparently substandard groups is now history. But this record, Mr. Chairman, will soon be forgotten and the physically handicapped again be abandoned as unfit and undesirable. For the greatest obstacle to the rehabilitation of the physically handicapped is public prejudice. The fundamental and deep-seated aversion is so insidious and powerful that many outwardly sympathetic persons do not realize the basis of their inwardly truculent attitude. Rationalization appears on all sides. Is there no way we can change this public attitude? Can we not demonstrate the value and effectiveness of these crippled and disabled persons? Can we not make reasonable people understand the important role that they play in our national and international life, that we have underestimated the potentialities of our physically handicapped population; that we have neglected them as an indispensable reservoir of manpower; that we have overlooked the possibilities of these human resources and how they can be increased by the technics and processes of rehabilitation; that we have ignored the great spiritual forces unleashed in the act of restoring the crippled and disabled to independence and economic security, and finally, that we have missed the opportunity for developing international understanding and good will through the medium of constructive rehabilitation measures?

Mr. Chairman, the record has been there for all to see. Twenty-five years of organized effort on behalf of the disabled have produced only limited results. The war periods were favorable, not because of a change in attitude, but because of need. Certainly we must continue this struggle against the monster of prejudice. Certainly we must arouse the general public and the professions to their responsibilities. But fundamentally and in the final analysis, they cannot be trusted. There is only one hope for the disabled: rehabilitation. Train them and develop them so that they can stand on their own. Provide them with the physical and vocational equipment that will enable them to face the challenge of competition. It was Balzac who said that most of us are just ordinary people seeking extraordinary destinies. The physically handicapped are extraordinary in that they seek only an ordinary destiny. This then is their challenge to us. Give us the opportunity to realize that destiny.

Dr. KESSLER. Reference has been made to different categories of disability, but perhaps at this time I should refer to the needs of the amputees.

During the war there were 18,000 service casualties that resulted in amputation, but during the same 412-year period, 120,000 civilians lost their arms and legs as the result of street accidents, industrial accidents, disease, and congenital deformities.

A fairly elaborate program was available for the needs of the military service casualties, but no elaborate and adequate program existed for the civilian amputees.

Perhaps I can best illustrate by reference to several cases. A mother brought her 18-year-old boy to me who had lost his leg below the knee when he was 4 years of age. He came in on crutches. I asked the mother where the boy's artificial leg was. She said that he had never had one. I asked, "Why not?" She said that the doctors and the neighbors said that he did not need any; that he could wait until he grew up.

There was 14 years wasted, 14 years during which time this young man was condemned as a cripple, an outcast, retarded socially, vocationally, and educationally, and in every other way. More important, there were 14 years wasted during which time this boy might have become adept in the use of his artificial limb.

In other words, there was no facility, no center, where proper counsel and advice could be given this young boy.

Mr. KELLEY. May I interrupt you there, Doctor? That is true with our program today-there are no facilities even now.

Dr. KESSLER. Exactly.

Mr. KELLEY. I think the report of the former subcommittee brought that out very specifically.

Dr. KESSLER. I could go on quoting any number of cases.

For example, a mother brought her little child from Arkansas all the way to New Jersey to my rehabilitation center. This child was born without arms and without legs. The child was nothing more than a head and a torso. There were three questions that this woman wanted answered. First of all, "Was this my fault?" I could reassure her and indicate to her this was nothing more than a biological accident, a freak of nature. She felt better.

Her second question was: "What can you do for my child?"

It was obvious we were faced with an almost impossible problem. However, in this center there were available other patients who had been helped that might serve as a basis for the management of this child. One of the patients in this center was a man who lost his arms