problem. The United States Public Health Service, supplementing its prewar programs with war programs, has attempted to face the entire problem. The proposed bill, S. 190, is in a sense an extension of the specialized research programs, but still does not squarely face the total problem. It does not provide for an over-all research agency in the health field, an agency much needed, as is evidenced by the success in the research in the specialized fields of cancer and infantile paralysis.

INSTITUTIONAL RESEARCH

In the drafting of this legislation, definite assurance should be given that it will stimulate research in educational institutions rather than unduly centralize it increasingly in the Federal Government. In practically every institution of higher education, and certainly in each of the dental schools in the United States, are individuals who by disposition, interest, and ability can develop and carry forward significant research problems. For certain aspects of their work, the schools themselves provide a unique laboratory; yet, for the most part, such research is now at a minimum due to the overloaded teaching schedules and administrative responsibilities of the members of the faculty of such institutions. To assure adequate distribution of funds, there should be written into this bill a statement indicating that the majority of such funds appropriated must be distributed among the institutions of the Nation on the basis of projects approved as significant in the national interest and on the abilities of the institutions to carry on such research. If such a statement is not included, there is the danger that the research fund will be increasingly used for the development of a centralized Federal program. The committee can make a significant contribution to the whole field of research by assuring fair and equitable distribution among the educational institutions of the Nation.

Specifically by recommendation, on page 8, line 3, there should be added the following:

Provided, That not less than 50 percent of the sums appropriated shall be distributed among the educational institutions as defined in section 4 (c) on the basis of the significance of the project in the national interest and the facilities of the institution to conduct such research.

There is another aspect of this problem which I realize does not fall within the discussion of these bills, but one which should be given immediate consideration. I refer to the increasing gap in the training of scientific and professional personnel. The normal capacity of dental schools is 3,000 for the first-year class. A report from the American Dental Association indicates that there will be less than 400 freshmen in this year's entering class. An equally serious situation exists in other fields both of health and technology. It appears that such legislation as the present bill may be of little value unless we begin now to stop this gap in training and provide for student deferment on a quota basis, either by legislation or by changes in the present policies of Selective Service.

The American Council on Education and the National Research Council have prepared a bulletin which has attempted to bring together the data on the seriousness of the shortage in the scientific and professional fields, and which definitely urges, either by changes

in administrative policy or by legislation, that students' deferment be established on a quota basis in order to stop this gap and provide the personnel for such a program as S. 190 makes provision for.

In regard to S. 1099, my comment will be brief. This legislation is in keeping with the trend of legislative action over the past quarter of a century, through which the Federal Government has increasingly subsidized State and community educational agencies in rendering specialized service. Such legislation inevitably raises an old but significant problem in education-the relationship of the Federal Government to non-tax-supported institutions or to individuals who are attending such institutions. There has gradually developed a distinction between assistance to institutions and assistance to individuals enrolled in such institutions. It is not necessary to argue whether or not this distinction is a real one, but it is significant to note that it has been a basis upon which some of the programs of Federal aid have been made available to private education. It has been argued, and with justification, that the Nation's responsibility is to all of its children and to all of its young people without discrimination as to the type of institution in which they are enrolled.

FUNDS FOR PRIVATE SCHOOLS

It is not clear in the phraseology of the bill as now worded whether such health programs would be restricted to tax-supported institutions in those States in which State funds, which include Federal funds appropriated to the States, cannot be allocated to private educational institutions. More than half of the States in he Union, as I am sure this committee is aware, now prohibit, either by constitution or by legislative acts, the expenditure of public money in private institutions within the State. If it is the judgment of this committeeand I am glad that it appears to be that dental programs in schools and colleges should be subsidized on the basis of increasing health services to individuals regardless of the type of control in the institution in which they are enrolled, then it will be necessary to include in the legislation one of two possible ways of circumventing these State restrictions. One is to include some means to provide for a direct contractual relationship between a Federal agency and an individual school or college; the other is to provide specifically that such funds may be allocated on a contract basis between the State and the individual institution, as is now done in regard to vocational rehabilitation. This is a distinctly legal question, and I am not qualified to render an opinion as to whether or not it is cared for by the present phraseology in line 12, page 2, "to educational institutions and other nonprofit agencies," and in line 8, page 4, which provides for payments to "each State or other participant." However, it is, in my judgment, imperative that such a comprehensive program of dental care be made as available to children and young people in private as in public educational institutions, and as such I would earnestly recommend that this be analyzed from the point of view of whether or not that phraseology is adequate to provide for such distribution. This brief statement can be summarized in just a few sentences. I am in favor of both of the proposed bills provided they are conceived as a part of the larger program involving the whole field of research, and especially of research in the problems of health. It is essential,

however, that the bills specifically state that such research shall be distributed among the educational institutions with only a small proportion of funds available for the carrying on of the Federal aspect of the program. The proposed bill for the extension of health services should definitely provide for the use of institutional facilities wherever they are available, and for all children without regard to the type of control of the institution in which the individual is enrolled.

Senator AIKEN. I think Dr. Brown brought up a point which I raised day before yesterday as to the availability of these funds for nonpublic use in nonpublic schools. I recall I asked that question of one of the witnesses, and as I understood the answer, he stated that it was the intention of the American Dental Association in drawing the bill to have the distribution of funds restricted to use in public schools or to investigations or inspections in public schools. I think, as Dr. Brown says, that is extremely important. In some States, most of the work would undoubtedly be done through nonpublic institutions, and it should be made available to them.

In one of the hearings on the education bill, of which I was one of the sponsors, on my part for the express purpose of improving the health of our children, we learned that my own State was the only one in the Union that had unrestricted use of such funds, if expended by the school boards. However, I don't know whether the State health departments have any restrictions or not. I assume that the Federal Government, the Surgeon General, would cooperate with the various State health agencies, and it may be that they do not have such restrictions, but certainly a good deal of our most important research work has been done through nonpublic institutions.

Dr. BROWN. That would also be true in terms of the health services. Approximately 1 in 5 children in the elementary schools are enrolled in private schools.

Senator AIKEN. We should make it very plain in this, Senator Pepper, that money could be spent where we could get the greatest value received for it, and as far as the health of the children themselves, the health of a child is worth as much to this country regardless of where he attends school.

Dr. BROWN. That is right.

The CHAIRMAN. I can see a difference in the principle involved where it is a matter of giving health care from the case where it involves education.

Dr. BROWN. That is right. This distinction has grown up very definitely, provided it is a service to the individual, such as transportation to and from the school, or school lunches as contrasted with subsidy to the institution as such for its total program, and this certainly would fall within the first of those two categories.

Senator AIKEN. In my State, we pay transportation of the child to school. I think in most subdivisions of the State, regardless of what school he attends in a small town, where they have to leave town to go to high school, if they can go to a private school and get an education which meets the requirements of the State, we pay the tuition to that school. I think it has worked out very well, and while we don't have much money in our State, I think we get as much per dollar spent as any State in the Union gets. It is immaterial to me whether the

health of the school children is taken care of through one agency or through another, so long as it can be done.

Dr. BROWN. New Jersey is more liberal than many other States of the Union in that.

Senator AIKEN. I am from Vermont. Vermont is more liberal than New Jersey.

Dr. BROWN. I am certain it is. I just don't know the situation in Vermont.

Senator AIKEN. The only thing I have to say about New Jersey is that when we get our teachers trained, New Jersey offers them twice as much to come down and teach.

Dr. BROWN. But think what that does for New Jersey.

Mr. MALMBERG. Did you wish to introduce any part of the bulletin into the record?

Dr. BROWN. I should think the part dealing with dentistry might be written into the record. It is prepared by the American Dental Association.

The CHAIRMAN. We will receive for the record the part of the special bulletin of May 28, 1945, headed "The Training of Dentists." (See appendix, exhibit 8, p. 135.)

Thank you very much Dr. Brown. We appreciate your coming.

The CHAIRMAN. Dr. Kitchin, will you give your name and address and capacity in which you come?

TESTIMONY OF DR. PAUL C. KITCHIN, SECRETARY, DENTAL SUBSECTION, AMERICAN ASSOCIATION FOR THE ADVANCEMENT OF SCIENCE

Dr. KITCHIN. Dr. Paul C. Kitchin. I am representing the dental subsection of the American Association for the Advancement of Science.

The CHAIRMAN. Your address?

Dr. KITCHIN. Columbus, Ohio, Ohio State University.

The CHAIRMAN. Will you just give us a sketch of your background, Dr. Kitchin?

Dr. KITCHIN. I have the dental degree from Ohio State University and a master's degree from Michigan State College. I am at present professor of dental histology and embryology at Ohio State University, with research thrown in.

Dentistry is a phase of public health administered in this country by about 70,000 members of the dental profession, and the point that I have in mind and wish to emphasize is that their time is entirely taken up in attempts to repair the ravages of two destructive processes about the cause of which they know little. They do know a great deal about the repair process and the materials that are utilized therein, and they know more about it than any similar group in the world. This outstanding ability has been heightened in no small degree by a cooperative effort of the American Dental Association and the National Bureau of Standards. But the point that I wish to emphasize is that the repair process is time and work consuming and therefore expensive, and while perhaps 90 percent of our people need it, only about a fourth of them get the benefit of a dentist's repair service; the other three-fourth do not. Some of them cannot afford

it; some are kept away by an ungrounded fear, and many have not been made sufficiently aware of the general health value of a wellkept mouth. If these barriers to adequate dental service could be removed, there would still not be enough dentists to care for all of our people, if such care is limited, as it now is, to efforts to repair the damage of uncontrolled dental disease.

"BETTER HEALTH IN MORE KNOWLEDGE"

Better mouth health for more people lies in more knowledge concerning the causes of tooth decay and the loss of the structures which support the teeth, and such knowledge will come from the hard work of young men and young women who have been well-trained in fundamental sciences and whose interests are kept in the dental field. Such workers must be attracted, subsidized, and rewarded. Hence, the necessity for a generous public support of an endeavor which has had little of such recognition to date. Adequate control of dental ills rests on the widespread application of preventive knowledge and not on the repair of uncontrolled disease.

The information which has and will come from well-directed research must be made known to the public and to the profession regardless of its effect on any vested interests. This can be brought about by making authentic dental health programs a part of the Public Health Service activities.

As a factor in such, it is the opinion of the subsection on dentistry of the American Association for the Advancement of Science that the amendment to the Public Health Service Act which has been proposed by this committe is indeed well chosen.

With less emphasis necessary on the intricate detailed work of repair for the individual patient and the possession of more knowledge of the possibilities whereby dental ills may be prevented, the profession will be in a much more advantageous position to render more preventive service to more people with the consequent partial elimination of time-consuming and sometimes not too satisfactory repairs. Human nature being what it is, reparative service will always be necessary, but it should not and cannot constitute the principal weapon in the war on dental disease.

Any dental public-health program must be centered on children. Every possible means of general prevention must be utilized in order to minimize the individual aspects of treatment. Adults represent a backlog of neglect and disease which is a terrific barrier to any general dental program. They can be helped only to a limited degree, and only after the dental ills of children have been cared for in preparation for a generation of adults whose mouth health maintenance cost will be thereby minimized.

The subsection on dentistry of the AAAS is 100 percent behind the bills which have been presented by this committee. I do think that we should remember, however, that the principal object of S. 190 is dental research, and therefore at least a half of the yearly appropriation for this purpose should be allocated to those laboratories and those institutions which are already in the field of dental research and are able to make good use of such funds.

The CHAIRMAN. You suggest that as the principle; you are not necessarily suggesting changes in the bill?