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Fairbanks now. And why they should stop at Fairbanks, I don't know. Why not bring it to Nome?

We are informed that across the Bering Strait Russia has a road across the continent. You can drive from Moscow to tidewater on the Bering Sea. I don't know. You members of the committee probably know more about that than I do.

Mr. O'BRIEN. I doubt it.

Mr. Young. If they do, it is something to think about. If peace comes and we get rid of the cold war, Nome will become an important traffic center, not only for air but for tourists. If there is a road across the other side of the strait, if the road is completed to Nome and Taylor from Fairbanks, there will be a stream of tourist traffic that we have never imagined. The United States has become travel conscious, they have become vacation conscious, and there would be thousands of tourists make this trip because they are curious about the country across the strait.

The development of the road system in the second division will solve many of the other problems of the division. The road construction will provide much needed income for the native population as well as the white and will bring about a revival that will boost the general economy of this part of Alaska.

Two weeks ago in the Saturday Evening Post there was an advertisement about roads. I don't remember the exact text of it, but it was to the effect that good roads are a good investment. I think they are, an investment in the country. They are an investment in the future.

So ladies and gentlemen, when you turn in your report or your recommendations, we urgently request that you give this consideration: that when our request for funds for the roads in the second division goes before Congress, when the request for funds for the NomeFairbanks trunk highway are presented that you give it consideration, that it is a good investment and as an investment it will pay dividends again and again.

Mr. Dawson. It is my understanding they are now undertaking a survey of the Taylor road, are they not?

Mr. Young. They are, yes, sir. That is true.
Mr. Dawson. You have a staff here in Nome at the present time.
Mr. Young. That is true.
Mr. Dawson. I met them down at the hotel. They are working

You estimated the cost of highway construction here as ranging from $15,000 up to what?

Mr. YOUNG. $100,000.
Mr. DAWSON. A mile?
Mr. YOUNG. Yes.
Mr. Dawson. What type of highway?
Mr. Young. Not of highway caliber as you know it in the States.
A road that you can drive over in the summertime or in the winter-
time when snow conditions will permit. It is simply a road that you
can drive over.

Mr. O'BRIEN. Thank you very much, Mr. Young.
Dr. Langsam. Give your full name, Doctor.

on it.

STATEMEMT OF FRED M. LANGSAM, M. D., NOME, ALASKA

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Dr. LANGSAM. My name is Fred M. Langsam, and I am the only civilian doctor here, an administrator of the local hospital.

Mr. ABBOTT. Do you have a prepared statement, Doctor?
Dr. LANGSAM. Not a written one; no.
Mr. ABBOTT. Will you proceed in your own way, then?

Dr. LANGSAM. I would like to, if I may, say something about our local medical facilities, our chief medical problems, and finally, something about mental health.

Our local facility is a 25-bed hospital, of which 10 beds are reserved for tuberculosis, with the remaining beds for general medical and surgical cases and for obstetrics.

Mr. Dawson. Are the tuberculosis patients isolated?
Dr. LANGSAM. Yes; in the tuberculosis wing.

The hospital, as such, seems to be fairly adequate from these figures. You know that we figured the business of a hospital by the number of patient-days. One patient in the hospital for i day is considered a patient-day. Our potential patient-day figures amount to 9,125. That counts newborn infants.

Our patient-days for 1954, according to the hospital statement of reimbursable costs on the Federal form-for 1954 this figure was 6,248. So we did not use our facilities to capacity, because there are times when they are crowded and times when they are slow, just like any other business.

I think the hospital is adequate. Also, it is very well equipped. We have just been surveyed by a man from the creditation board, the joint creditation board of the American Hospital Association. We have not yet received the official results from that, but the man was very favorably impressed, and I am keeping my fingers crossed. I would, if it were not for the fact that this institution is under the auspices of the women's division of the Board of Missions of the Methodist Church, and I wouldn't like to introduce any superstition for that reason.

Speaking of this very wonderful group-I am not a Methodist, so I think I am more objective than I would be if I were—I would like to to mention they gave us in cash outright approximately one-third of the money that was required to run the hospital during the last fiscal year.

I might add to the figure that I mentioned before our occupancy is 68.47 percent.

We serve an unusual large area here of approximately 10,000 square miles, actually more. We do not serve only the local community of about 2,000 individuals.

Of course, this area is very sparsely populated, which in, a sense, makes it easier-less people. In another sense, it makes it harder. As you can well imagine, it is pretty difficult for an average family or poorer native families in outlying villages to come to Nome and pay $100 carfare.

We try to take care of this in two ways: First of all, the Federal agency, Alaska Native Service, which used to be the Alaska Native Service and now the Public Health Service. There is not a lot of difference between the two organizations I can detect

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They help us to pay for transportation to Nome, but it has to be really worthwhile. If the child is one who has large tonsils or adenoids, it wouldn't be enough. We have to wait until the child is practically deaf before it is really worth sending him. We try to take care of that by going to the villages, bringing the hospital to outlying villages. Unfortunately I do not want to exaggerate our services—we have not been able to do this to the fullest extent I should like to have it done.

I can see in this kind of fieldwork the only real solution to the medical problem in Alaska for a long time to come. It is impossible to establish a hospital in every one of these tiny communities, and much depends upon fieldwork, which has been very wonderfully performed by the nurses of the Public Health Service in the Territory, as stated by the Paran report.

Of course, the nurse's job is not that of a doctor. A lot of people think a nurse is someone who knows just a little less than a doctor knows. Of course, a doctor's work is not the same as a nurse's and vice versa, and doctors have to get to outlying bases in order to detect disease and help people right there and then. It requires the missionary spirit to do that because it is connected with a lot of hardship, and there will be a great many more coronaries in the medical profession if this is done, but that is the only solution I can see for the so-called rural conditions here.

I would like to say something about the expenses. It costs us here per day to keep a patient in the hospital $22.95. That is last year.

Mr. ABBOTT. That is all expenses, Doctor?
Dr. LANGSAM. Yes; on the average.

On the west coast, that is, Washington, Oregon, and California, probably also Idaho, the costs for hospitals of the same size is approximately $30.

Mr. ABBOTT. On that point. Is this hospital tax exempt?
Dr. LANGSAM. Yes; it is nonprofit.

Mr. ABBOTT. And the figures to which you refer on the west coast would be private institutions?

Dr. LANGSAM. That is the average.
Mr. Dawson. Nearly all hospitals are tax exempt, are they not?
Mr. ABBOTT. If not for profit, I believe.
Mr. O'BRIEN. Is Morningside tax exempt?
Mr. ABBOTT. No.
(Discussion off the record.)

Dr. LANGSAM. I believe they have to be nonprofit in order to be tax exempt.

The reason why it is more expensive on the west coast than we have here, although prices for supplies are much more expensive, freight and all, many of our things have to be flown in. If we send by boat part way and then by plane, it is 15 cents per pound more.

we send it plane all the way, it is 23 to 26 cents a pound more. So that alone is a great item.

If something goes wrong, we can't call up the service man and have him come up here. No one specializes in work like that in town. If an X-ray tube goes wrong, we can't have a man here in half an hour like in Seattle or other cities in the States. It is a major catastrophe. But we really are very well equipped even though we have this great problem.

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Mr. Dawson. What was the reason you said your costs are lower here than the west coast?

Dr. LANGSAM. One reason for that is that we are doubling and tripling in different capacities so often on various jobs. The administrative physician is often night watchman also, and a few things like that. Mr. ABBOTT. Are you a surgeon? Dr. LANGSAM. I am a physician and surgeon; yes.

Mr. ABBOTT. A physician, surgeon, roentenologist, and gynecologist?

Dr. LANGSAM. Of course, a community like this cannot afford a specialist. Of course, I don't mean to say I do all of those things. If it is at all possible, I personally take care of it. Otherwise, I try to get them transferred to a place where they can receive attention that can't be given here.

We have one great problem, too, in a little private institution like this, and that is the purchase of expensive equipment which may be used once or twice a year, where in the States it is used all the time. The question of whether such an expenditure is reasonable and justifiable. Of course, when it is needed here it is just as badly needed as anywhere else by the individual who requires it. On the other hand, as I say, is it justifiable to buy this expensive piece of equipment and have it lying idle. That is one of the peculiar problems of Alaska.

. In the meantime, I have taken the stand that we need it and we have been getting just about everything we have needed.

Just to give you an idea, our washer right now is broken down. Do we have to have a new one? That alone costs over $4,200 just for our laundry.

So much for the local facilities,

As for the chief medical problem, I need not tell you that is tuberculosis. It is worse here than elsewhere. I think we are making some progress in it but it is far from solved. We are presently treating 30 and 40 outpatients with chemotherapy. I think that is a wonderful thing. In fact, I have been doing chemotherapy since I have been in Alaska, but I don't think it will solve the problem. I think we have to put these people to bed, because the same people in many instances will not do as well with the same chemotherapy at home or receiving it as an ambulatory patient. My purpose in bringing this out is simply that I don't think because chemotherapy is now being considered so wonderful, and it is wonderful, that this will mean we will need less beds for the tuberculosis patients. We will not. We will need more beds if we are going to lick the problem.

The solution of the TB problem, as I see it-I don't want to sound pompous, but I can't help forming opinions-does not lie entirely in the medical realm. It definitely is also in the realm of social services and welfare, proper living conditions and diet, and so on, especially for the native population who, of course, are a minority here in wealth, if not in numbers.

I want to say that what seems to me an extremely progressive move has been made by the Alaska Department of Health, and I think it will be of great credit to them, although it has not been exercised fully, and that is their initiation of a sanitary-aid program where they take people from the villages, native young promising people, and give them a short course of 6 or 8 weeks of training in the essen

tials of hygiene and send them back to the village and have them as local sanitarians, as it were, under the jurisdiction of the health department. We will try to cooperate with that. We are going to put the facilities of the hospital at their disposal, fix up a dormitory for them so when they come to Nome they will be taken care of. And we are going to feed them. Not with the idea of making money. We will get $5 a day for room and board, but we are glad to contribute that much to the worthwhile and progressive move on the part of the Alaska Department of Health.

Lastly, about the mental health situation. I think it was best summed up by Dr. Overholzer, who you probably know, from St. Elizabeths in Washington, D. C., who came through here with a committee and looked over the situation. He said, in his inimitable wit, that we had come away from the Middle Ages, we were no longer beating the insane. And that just about describes the situation.

Without becoming personal, I would like to say, imagine some one in your family, some one you loved, your wife or daughter or some one close to you became insane here in Nome or in the vicinity and had to be taken care of. First of all, you would have to swear out a complaint just like a criminal case. You would have to accuse him of insanity just as though it were a theft or a crime. Then the individual would be--the deputy marshal would be sent after him and he would be put in jail. That is the only place to keep him. And then, if a doctor is present, the doctor would see him. Here there is a doctor and so I go to see him. Out in the outlying villages that is not the

case.

There is no such thing as padded cells when they are locked up. Of course, there are pros and cons on padded cells. There are no special precautions at all for them excepting they are locked up.

Incidentally, this is very cruel not only to the sick but to the rest of the prisoners, because it is very nerve racking to be a prisoner in with a mental patient. As you can very well imagine, the others do not get any sleep, and it is really very bad.

So something really should be done about this mental situation, and I know you are aware of that fact. The question is what?

I have never been to Morningside, neither as a patient nor observer.

You probably have heard that up here we speak of “inside, outside, and Morningside.It is that well known up here.

I can't vouch for the quality of treatment given there, but undoubtedly the treatment locally in the community or in the Territory, at least, would be much superior to any long-distance treatment. For one thing, it would make the patient feel better, and the mental attitude of the insane is not something to be ignored. We can do much for them here. There is more of a possibility for their relatives to visit them, and it means a great deal. You can well imagine if you were in the hospital you would like to have your folks come and see you once in a while. That does much for improving their morale and also improving their condition. Of course, it depends upon the stage of insanity. As you know, there are various stages. But there is no reason why, if we had the money to do it, we could not have one room for such cases in the hospital. Dr. Overholzer pointed out a place and suggested where it could be done, where we could keep such people. Some of them, with the modern treatment, we could even perhaps cure and not have to send out.

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