A description and analysis of planning in a large city as related tohealth and how it led to a formal planning office in the Public HealthDepartment are presented. How this unit operates within thegovernmental structure and relates to the community andits disparate elements is the substance of the paper.

PENNIES, PRIORITIES, AND PEOPLE PRESSURES-CAN

PLANNING IN AN URBAN HEALTH DEPARTMENT HELP?

Joanne E. Finley, M.D., M.P.H.

THE health scene in Philadelphia inthe last swiftly passing year might

have been Anycity, U.S.A. A fiscalcrisis in the city occurs, complete withlawsuits against the right of City Coun-cil to levy an "interim" tax package.City services are temporarily cut, in-cluding a million dollar retrenchmentin Health Department funds to purchaseambulatory and emergency care by con-tract from many of the city's hospitals.The mayor perceives the problems of

the public hospital to be so pressingthat he appoints a blue-ribbon commit-tee to recommend a way out of thewoods. A financial crisis in the statebrings a Governor's Executive Orderto cut back eligibility standards ofmedical indigency under the Pennsy-care (Title XIX) program.

Local hospitals, waxing and waningin numbers from four to ten, respondwith anguished threats to close theiremergency rooms entirely, to limitclinic care to present patient load, orpaid-up customers. Some of these areteaching hospitals of medical schools.Together they represent many morethan 100,000 emergency-care visits peryear. The mayor, as well as the hos-pitals and many civic organizations,

bring all their weight to bear in thestate capitol and somehow Medicaid getssaved for another year. The City Coun-cil holds investigatory hearings on hos-pitals' costs and financial problems.During these ups and downs a featureseries appears in a local newspaperheadlined: Medical Inflation at Crit-ical Level, Revolution Is Near.1Two angry, black citizens, both

known for neighborhood leadership,bring a taxpayer's suit to enjoin thestate from releasing funds for the localcommunity mental health centers plan,because consumers were not sufficientlyinvolved in the planning. When thestate's mental health contribution isfinally released, it is $4.8 million lessthan the minimal request-based merelyon what was necessary to keep exist-ing programs going.

Four separate 314-e grant applica-tions for neighborhood health centerprograms in the Model Cities area hearthey may sink together for havingplanned alone. And so it went in "fiscal'68-'69."As a broad canvas on which to paint

the thesis of this paper, this may havethe look of Guernica-many dismem-bered bodies, much smoke, a bit of

JULY. 19970 1213

death in the corners, lots of drippingblood.

Quite the contrary. In Philadelphia,we view the tumult as inevitable. Weview it as a mark of health in the com-munity's processes that consumers, pro-viders, political decision-makers, andlarge purchasers of care including thelocal government-have, from theirseparate ways, arrived at a vociferousrecognition that our health care systemis irrelevant, costly, unequally dis-tributed. uneven in quality, incrediblybadly planned. We hear them sayingcollectively. "We must do somethingabout this."

Planning in the Health Departmentmay be a way for all who are bothered-to do something "about it." We findit fortuitous that a decision made manymonths ago-to develop a planning unitin the health commissioner's officewas consummated in 1968. It now ap-pears that the embittered consumer islooking for technical assistance in plan-ning his own services. He will acceptsuch help from the public agency if itis given in the spirit of recognizing hisrights, and his importance as a con-sumer of health care.

At least in our city, some of the pres-ent leaders in the rest of the health caresystem have concluded that they needlocal government as much as they needthe federal government. The Medicaidemergency room crisis in Philadelphiaculminated with a distinct statementfrom some affected hospitals that theywished the Health Department to takeleadership in planning and in policyformulation, so that "a health care sys-tem that makes sense" can be developedin Philadelphia.

Planning for Planning in thePhiladelphia Departmentof Public Health

The department has always planned.The city has a long and thoughtful heri-

tage, especially since the Reform Char-ter of 1951, of publicly appointed orcommissioned study processes. TheHealth Department has usually staffedthese. Frequently, the commissioner hasbeen the convener or chairman. Alwayshe has been a member. Most of thestudies have been implemented, per-haps an unusual series of events. Infact, a specific role assigned to the firstdeputy commissioner is program de-velopment in relation to the plans aridrecommendations put forth by the vari-ous study processes.

Even with this healthy history of con-scientious recommendations for new di-rections in health policy, the Depart-ment of Public Health would be thefirst to admit to haphazard planning, tobeing incompletely staffed. internallyincoherent, and sadly lacking in thebasic data system on which planningand evaluation of effort must rest. Itwould admit that much of its planningwas occasioned by unforecast commu-nity crises or new "bait" in the formof federal grants.2

Understandably, then, the initial de-cision to organize a formal PlanningOffice rested on a recognition of internalneed. This unit was conceived, afterthorough studv by the department'smanagement staff, of both the litera-ture. and the two other notable existinglocal Health Department Planning Di-visions-those of Washington, D. C.,and New York City. Interviews werealso conducted among departmental em-ployees in decision-making positions, todetermine their views on the need forplanning and desirable structures. Theunit was laid out on a tentative draw-ing board as a process and staff for as-sisting the commissioner substantively inhiis administrative policy-making role,for affecting and assisting the depart-menit's operating machinery in adapta-tioIn to new public policy, and as achannel for departmental response tothe city's notable efforts to put the en-

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PLANNING IN AN URBAN HEALTH DEPARTMENT

tire public fiscal program into a Plan-ning, Programing, Budgeting System.

Typical of the compromises that haveworked well in Philadelphia-whichcentralize policy but decentralize opera-tions-the "plan for planning" recom-mended an organizational structure thatborrowed from both New York andWashington but was not exactly that ofeither."A systematic approach to define the De-

partment's mission and objectives . . . requiresa focal point-a planning staff-which candevelop overall Department philosophy, butthis planning staff can only be successful ifthe components of the Department have thecapacity to develop a meaningful dialoguethrough a staff which has the capability toprovide good program analysis and a goodinformation system."3

So it all began in an orderly enoughfashion. Budget for a small planningstaff for the commissioner's office sig-nified top-level approval within govern-ment. A planning director was hired.Staff was recruited-or temporarilyscrounged from other parts of the de-partment or city government. A Plan-ning Committee of the department waslaunched. This consists of all deputy orassistant commissioners, including theexecutive director of the PhiladelphiaGeneral Hospital, who are the heads ofthe various components of the HealthDepartment. Other members are thedeputy commissioner and the assistantcommissioner for administration. Theplanning director staffs this committee.

After a few ventilatory sessions nec-essary to exorcise fears by componentsof an authoritarian takeover of theirplanning, the committee began to func-tion on the business at hand such as:

1. Serving for the Finance Department, asthe Program Analysis Committee for the "Con-servation of Health" budget program;

2. Considering the various problems of de-veloping a health planning information sys-tem:

3. Attempting to develop the mechanismsto create departmental policy on consumerinvolvement in planning and in program that

would support, but also guide, the manycreative but inconsistent efforts going theirseparate ways in the components, or in specialprojects;

4. Reviewing grant applications;5. Reviewing current state and federal legis-

lation for its potential effect on local healthpolicy and program, and advising the city'srepresentatives in Harrisburg and Washingtonaccordingly.

How then did we advance so fastfrom this quiet, internalized, systematicbeginning of a planning process to anapparent role that could, and should,affect the entire community system?This will be the subject of the remainderof this discussion. However, first a di-gression is in order.We all recognize that we are collaps-

ing together in the nonsystem that cur-rently prevails. But, in the renaissanceor perhaps altogether new birth thatmust come, who is to represent the pub-lic interest? It is the especial thesis ofthis discussion that the health arm oflocal government may be the bestplaced agency to do this. If the publichealth agency is not ready to take thiskind of leadership, consumers in par-ticular will, and must, find another andmore revolutionary way. This statementis a switch from the anxious dialoguethat leaks from the traditional portionsof the so-called health care system. Thatis: "If we do not get our house inorder, the government will take over."In reality, if the governmental healthleaders, through planning and progres-sive policy formation and implementa-tion, do not help get the community'shouse in order, they will go down withthe rest of the burdensome, irresponsi-ble system. After all, who ever thoughtthat we would be suggesting a privatecorporation to deliver the U. S. mail?

It is necessary, then, to enumeratesome of the elements the public healthagency must have "going for it." inorder that it can fulfill this role. Ifthese are not present in your commu-nities. the primary task for local health

JULY, 1970 1215

officers, and citizens genuinely con-cerned for the health of the health caresystem, is first to find out why not-then to work, lobby, vote, "politic,"testify, whatever you want to call it,to bring these elements into being.

Climate and Structures Necessary forHealth Planning in the Public Interest

No community is utopia, and theconstant struggle of human beings toperfect their institutions is the excite-ment of living. However, someone whohas experienced the obstacles in othercommunities can assess what is presentin one city (or county), and not inanother, that makes it possible for lead-ership to be taken-and given-to thepublic's agency, and therefore for localhealth policy to be born.

1. A rational, sophisticated, modernorganization of the government, andtherefore of the public health functionswithin it.The great leaps forward in Philadel-

phia, which still to a large degree pre-vail in urban redevelopment, healthprograms, educational experimentation,regional transportation, recreation, andjob opportunity, have all occurred sincethe passage, by referendum, of the Re-form Charter in 1951. This documenttotally restructered city government. Itmade the Health Department, in largepart, in the image of a health servicesadministration containing CommunityHealth Services, the Medical Exam-iner's Office, the Philadelphia GeneralHospital. Internal reorganization or ex-pansion is possible by administrativeaction, independent of the need forcountless new pieces of legislation. Thus,new components have been easily bornto meet modern times: Air Manage-ment Services, the Office of MentalHealth and Mental Retardation. En-vironmental Health Services have beenelevated in the table of organization.The structure of government under

the new charter permits a wide varietyof flexible contracts-for services orconsultation-and still retains the bestinterests of public accountability. It pro-vided the structure of a Managing Di-rector's Office which coordinates andintegrates the work of nine service agen-cies of the government. This makesdialogue and cooperation operable. ACivil Service system was created thatfunctions better than most, is scrupulouslyoutside patronage pressures. The char-ter is almost two decades old and hasits flaws like all human documents, butthe system of government it createdstill attracts excellent professionals.There is a structural edifice withinwhich they feel they can get things done.

There is also an advantage in beingamong the handful of cities in theUnited States which are both a city anda county. Thus, abridgement of juris-dictional conflicts necessary to rationalregionalization has already occurred toa striking degree.

Those mired in hopeless organiza-tional and political problems need onlyremember-whether at the urban levelor at the state level required for county-wide reorganization-that voter revul-sion over archaic, wasteful, and non-functioning government, brought aboutthis kind of reform in Philadelphia.

2. Political leadership's understand-ing of the importance to aU the elec-torate of an effective, equal-opportunity,high-quality health care system. Thisunderstanding must be coupled with aclear assignment by the political leader-ship of the technical and health policyformulation role to the commissioner ofhealth.The Home Rule Charter assigned

broad and flexible powers to the De-partment of Health in all areas thatcould be defined as protecting and main-taining the public's health.4 Each mayorsince the Reform Charter has exhibitedthis support of the official health agen-cies' role.

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PLANNING IN AN URBAN HEALTH DEPARTMENT

Further, the public seems to expectcity councils and mayors to both in-vestigate and administer in health af-fairs, in the public interest. We all knowof cities in which a mayor's or coun-cilman's efforts to look into a seriouscommunity health problem-such as ahospital insurance rate increase, or anemergency care and transport crisis-are scorned as "not minding the store."The attitude in Philadelphia is the op-posite.

3. The existence of support to thepriority of good health care and ahealthy environment for all, throughadequate budget for the public healthagency.

Public Health professionals doubtlessnever feel their wvork is receiving thebudgetary priority deserved. Philadel-phia is among the many cities in thecountry responding to the electorate'sfeelings by increasing budget for crimeprevention and personal safety. How-ever, the present basic operating budgetfor health, exclusive of the public hos-pital, is five and a half times greaterthan that in a city, well-known to theauthor, that is two and a half timessmaller. Capital budget for health cen-ters, in a city that has nearly com-pleted its timetable for covering all dis-tricts with good and esthetic buildings,is three times greater. Federal incometo the local public health system has in-creased, through grants and third partypayments to the public hospital andpotentially to the Health Centers, butthe city's General Fund allocations tohealth-related areas have not noticeablydeclined since 1960 from the 8 per centor 9 per cent of the total local dollaroutlay.

4. A public finance system that sup-ports and permits some of the localhealth dollars to be used in the privatesector, through contracts and other ar-rangements for purchase or sharing ofcare and services. Even better: the de-velopment of public fiscal policy that

permits public-private combinations inthe use of the capital budget.Money is leverage. The federal gov-

ernment has learned this to a mild de-gree. But states and charter cities withinthem hold the constitutional delegationof the powers of protecting the publichealth and safety and, in public financeterms, have more control in the interestsof public accountability. Political deci-sion-makers are more likely to sit upand take a good look at what the gen-eral public is getting for its health dol-lars when they have approved localtax input into the whole system.

Health economists working with thePlanning Office tell us that "the publicdollar is quite meaningful in (Phila-delphia's) medical care market since itrepresents about 35 per cent of thetotal."5 But the local portion of thispublic dollar is not as high in Phila-delphia as it might be to be fully effec-tive as leverage on the system. It isonly about 6 per cent of the total out-put, locally, for personal health care.The direct operation of the PhiladelphiaGeneral Hospital is currently the chiefexpression of public fiscal responsibilityfor medical care.

Political jurisdictions with more fis-cal input into the whole system can domore to a system. Nevertheless, we aretold the 6 per cent affords important"marginal economic leverage. .-. . TheCity has a great deal of potential dis-cretion-or flexibility-over its alloca-tion of funds within the system."6 Cap-ital budget has not yet been used asinput into the private sector to obtainthose facilities planning proves mostneeded. However, the legal mechanismsand structures exist for doing this, andhave been tried in economic develop-ment and in housing.

5. An end to the public-pritate warthat prevails in public health poliey in somany parts of our nation. Partnershipin health must actually function.One suspects that when a health de-

JULY, 1970 1217

partment is structurally, fiscally, andpolitically permitted strength, its equal-ity follows as a matter of course.

6. Top leadership in the health de-partment that perceives its mission ashere described.

How We Were Turned Outward

There was barely time in Philadel-phia to review the tools and resourcesof the public agency and to inventorydata being collected, before the "criesfor help" pulled the Planning Officeoutward. While the department's Plan-ning Committee labored through itsprogram analysis functions for the PPBsystem-defining needs, setting priori-ties, creating objectives-the mayor,City Council, consumers, and providerswere loudly defining community needs,and even the mission of the Health De-partment.To the very systematic planner, the

"project approach" may defy the truemeaning of long-range planning. If thequestions involved in "the project" areperceived sufficiently broadly, the par-tial crisis approach can rapidly tuminto the most meaningful of efforts inlong-range planning.The occasion was the mayor's concern

for the future of the Philadelphia Gen-eral Hospital, a venerable institutionbegun as a Quaker almshouse in the1700s. The mayor's charge to his spe-cially appointed committee was broad,and therefore promptly defined thestudy in terms of the future of localpublic responsibility for personal healthcare. Therefore, the opportunity hasalready arisen to spell out that veryflexibility to affect the system by al-ternative methods for allocating re-sources, which the economists tell us wedo possess.The study called back, as its princi-

pal consultant, Dr. James P. Dixon whohad been Philadelphia's health commis-sioner in the first days of the imple-

mentation of the Reform Charter. Theplanning director was appointed staffdirector for the Mayor's Committee.The local use of master-planning fundsfrom the capital budget of the publichospital enabled the addition of capablestaff in several disciplines, some ofwhich the Planning Office hopes tokeep.

Existing data was sufficient, when wellanalyzed, to define and project the realneeds in the whole system vs. presentprograms and allocation of resourcessuch as money, space, and manpower.To mention a side value of a purchasesystem, the hospitals-under contractwith the city to provide emergency andambulatory care to the populationsfor whom there is no other sourceof payment-were reporting importantinformation on total emergency roomand OPD utilization as they billed.These data, reworked, gave us an insti-tutional ambulatory and emergency carepicture for the total community.The study rates as highly important

the inclusion of the attitudes of currentusers of the Philadelphia General Hos-pital toward both the public health sys-tem (hospital and health centers) andthe other personal health care resourcesin Philadelphia. It includes researchinto opinions on the most desirable fu-ture system, of a wide range of repre-sentatives of neighborhoods that havebeen forced into dependency on currentpublic programs.The Mayor's Committee itself is a

well-balanced, but not a self-annihilat-ing, composite of interest groups-con-sumer and provider-that would be themost affected by any local reordering ofthe system.

Economic analysis helps the mayor-and the taxpayer-know what hegets now from the present applica-tion of local tax dollars, and what mightbe forecast as the cost benefits of al-ternative applications. Finally, the ex-pertise of the staff makes it feasible to

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PLANNING IN AN URBAN HEALTH DEPARTMENT

forecast the local role-both as to plan-ning responsibilities and as to futurebudget allocations-in the event of anational health insurance system. Webelieved it desirable to give our particu-lar mayor the dimensions of such a sys-tem which would be best for our ownpeople and the future interests of thecity.We regard the consumer-or tax-

payer, or voter, whatever you will callhim as the primary voice that mustbe represented if the public interest isto be represented. For this reason, thedepartment's most important planningeffort may prove to be the architectureof a Consumer Health Corporation tooffer planning, evaluative, and evencontract-review capabilities. Such agroup is applicable to the review of to-day's local resources allocation, and maybe key in the success and economies anational health insurance system willrequire.Two concurrent happenings fit the

rapid evolution of the policy-planningfunctions of the department. Anotherpaper has given a full explanation oftheir meaning7 so they will merely belisted here:

1. Primary-Family Care-Since 1949,the community has many times rec-ommended that Health Centers be theneighborhood places where all familyservices for better health are housed. In1968, a committee of the Board ofHealth revived these recommendationsand supported them for real initiationin appropriate District Health Centers.City budget processes backed these reso-lutions. It is probable that the depart-ment's effective work with Model Neigh-borhood consumers, in planning theirhealth services, made it timely, finally,for the Board of Health, the commis-sioner, and the District Health Opera-tions Division of Community HealthServices to launch this program whichhad been on the philosophical circuitfor so long. The priority recommenda-

tion of the Mayor's Committee also wasthat future public dollars stress ambu-latory care over beds.

Once more, what began as an internalprocess of response to community re-quest has evolved into a public-privateprocess for master planning of all neigh-borhood health centers regardless ofauspice. The goal is to blanket the citywith grouped services meaningful tothe demography, health status, and per-ceived needs of each neighborhood.

2. Emergency Care Planning- Intestimony before City Council hearingsafter the emergency room crisis, onegroup of administrators said: "The im-mediate crisis was averted when theCommonwealth restored its Medicaidprogram . . . but the real problems havenot been met. It is now the differencebetween opening an artery and openinga vein. We will still slowly bleed todeath, unless the various levels of gov-ernment cooperate in solving the prob-lem. Much public benefit can be broughtabout by solving some of the peripheralissues such as developing a system forcity-wide planning for the delivery ofemergency care.... 8

This is a frank request, to which therehas been quite formal response. for theHealth Department to enter into emer-gency care planning and, if necessary,regulation. To forestall the effect onother hospitals. or the public, of the ar-bitrary action of any one hospital, anew Board of Health regulation is nowon the books prohibiting emergencyroom closure without specific recommen-dation of the health commissioner. It isthe board's avowed intent that this be atemporary restraint while an evalua-tion is made,, designation by capabilityoccurs, and financing is straightenedout. It is intended that the communityemerge with a definite plan for highduality emergeincy care.

Obviously ambulatory care planiningis closely related. So is better planningfor chronic ancd extended care. an area

JULY, 1970 1219

in which Philadelphia has been defi-cient. Family problems and long staysdeter our hospitals from their logicalrole.

Staffing the Health DepartmentPlanning Office

We have learned of the especial needfor certain disciplines and activities. Webelieve the following types of staff to benecessary for a well functioning healthdepartment planning office:Health economists; facilities planners who

combine architectural knowledge with a pro-found sense of health care functions; man-agement planners and analysts, preferablyfrom the field of public administration.

There is also great need for a "systemstype" who defies a specific title but, for wantof a better one, we call him a data utilizationanalyst. He must be good at research design,data analysis, and be able to talk to com-puter people.

Beyond this, creative, open general-ists will do. For the Mayor's Commit-tee, we have used graduate students incity planning, medical students with aninterest in community process, and citi-zens with great success.The department's planning staff is

there to serve-not only our own operat-ing personnel, but members of variouscommunities who request their consulta-tion.

Relationship to the RegionalComprehensive HealthPlanning Agency

There is a funded developmentalgroup in the Philadelphia five-countyregion considering the shape of the314-b agency. This occurred through aprocess originally convened by thehealth commissioner.9The chairman of the developmental

group is also a member of the Mayor'sCommittee on Municipal Hospital Serv-ices, and in turn is its liaison to theBoard of Health Committee on Neigh-

borhood Health Centers. The Philadel-phia Health Department would not at-tempt to be a regional planning agency.But when actual regional planning oc-curs, there must be specific input fromthe parts of the region. For Philadel-phia County, the Department of PublicHealth and the City Planning Commis-sion appear to be the only viable sourceof much of the basic data for a healthplanning information system. The HealthDepartment has been asked to be theumbrella mechanism within its jurisdic-tion for getting groups together, so thatindividual plans fit the public interest.In environmental affairs such as airquality control-the most logical of en-terprises to be regionalized-and mentalhealth planning, the Philadelphia De-partment of Public Health is alreadymandated certain roles under state andfederal laws. Therefore, no conflict inthe role of the Health Department inperfecting its own planning, and in guid-ing plans within county boundaries,has been raised.

Summary

In Philadelphia, the creation of acompetent Planning Office in the De-partment of Public Health was originallyconceived as an internal necessity. Thislarge organization was beset with itsown aimlessness, or crisis response, indeveloping programs and allocating re-sources. Further, total city government-by setting up a Planning, Program-ing, Budgeting System, and in its out-standing charter-requires health plan-ning.

However, external problems and pres-sures recognized by political decision-makers, consumers, and providers havedefined a role for the Health Departmentin public health policy formation andin regulation of the system in the pub-lic interest.The planning functions of the Health

Department do not decrease in responsi-

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PLANNING IN AN URBAN HEALTH DEPARTMENT

bilities "on the inside," for it is evenmore important for the agency to re-spond effectively to community need,and for it to be the data base from whichcommunity need can be substantiated.However, as perceptive forces "on theoutside" request of the department aleadership role in rationalizing a mostdefective health care system, and inguiding the allocation of local dollarsand other resources in positive direc-tions, the planning functions of the de-partment become of equal service andimportance to the whole community.

REFERENCES

1. Philadelphia Inquirer. The High Cost ofMedical Care, a Special Report. (Sept.7-11), 1969.

2. University of Pennsylvania, Fels Instituteof Local and State Government, Govern-ment Studies Center. Review and Analysis

of Long Range Planning Procedures inthe Philadelphia Department of PublicHealth. (Prepared under a contract withthe Philadelphia Department of PublicHealth.)

3. Wagner, D. A.; McCracken, B.; et al. Cityof Philadelphia Department of PublicHealth-Report on Planning. (unpub-lished)

4. City of Philadelphia, Home Rule Charter,-Section 5-300 (Apr.), 1951.

5. Brewster, A., and McCrory, 0. Cost ofPersonal Health Care System, Part IV-C,Report of the Mayor's Committee onMunicipal Hospital Services. (Feb.), 1970.

6. Ibid.7. Ingraham, N. R. A Big City Strives for

Relevance in Its Community Health Serv-ices. A.J.P.H. 59:804-810 (May), 1970.

8. Statement of the Woman's Medical Collegeof Pennsylvania for Its Hospital, to theSpecial Councilmanic Committee of theCity of Philadelphia. (Sept. 26), 1969.

9. Polk, L. D. Areawide- ComprehensiveHealth Planning: The Philadelphia Story.A.J.P.H. 59:760 (May), 1969.

Dr. Finley is Director of Health Planning, Philadelphia Department ofPublic Health (540, Municipal Services Building), Philadelphia, Pa. 19106This paper was presented before the Public Health Education Section of the

American Public Health Association at the Ninety-Seventh Annual Meeting inPhiladelphia, Pa., November 11, 1969.

Mid-Career Training in GerontologyThe Institute of Gerontology of the University of Michigan-Wayne State Uni-

versity is offering an intensive 14-week orientation in specific skill areas for personswho are or will be working with older people. Fall and winter institutes are sched-uled for September 13 to December 18, and for January 11 to April 16, 1971. Thefour subject areas to be covered are: Retirement Housing Management; MilieuTherapy; Public Policy-Planning and Programing; and Multiservice Senior Cen-ter Management. (Write: Bob Benedict, Project Director, Residential Institute,Institute of Gerontology, University of Michigan-Wayne State University, 1021 EastHuron Street, Ann Arbor, Mich. 48104.)

JULY. 1970 1221