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I talked with the Chief of the Children's Bureau about this bill before she sailed. She wished it made clear that, if the question arose, there is no conceivable objection to having cities embraced within the scope of this bill. The word “rural” was put in for two reasons: First, because Uncle Sam seemed to be more completely oblivious of his rural children than of the urban ones. In the cities we have various agencies of assistance, educational and others, and we have just recently had a crusade carried on by the Federal Government to assure, as far as it is possible by its intervention, that the children born in the future shall be free from taints which have affected children in the past. But rural folk on the whole have been meagerly treated. In the second place, it was thought that inasmuch as the Government had never done anything along this line for mothers and babies before, it might continue to be niggardly, as it was at first with the Children's Bureau. The Children's Bureau started with a pitiful, paltry sum of $25,000.

There is no conceivable objection to as generous an appropriation as Congress may be moved to give to take care of all children in the cities as well as in the country districts. I know there will be no opposition to that.

Coming from New York, and having seen the admirable work of Dr. Josephine Baker, of the New York City Department of Health, for the alien children there, I wish to go on record and express my astonishment at the absence of both Ďr. Baker and the president of the American Public Health Association, Dr. Frankel, who is also the head of the greatest funeral insurance company that has ever existed anywhere on this planet. I can not conceive of any public meeting that could occur to-day more important than this hearing.

May I add to what I said before in relation to Mr. Nolan's question? I think the work of the Children's Bureau in those cities where they have studied infant mortality has resulted in ways quite unforeseen and is of even national significance; and that we shall be able to go back to those cities at the end of 10 years and show what the stimulus of the investigation did for them. I know from Miss Lathrop that numbers of cities have asked to have investigations made, and they have had to be refused where they were not within the registration area, because the material for study was not available. It is indispensable for finding out how many children die of a thousand born that records should be kept both of the children who are born and the children who die. The impetus toward starting birth registers and death registers in the States which are not urban has been a most significant result of these inquiries.


Tuesday, January 28, 1919. The committee met at 10.15 o'clock, a. m., Hon. Jeff. McLemore (acting chairman) presiding.

There were also present Representatives Almon, Robinson, Hersey, Zihlman, and Miss Jeannette Rankin.

Mr. McLEMORE. I believe there is a Mr. Frankel wishes to be heard.
Mr. FRANKEL. Dr. Baker wishes to be heard first.
Mr. McLEMORE. All right. We will hear Dr. Baker.



Dr. BAKER. Mr. Chairman, I am appearing here in my capacity as president of the American Child Hygiene Association, which has a membership of about 1,200 people who are interested in child welfare movements. These members come from 41 States of the Union, and there is also a small membership from the other American countries. At a meeting of the executive committee of our association held last week, I was instructed to appear before your committee, if possible, in regard to House bill 12634.

Mr. FRANKEL. Mine is Senate bill 4782. I think it is the same bill.

Dr. BAKER. The American Child Hygiene Association wishes to place itself on record as favoring the purpose of this bill. It believes that the extension of maternity and infant welfare nursing is a matter of fundamental and vital importance to the welfare of the people of the United States. It wishes, however, to register a protest against the machinery of this bill. In order that there may be no misunderstanding as to the lateness of our protest, may I say that in July, I brought this matter to the attention of the Chief of the Children's Bureau, regarding just this protest against the machinery of the bill, and have an answer from the Chief of the Children's Bureau to thé effect that she considered my position a strong one and felt that the bill could be amended. Since that time nothing has been heard írom the bill until the notice was received for the hearing, as far as I am concerned.

Our position is that it is fundamentally and basically wrong to create in each State a new board to care for this work when there is in each State of the Union, actually or potentially, a board of health with its own machinery and power and legal authority to carry out all the functions of this bill; that in 11 States of the Union there are already established divisions of child hygiene whose main purpose is the care of infancy and infant welfare, and nursing; that if this bill is passed and a new board created in each State to care for this work it will tend in effect to wipe out these divisions. Practically all present divisions of child hygiene have started with infant welfare work. If this part of the work is taken away from them it, in effect, retards the movement and development of child work welfare all over the United States to a very appreciable extent.

I believe that the purposes of the bill could be just as adequately met by transferring its power of enforcement to the State boards of health by means of a special division or special committee, if you choose, possibly with the same personnel that this committee has, but nevertheless working through the already organized bodies in the State departments.

We do not believe that the machinery of this bill will result in the best good to the children of the country. We believe that it will have a detrimental and harmful effect in a large number of States, and we believe that if the State's board of health can be substituted for the special and additional board, that it will be an incentive for the States boards of health to extend their child welfare work and make it much more effective than it is at the present time. We also feel very strongly on any one of these subjects relating to this that it is wrong to create additional boards. May I call attention in my own State to the fact that the governor of New York has recently sent a message to the

legislature asking that the recently established board for the control and use of narcotic drugs be abolished, and that its functions be taken over by the State board of health that is legally authorized to do that work. I feel that the policy of my own State and the policy of nearly all the States at the present time is toward more centralization instead of constantly forming new boards to do work that can be 'better done by boards already in existence. We believe it is selfevident and not only economic but for the greater good of the children of the United States that the machinery of this bill should be amended.

Mr. HERSEY. Will you tell me the extent of the jurisdiction of your association ?

Dr. BAKER. It represents 1.200 members coming from 41 States of the Union. They are all either active child welfare workers or much interested in child welfare work. My action in speaking here to-day is by authorization of the executive committee of that organization, the American Child Hygiene Association.

Mr. HERSEY. An organization in 41 States.

Dr. BAKER. No, sir; one national organization with a membership representative of 41 States.

Mr. McLEMORE. Would this bill affect your organization, the way it is? In what way would it affect your organization?

Dr. BAKER. It would not affect our organization in any way whatever. Our organization is simply to cover child hygiene organizations interested in the problems of child welfare.

Mr. McLEMORE. It would not impede or interfere with your work at all then, would it?

Dr. BAKER. I think there is some misunderstanding. We are not an administrative or executive organization, Mr. Chairman. We are an organization interested in problems of child welfare all over the country. We are not ourselves, as an organization, administratively responsible individually; practically every one in the organization holds some position which would be more or less interfered with by that bill.

Mr. McLEMORE. Admitting all that, still would your organization be hampered in any way in the world should this bill become a law ?

Dr. BAKER. We feel practically the things we stand for would be so retarded in development by the passage of this bill, that the present, that is, the present administration machinery, that we are emphatic in regard to it. We thoroughly approve of the bill, simply the method of administration we object to, that it would practically retard child welfare work throughout the United States, and in the opinion of the executive committee of the American Child Hygiene Association would be exceedingly detrimental to the ultimate value of child welfare work, and the ultimate results. As we are much interested in the development of child welfare work, it would naturally retard our progress to that extent.

Mr. HERSEY. You work through the health boards of your State? Dr. BAKER. Yes, sir. I shall be very glad to submit a short brief. Mr. McLEMORE. Yes,

Mr. HERSEY. I move that the brief to be submitted be put in the hearing, as a part of the statement.

Mr. McLEMORE. Could you submit a list of the cities represented in your organization?

Dr. BAKER. Yes, sir; may I submit that later?


Mr. HERSEY. I understand the brief statement by the lady will appear in the hearing?

Mr. McLEMORE. Yes; and you will supply the list of cities, Dr. Baker?

Dr. BAKER. The brief you refer to is regarding Senate bill No. 4782, entitled “A bill to encourage instruction in the hygiene of maternity and infancy and to extend proper care for maternity and infancy; to provide for cooperation with the States in promotion of such instruction and care in rural districts, to appropriate money and regulate its expenditure; and for other purposes.

The executive committee of the American Child Hygiene Association have asked me to appear before your honorable body in regard to Senate bill No. 4782.

The American Child Hygiene Association has a membership of 1,200 persons who are directly interested in child welfare work. This membership is made up of representations from 41 States of the Union.

The executive committee of this association have directed me to present a definite statement in regard to this bill. They wish to record themselves as being heartily in favor of the purpose of the bill in question, as they believe that instruction in the hygiene of maternity and infancy and proper care for maternity and infancy are matters of supreme importance for the welfare of all of the people of the United States. They wish, therefore, to commend the purposes of this bill and to record their approval of the furtherance of its object by action of Congress. They wish, however, to express a decided protest against the machinery which is created to carry out the purposes of this bill, and on their behalf I am presenting herewith a copy of the amendments which they desire to have made in this bill. These amendments would, in effect, eliminate all references to the creation of State boards of maternity aid and infant hygiene and would provide in place thereof that the provisions of the bill be carried out by the State boards of health. They believe the machinery of the present bill to be undesirable and harmful and the substitution of State boards of health for State boards of maternity aid and infant hygiene to be desirable and proper for the following reasons:

There is in each State of the Union a health board or health department which is created to care for public health. In 11 States, divisions of child hygiene have been created under the State health authorities. The functions of these divisions of child hygiene are mainly those which promote the welfare of infants through the establishment of local divisions of child hygiene for the care of infants and young children, with a particular view to reducing infant illness and death.

The creation of a State board of maternity aid and infant gygiene, entirely distinct from the State board of health, would take away from the latter the incentive to organize child welfare work and would, in the opinion of the executive committee of the American Child Hygiene Association, mean the practical destruction of these divisions of child hygiene and the elimination of the incentive for each State to carry out proper work for the conservation of child life through the State board of health. While the bill provides for maternity aid and infant nursing, it is not probable that State boards of health will


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undertake the health care of older children without the stimulus which would be provided if they already had under their supervision the health care of infants and young children. The said executive committee believe that the work of child hygiene is of such vast importance to the future of this country that this bill should not be passed, except with the amendments suggested because of its possible detrimental effect in this direction.

There is no necessity of creating this additional board, as each State has, actually or potentially, the power to carry out the work outlined for the State board of maternity aid and infant hygiene. It is contrary to public policy to establish additional boards to carry on work for which adequate machinery already exists under existing State institutions or departments. It allows duplication of effort, leaves the way open for conflict of authority, and greatly increases the overhead cost of administration. The executive committee of the American Child Hygiene Association therefore earnestly petitions your honorable body not to report this bill in its present form but to amend it so that State boards of health will be substituted in each instance for State boards of maternity aid and infant hygiene.

(The list submitted by Dr. Baker is printed below).



The American Child Hygiene Association was organized November 13, 1909, under the name of the American Association for Study and Prevention of Infant Mortality as a result of a conference called by the American Academy of Medicine. The scope of the Association has gradually been extended to include prenatal, maternal, infant, and child care.

The name was changed to the American Child Hygiene Association January 18, 1919, as a result of recommendations made and approved at the 9th annual meeting held at Chicago December 5-7, 1918.

The association has a total membership of about 1,200. Organizations as well as individuals are eligible for membership, and the total enrollment includes 175 organizations engaged in some form of infant, maternal, or child welfare work, and about 1,025 individual members. Included in these organizations are infant or maternal welfare societies, health departments, nurses' associations, and other organizations dealing with some phase of the health of children. The individual membership, in turn, includes children's specialists, obstetricians, general practitioners, health officers, nurses, social workers, educators, and lay members who are interested in some phase of infant conservation.

Forty-one Stat s, the District of Columbia, Hawaii, Philippine Islands, Panama, Canada, China, England, and New Zealand are represent d in the membership.

The States referred to are the follo ving: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin. Also, Canada, Chile, Hawaii, Panama, Philippine Islands, England, and New Zealand.



Mr. FRANKEL. Mr. Chairman and gentlemen, I am appearing here on behalf of the American Public Health Association, of which I have the honor to be president. This association is 47 years old. It was originally organized by the prominent health representatives

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