of the State boards of health. There is practically no child welfare work of any moment being done except in this eastern locality. The great West and South have developed no child hygiene work under State boards of health or are just beginning to start such divisions in five or six States. I am sure we are therefore not superseding any machinery.

Now, there have been other agencies doing splendid work in many of the Western States to promote health in rural communities. I am referring to the work of the extension divisions of our State universities, through which demonstrations, lectures, and actual welfare conferences are held throughout the rural districts, especially in Wisconsin, Utah, Oregon, and Indiana, and to a lesser extent in Michigan, Minnesota, and Kansas. This work in Wisconsin has been going on for over five years, and also agricultural extension work in health has been started in our State. I do not know whether you understand what extension work is. We go out to little towns, even in Wisconsin, 25 miles or 40 miles from the railroad, and there hold institutes or farmers' meetings for both men and women, and also women's meetings, where we take up among other things the health of the mothers, the question of prenatal care, the need of good obstetrical care, and the feeding of infants and older children. In the evening, at general meetings, talks are given on the health of the community and contagious diseases. Usually, in Wisconsin, we have health conferences at the end of the day, where we actually examine children, and give advice to mothers in regard to their own health problems and those of their child. Very often this is the only chance that the mother has to consult a physician. These families will come 10 to 40 miles to these conferences, because there is no other opportunity for them to consult a children's specialist. This work has been developed in many of our Western States, and I wish to say, for the sake of the other people in this work, that this is actual service for humanity, for the community. It necessitates hard and arduous traveling out into remote places, five or six days in the week, exposure to bad weather, and the danger of getting snowed up or caught all night in a stalled train. It is indeed hard, wearing work, and unless you have a real love of humanity you will not stay very long in extension work of any sort, for the salaries are quite small, practically the ordinary teacher's salary.

Appropriations to further this work have been easily obtained from the State legislatures. For instance, Utah, in 1917, was granted $5,000 by the State legislature for the child hygiene work of the extension division of the State university. The legislatures, I think, on the whole, in the Western States, the ones I know about, are glad to give funds for this extension work of the universities, while they have been less generous to State boards of health. I do not say the State board of health projects should not be forwarded, but in the West it is university extension projects that have been favored. In Iowa there is a Child Research Division for studying the conditions related to child welfare and the promotion of better health conditions for children, especially in rural districts. The State legislature, in 1917, appropriated $25,000 to start this at the State university-a very unusual example of State generosity. So much for extension work.

I am a physician, a member of both the associations which Dr. Baker and Mr. Frankel represent. It is unfortunately true in the medical profession, as in many other professions, that you rarely find the modern, scientific equipment necessary for a fine physician or surgeon coupled with a broad social knowledge, a disinterested love of humanity, and the common sense point of view, such as we used to have in the old-time practitioner. The medical profession is so exacting in its training that to be expert in branches of medicine and surgery so much time has to be devoted to professional training that the social point of view is apt to be lost. I think there are exceptions where one gets disinterested love of humanity plus that scientific medical knowledge, but I am sorry to say that in many ot the States where I have worked you are not apt to find it, in rural communities or in county health officers. The State boards of health in the past have been very largely interested in combating disease, and they have not been willing or anxious to take an aggressive in attacking the fundamental causes which injure the health of the community.

I believe the reason why they have not been willing to take this aggressive action and sometimes they have been asked to do it and, have refused, is because they are afraid of the small practitioner in the locality where they wish to undertake or start some health project. There are physicians, unfortunately, who consider their profession a money-making business and are not willing to see started in their community a project that may injure their pocketbooks. I have been told by health officers that they could not undertake work in certain places because the local practitioners would object and would go to the State medical association, which was backing the State board of health, and make trouble for them. I think that this has undoubtedly happened in some instances. I do not think any one profession is apt to see outside of their own particular field; a board composed of any one profession would not therefore be as broad minded or have as wide a vision as a board made up of several different professions.

I want to say a word about the nursing profession. It is a very practical profession. These women will very largely carry out the measures of this bill. The nurse will go into the homes and teach the mother how to care for herself and for her child and will start the centers and conferences for mothers and children and largely carry on this important part of the work. The nursing profession, as I am sure we all realize, is a profession peculiarly disinterested, with a great desire for general public service. Nursing is also a profession of women, and I think that it is only right that women should be represented in the administration of this bill, which has to do with the instruction of mothers in regard to their care and the care of their children. For another reason, I think it is an excellent thing because the nursing profession always cooperates with the medical profession, and naturally the physicians and nurses in the State board of health would work together in the administration of this bill. The nursing profession, the public health nurse, should be represented in this board.

For two reasons it seems to me that it is very much better to have the administration of this bill left as it is. One of them is that the first object of the bill is that of instruction. It is educational exten

sion work to promote proper hygiene of maternity and infancy. Then, the carrying out of this bill involves nursing work, under the direction of physicians. Since the bill involves the use of three professions, the extension teacher, the nurse, and the doctor, and is a social and not a purely medical bill, these three professions-a teacher from the State university or agricultural college, a physician representing the State board of health, and a member of the nursing profession should administer the bill. I can not see that this will not be a better plan than putting the administration of this bill in the hands of the medical profession alone. It is not a medical bill, but an educational extension bill. It is a social bill. It is not best for any one profession to have the administration of it. I am here to answer questions if there are any.

Dr. FRANKEL. May I correct the minutes as to the animadversions against the medical profession. Possibly I ought to consider myself fortunate in not belonging thereto. I am not a physician.

Dr. BAKER. I am a practical hygiene administrator myself and have a very extensive piece of child work under my jurisdiction in New York City. I am not speaking as an individual here, but as a practical administrator. I have been firmly impressed with the work that the public health work was doing, and that all functions of the municipality or of any part of the Government that relate to a detailed piece of work should be submitted to the part of the Government which is created to deal with that work. Crime necessarily belongs to the police department, fire prevention to the fire department, and education to the education department; the health is a function of the health department. There has been nothing said here that the public health is not eminently social in its nature. There is nothing said here that brings out the contradistinction that the bill is itself a public health bill. Its provisions are themselves recognized as public health work. The statement that was made that the nurses in this bill would be the public health nurses is not borne out by the bill itself. The bill simply says a nurse. The statement that the medical representative would be a member of the board of health is not borne out by the bill. It simply says a physician who shall be a representative of the board of health, and that means the Governor might appoint the lowliest medical inspector without administrative authority or anything else except political preference. There is no reason to believe, nor as far as I have been able to hear, have any arguments been advanced which would show wherein this work would be better carried out by that separate board than the already created health boards.

When one speaks of the delinquencies of the medical profession and the fact about a love of humanity, who are you going to use except the same ones. You will have to use through a separate board the same doctors, and nurses or health department employees. They are merely citizens of the States and with all their faults or virtues they would have to enter into any other board created. I do not see how you can possibly separete infant and child welfare work from the legal and authorized functions of any department. If you should in New York State take that part of our work away from us we would feel that we were negligent in allowing anyone to take it away from us. It is a truism that infant mortality is the sanitary index of any vicinity. The basis of welfare work and the

basis and index of all sanitation is welfare work. No board of health would delegate its powers unless the people made it do so. I believe, as an administrator of public health affairs, I can see no feature of this bill but what I am heartily in favor of the bill and its purposes, that can not be just as well performed by and through the State Board of Health and their separate boards. It is no argument to say that State boards of health have not done much. It is simply a theory that some imdependent board is going to do it better. The incentive to endeavor through States boards of health would be just as great an incentive as to some newly created board. If the State will not authorize its own board to undertake it, they will not be interested to organize any separate and independent board to begin. It is the beginning of a fine piece of propaganda work on the part of the Federal authorities to stimulate child welfare work by boards of health in the United States. It is an opportunity that should not be lost, and on the other hand, you are definitely antagonizing your health authorities by taking away from them some of their functions to no purpose. · There is nothing to show that your independent board appointed will in any way be more effective than your State board of health, also appointed by the governor.

Mr. McLEMORE. Is there any positive proof that the State board of health would be any better?

Dr. BAKER. Is there any proof that your board will be any better? Mr. McLEMORE. Is there any evidence judging from the past that your State board of health would do this work any better than proposed in this bill?

Dr. BAKER. I think that is purely a hypothetical question nobody could answer. You can not say how a board which is not in existence would do it better than a board now.

Mr. McLEMORE. You said this State board would do it better. Dr. BAKER. I believe there is no reason to believe they will not do it as well. It is their function in life. They are appointed by the Governor. Why should a new board appointed by the Governor do it any better? Either of them will rise simply to the level of administration in that State. They will not be the same in all States; simply the tendency of the people in each State. There is nothing to show nor has any argument been advanced to show that this new board which is to be created would itself, either by virtue of its constituent elements or any inherent power it may possess, in any way be rendered more liable to do the work better.

Mr. McLEMORE. Only that this board has never been tried while the State health boards have.

Dr. BAKER. If there is a credit to anyone, it is a credit to the State boards of health.

Mr. ROBINSON.

to do the work.

The State boards of health have not had the means

Dr. BAKER. It is my honest conviction that this would be the biggest incentive for child welfare work through the United States, working through the State boards of health, and not only this, but infant and maternal welfare. It could be extended on a broad scale to the public schools throughout the entire child life up to the period of adolescence, without taking away from the work for the older child.

Mr. ROBINSON. Have you any good reason why you should have two sets of officers doing the same work?

Dr. BAKER. Absolutely; you are doubling your overhead, your administrative expenses. You can not take away from the health board its legal power to do this work. Therefore you are running the possibility of duplication of overhead and conflict of authority, and you are simply setting up another piece of machinery to do a piece of work for which provision is already made in every State. I can see no reason for it. I am extremely anxious to see this bill go through. I have spent my entire working life of 17 years in public health work and for 10 years have headed the bureau of child hygiene in New York State, employing over 700 people, most of whom are doctors and nurses. I have had this particular work under all the administrations. I am merely saying to you as a practical administrator that you are doing a wasteful thing which has a tendency to wipe out the orderly progress of the public health movement in which I am deeply interested, and so far as I can find out you are not gaining anything. I have come down here to hear it and I have not heard it. I do not know what the purpose is of creating a new board. Wherever the words "State board of maternity and nursing," occurs, it should simply say "State board of health."

Mr. ROBINSON. County boards?

Mr. McLEMORE. I would judge from what you state that the main incentive to this State board of health would be the money they would get out of it.

Dr. BAKER. If you have understood that, of course, I think you have understood something which I could by no possibility have said. The States will not create separate boards unless you promise them money; no State board could do this work unless it gets public appropriations. It depends upon that for its livelihood. If the United States, the Federal Government, will give each State $10,000 a year, that would be an additional incentive. It is an important thing in any line of work. Any subsidy of that sort would be an incentive, I think, to do that kind of work.

STATEMENT OF MRS. MAX WEST, CHILDREN'S BUREAU, DEPARTMENT OF LABOR.

Mrs. WEST. May I ask a question? The assumption that Dr. Baker makes is that any State board of health is given any administrative power in this bill, that the assumption would be that the members of the State board of health are altogether qualified to carry on such work. That is not a fair assumption. I do not know whether Dr. Baker thought it was. We have State boards of health of all degrees of intelligence, and in so many cases of even full-time health officers, and in the majority of cases, without doubt, no member of the State board of health has had exeprience in infant welfare or maternal welfare work of any sort, and in many cases is hardly conversant with it. To point out that giving the State board of health this power, therefore, makes it a suitable board is assumption that possibly may not be borne out in fact. As Dr. Baker, Mr. Frankel, and all the rest of us, most of whom are members of one or the other of these associations, have said, the thing is we are