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all in favor of the purposes of the bill; the membership of Dr. Baker's association, and Mr. Frankel's association, feel personally like them, and they are coming out in favor of the purpose of the bill. There can be no doubt about that. As a whole, we are all interested in having this bill carried out in the best way. It appears to us of the Children's Bureau that by the creation of a board having a doctor and public-health nurse the purpose of the bill could be carried out better. Now, if the State board of heatlh were going to be composed of people that included those three persons in their personnel-but are they? You see one great purpose of our bill is to enlist the educational forces-paragraph 9 of the bill asks that the State College of Agriculture and State University be appealed to to give instruction with, say, two or three courses of instruction in welfare work carried out through education extension. I simply ask if you put it into the State boards of health, can we then assume that the educational feature of our bill will be equally well carried out as if you had a measure which designates a board to work through education institutions.

Mr. FRANKEL. I want to suggest an amendment there.

Dr. BAKER. I want to submit a question. The governor is appointing officer for both. You can not expect to rise higher than the governor's personal predilection of his duty as governor.

Mrs. WEST. Our board of health is already appointed.

Dr. BAKER. They are appointed by each governor. They are appointive offices. In this bill the Children's Bureau has exactly the same right to outline its program through the State board of health as it would through its special committee. It has just as much control and you can have no more feeling or doubt, it seems to me, over one group of persons than over another group of persons because you do not know what your appointments will be. They may be anything the governor chooses to make them, and from my exrience as an employee in a State department, I can assure you that I believe thoroughly they will be simply political appointments in nine-tenths of the cases.

Mrs. WEST. Not if that bill goes through.

Dr. BAKER. You will not get your exalted doctors as representatives of the board of health, but some little medical inspector. Mrs. WEST. You will get it either way.

Dr. BAKER. You will not get public health nurses, but any nurse who has enough political pull and any teacher who has the political pull.

Mrs. WEST. It provides State university or college.

Dr. BAKER. Plus her ability to get the job. There is nothing to show in either case. There is nothing that I can see that the State board of health, the same as your special board, can not do to cooperate with your agricultural college or in any way prevents or alters the possibility of extension work in child welfare.

Mrs. WEST. Will you State board take cognizanc. of that? Would they give these courses?

Dr. BAKER. What control will you have over your special board that you will not have with the State board of health?

Miss RANKIN. They will be representative. That is a big point as it places responsibility and specializes. This gives a special board whose sole duty it will be to carry out one line of work. That work

can not be switched off by epidemics or anything else. It places responsibility and gives them a special work to do. The fact is you can not depend upon these boards any more than you can upon the integrity of the governor, particularly in that they come in direct connection with the board. They would insist upon having a better representation and the universities will no doubt appoint the person that they ask the governor to appoint. The nursing profession will have its candidate. It makes a special board and places responsibility absolutely in giving that board the power to cooperate with every institution in the State and making it possible for every institution to feel that it is represented in that work.

Dr. BAKER. I feel that is an argument that can be advanced on any part of the government whatever. You can follow that out without limitation; you can take almost anything else away from boards of health under the same argument. It becomes basically a fundamental proposition. Are we going to, under our form of government, concentrate and centralize under one board of efficient membership the purposes for which that board was created or are we continually going to divide our efforts and place them under special offices and special boards? I think the tendency at the present time in State and Federal Governments is to have things together and eliminate useless boards. In New York State, with which I am most familiar, the present governor feels strongly in that regard. That is the impression everywhere. As far as I am concerned, I do not think there is much value in discussion of details. It is the fundamental thing that interests me. The question is whether or not the health work is to be done by the health departments. I think it could be and it should be from the point of view of the health administrator. Mr. FRANKEL. I think there is equally the danger of overspecialization, and it is a question of overspecialization that has created 57 varieties of health organizations. In Kansas they have the Kansas society interested in heart disease, baby welfare work, baby-welfare organizations, and there are actually 57 societies in the United States at present engaged in health work. Each has its own overhead, its own officers, and I think there is an overlapping and duplication. Health work, the question of child care and maternal care, is not an entity by itself, but tied up with every phase of sickness. It is immediately connected with the problem of venereal disease and tuberculosis and questions of contagious diseases. You can not consider childhood or infancy or maternity by itself. It is the entire health of the community, and the moment you separate it from the others you do harm to the general cause. I simply want to indicate that every State in the United States has to-day a State health law as part of its organic law and part of its State constitution, and practically every one of these States under that constitution provides for a State board of health which has, as I stated, a very distinct province that can not be taken away. You are attempting to take away from the State board of health what it is now delegated to do by the Constitution.

I am not here with a brief for the State boards of health. There are any number of them that have done remarkable and efficient work. I only need to go into the question of our statistics for the last 40 years and show a review in reduction of death rates from transmissible infectious and contagious diseases. The very question

of child mortality in the United States in the last 20 years and the reduction from diphtheria, pneumonia, and other things, as compared with 20 years ago, indicates what the value of the health departments of our States have been, a very remarkable piece of work. If they haven't handled this problem yet, it is because they have not reached it. Here is the opportunity to reach it and give them the encouragement, as Dr. Baker says, and you will find every State will avail themselves of it. I see no reason why this bill should not be amended. Instead of having section 3 delegate this to a separate State board, that this be transferred and funds given to the State, provided the State board of health organizes a division of child hygiene. The money is to be paid to the State under those conditions. Under that division of child hygiene there shall be appointed the special representatives recommended here, nurse, physician, and others.

Mr. HERSEY. When you have amended that bill in accordance with your thought, what have you but simply a bill making an appropriation of so much money to each one of the State boards of health?

Mr. FRANKEL. That is what you have now under this appropriation to a special board. Of course I presume a bill of this kind ought to be so tied up with regulations that this money will not be disbursed by the Federal Government and continued unless the States produce results, irrespective of the type of administration. Surely the Government is not going to continue indefinitely money appropriations of this kind, and I think there is a provision of that kind in this bill. (The following letters were offered for the record:)

DR. RUDE,

NEW YORK, January 14, 1919.

Federal Children's Bureau, Washington. Deeply regret my inability to appear in person owing to unexpected complications here, and to speak in favor of your bill. Please present to the committee in my behalf my ardent support of the purposes of mine in the bill. Never has the need in rural districts been greater than to-day for improved oversight of expectant mothers and young children. The first and best method of accomplishing this is by a great extension of the nursing service. My hope is that this may soon be accomplished. Warm greetings.

Dr. ANNA RUDE,

Dr. RALPH W. LOBENSTINE.

NEW YORK, January 14, 1919.

Federal Children's Bureau, Washington, D. C. Twenty-five years' experience as head of the New York visiting nurse service is my authority for asserting the value not only the saving of life but the enormous importance of education of mothers through public health nurses. Our record show definite

results and are on exhibition. The consistent decline in mortality from diseases incident to childbirth among policyholders of the Metropolitan Life Insurance Co. who have had the care of the public health nurses is in marked contrast to the increase in death rates from these diseases in registration areas of the United States. Federal aid to State to encourage the employment of trained nurses and doctors to instruct and care for women in childbirth would bring America up to the standard of other civilized countries in this respect.

LILLIAN D. WALD,

265 Henry Street, New York.

Mr. McLEMORE. If that is all, we will stand adjourned.

(Thereupon, at 11.55 o'clock a. m., the committee adjourned to meet again at the call of the chairman.)

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