than we can meet. We have not enough doctors and nurses to meet the demand, it is so great.

The CHAIRMAN. And do the people resent the work that you do at all?

Dr. BAKER. No, sir; on the contrary, they welcome it and they ask for it, more than we can give them. Our greatest limitation is that we have not enough people to take care of those who want it. Senator STERLING. And is the work done among all classes of people of the city of New York?

Dr. BAKER. It is absolutely free to all classes and all classes may have it. There are no restrictions whatever, so far as the work is concerned. Naturally, we get a great many more people below a poverty line than we do of those above it.

Now, there is nothing in this bill, as I see it, and there is nothing in the work that we are doing in the city of New York which imposes any medical treatment of any kind upon anybody in the world. Every mother is free to select her own physician for childbirth, and I see nothing in this bill that would prevent every mother from selecting her own physician for childbirth.

Senator STERLING. And do you have consultation centers in the city of New York in your work?

Dr. BAKER. Yes, sir; we have 68 of them with doctors and nurses in attendance.

Senator WALSH. And are there hospitals?

Dr. BAKER. We do not run the hospitals, Senator. We have no medical treatment for them, and I see no provision in this bill for any medical treatment. It seems to me that it follows out the same general line that we are working on, that it is entirely along the line of preventative work. Now, I would hesitate to try to compare the different types of work in the matter of saving mothers and babies, but I may say that putting the medical work on one side and the social work on the other side, that I think it is about a 50-50 proposition, and we recognize quite clearly that all of the social conditions that affect the health of the mother deleteriously have to be corrected, and our nurses are giving as much concern in securing good living conditions as they are in seeing that the mother is referred to some place where she may get good medical attention if she chooses to go to some place where she can get decent medical attention.

The CHAIRMAN. Can any prospective mother in New York come to your center and get advice and help, Dr. Baker?

Dr. BAKER. Yes; they can come and get all the advice that they

want to.

The CHAIRMAN. And do they come quite generally?

Dr. BAKER. Yes, sir; very generally, and they are anxious to get it, and the results are remarkably good, and after they have been there well, the death rate has been most unusually low.

The CHAIRMAN. And do you think there is any question of socialism entering into this bill?

Dr. BAKER. Why, quite to the contrary. There would not be anything further removed from it, and it is really preventative of those doctrines.

The CHAIRMAN. And do you think that this bill would infringe on the doctors at all, Dr. Baker, and do you infringe on the doctors at all there?

Dr. BAKER. No, but on the contrary, they are most cooperative and we have no difficulty with them whatever.

The CHAIRMAN. And are some of the doctors in your city somewhat hostile to your work, and have they been against what you are doing?

Dr. BAKER. Yes, sir, in the early days they were, but not now. After this was going a year or so there were some objections, but there are no objections now. I remember that after we were going a year or so there was a petition sent to the mayor asking for my removal, and it was signed by about 40 and the objections were it was on the ground that there were no more sick babies, and the death rate had been so reduced, and the mayor sent it down to me and I wrote to him saying, "I do not think that this is a complaint; I think it is a compliment," and I sent it back. I never heard anything more about it, and the babies are being saved.

The CHAIRMAN. Do you think that you have taken away any of the business from the doctors?

Dr. BAKER. No, on the contrary, we have been building up their business, for they have been getting patients which would ordinarily go to the midwives and to untrained care.

The CHAIRMAN. Then you think that-do you advise them to go to the doctors?

Dr. BAKER. Yes, we advise them to go to the doctors.

The CHAIRMAN. So that the doctors feel better about it now? Dr. BAKER. Oh, very much so. At the beginning of this present city administration in the city of New York, there seemed to be some question about whether this was going to be given up or not, and the Academy of Medicine protested against its being given up, and the medical societies of five counties had several meetings and they passed resolutions, to the effect that they would not allow it to be given up. Moreover, all of the citizens were equally strong in favor of it, and the mothers themselves threatened to start parades. before the City Hall, from those in the tenement districts

The CHAIRMAN. And you do not need this bill so far as your city is concerned?

Dr. BAKER. No; we do not; but we do think that a baby in South Carolina is worth as much as a baby is who lives in New York City.

There is no question about it that the position of the United States at the present time is extremely humiliating. There is not a person now who comes to visit this country, who knows anything about the conditions, who has not remarked about the present curious position of the United States in this behalf. These mothers want to be saved, and they are anxious to get the information which would be sent out. I think that it would be a reasonable estimate to say that we could save some 15,000 women and 100,000 babies a year by passing this bill.

The CHAIRMAN. And that would justify the expense. Have you the plans and laws of other nations in relation to this subject?

Dr. BATER. No, but quite the best law that I krow of is that relating to the infant and maternal welfare of England, which is probably the most complete law of the kind in existence, and I am sure Miss Lathrop will have that for you. It is a very remarkable law, and it has resulted in the death rate of England being brought

down very remarkably. Last year London's baby death rate was 10 points lower

Senator STERLING. I would like to know, if you can state, the cost of this service to the city of New York?

Dr. BAKER. We estimated it about a year ago, that it cost about $2.50 to give a complete maternity prenatal service to a woman by a nurse and $3.50 if a doctor's advice is also included. Its costs somewhere between 80 cents and $1 per month per baby at the baby health stations after they are 1 year of age.

The CHAIRMAN. And have you the total appropriation?

Dr. BAKER. The work of the bureau of child hygiene includes all children of free school age, and various activities, such as the enforcement of the child labor law, and so on. The total appropriation for this last year was very nearly $900,000, and the appropriation for this work alone would be about $250,000, for caring for 60,000 babies, and all of the side lines.

The CHAIRMAN. And do any work, what you would call Americanization work?

Dr. BAKER. Nothing except that in so far as we can we try to have the mother retain all of the best traditions and habits that she brings with her, and we try to have the mothers assimilate their lives with ours so that they will not suffer too much by being transplanted. You must take into consideration the fact that people from some of the nations are agricultural people, and they have lived out of doors in warm climates the year around, and when they come to New York the baby death rate is extremely high from pneumonia and tuberculosis, because they have not been accustomed to that cold climate.

Senator WOLCOTT. The apprehension was expressed that if this bill became a law, and the officers and employees got into the work in the educational field, that they would permit this propaganda in favor of birth control. I want to ask if it is the experience in New York City that there has been any complaint of any attempt to pervert the service to these babies in that way?

Dr. BAKER. No; there has never been any complaint, and there seems to be no relation between the two. The department of health has never taken any stand on the subject of birth control, and it never enters into our work, and if any such teaching were attempted, it would be severely dealt with.

Senator MCKELLAR. To what extent has politics affected your work there in New York City?

Dr. BAKER. Well, I am a veteran of nine city administrations, so I may say that it is reasonably free from politics.

The CHAIRMAN. And you do not know of any sinister purpose on the part of those who are behind this bill to turn it into a birth-control

affair?

Dr. BAKER. I never heard of it until to-day. It is the first time that I have ever heard of that. I never heard of any possible connection between the two until I heard one of the witnesses speaking in regard to the meeting in Carnegie Hall, and I understood from the paper that it was quite a lawless proceeding, but no one of the health department knew anything about it.

The CHAIRMAN. It was not a Democratic meeting, was it?
Dr. BAKER. I hope not.

The CHAIRMAN. We are very much obliged to you.

STATEMENT OF DR. ELLEN C. POTTER, OF THE DIVISION OF CHILD HEALTH, OF THE STATE OF PENNSYLVANIA.

Dr. POTTER. Mr. Chairman, I am suffering from the same embar rassment that Dr. Baker spoke of, as being a physician who has come into the public health work, either through failure in private practice or because of politics.

I am glad to have the opportunity to speak on behalf of this bill, which, it seems to me, embodies one of the most constructive programs for the welfare of the United States that possibly could be conceived. You have heard it said that there are women who are not in favor of this bill. I can not speak for the women of all of the United States, but coming from Pennsylvania, I can speak for approximately one-twelfth of the women of the United States, because within her parallelogram as you know, there is about one-twelfth of the population of the United States, and I have been going up and down the State, in the big cities and in the small villages, and I have been meeting the women of the State either through organizations or individually, and I can say to you that it is not true that the women of Pennsylvania are against this bill, but they are on the contrary for this bill. And I can say to you also that the women of Pennsylvania are for this bill because just before the last few turbulent days of our own legislative procedure, they passed a bill instructing our department of health to accept the funds of it when it is passed, because they believe that some day this bill or something equivalent to this bill will be passed, and they instructed the department of health to accept the funds and to take such measures as to enable us to accept the funds and to carry out the program outlined in the bill.

The CHAIRMAN. That law has been passed by your State?
Dr. POTTER. Yes, sir.

The CHAIRMAN. And what was the vote on it?

Dr. POTTER. Unanimous.

We are, as you know, one of the richest States in the Union, and we, as a great State, feel the need of this bill. I have been in the department of health just one year since the 1st of May. In that time I have been putting into practice in a very limited way the program as it is outlined in this bill, and I have gone to Dr. Baker for advice, knowing that she had evolved a method that they found to be most practical, and from that in one year, with very limited resources that we had in our hands, we have been fortunate enough to decrease the infant mortality in our State 10 points.

Now, we are a State which is supposed to be crowded in population. We have a very large number of people within our borders, and yet there are districts in our State so far removed from the possibility of any sort of advice or any sort of care for mothers and infants that we feel keenly the need of the stimulus that this bill would give us, and would make it possible for us to do the work as we think it ought to be done.

The CHAIRMAN. Just how would you enlarge your work? You heard the argument that in large States like Montana that a few nurses do not amount to much?

Dr. POTTER. We would enlarge our work beyond what we are now doing just by placing nurses in certain centers, with substations in the

surrounding country, and securing the cooperation, either as part of our regular State staff or as volunteers in the service and carry on this educational campaign, which would give the mothers the information and instruction that they need in regard to the care of themselves and the care of the children. As you may possibly know, in the State of Pennsylvania we have a system of hospital subsidies, which makes it possible for hospitals to maintain themselves, and so that machinery we could put to work if additional hospital care should be made necessary. But this is not a bill primarily to deal with hospital care, or surgical intervention, or anything of that sort. It is a broad program of education which would enable mothers and their children-would educate them to such an extent that they could put into practice the laws of health, which ultimately would lead to a much more sturdy group of citizens, because they would learn to take care of themselves when young. It would enable the mothers and those about to become mothers

Senator WALSH. You speak of persons who are about to become mothers; how do you ascertain them?

Dr. POTTER. We seek them out, so that they may know that the station is established. We speak to strategic individuals in a community-the superintendent of the Visiting Nurses' Association or to people who are connected with the churches and parties who are known well--but we do not force ourselves on them through our nursing service.

Senator WALSH. A person usually who needs advice and assistance in this matter is apt to be very careless, don't you think?

Dr. POTTER. I think that our situation is very similar, although rural, as compared to New York; that women are anxious to come when they know that there is a place where they can receive advice, and they come without urging.

The CHAIRMAN. Do you have very much correspondence with the

women?

Dr. POTTER. We have some correspondence, but the organization is still new; so very often the correspondence comes to us through the Children's Bureau. They correspond with them because they know of it and they refer it to us, so we get in touch with the families in our State.

Senator MCKELLAR. You have only had it established a short time?

Dr. POTTER. It was originally established in 1918, but because of the very inadequate appropriation it did not do much, and within the year I was appointed I was appointed in May, 1920-and the active work of organization has gone on since that time.

The CHAIRMAN. And has there been any reduction in the rate of infant mortality?

Dr. POTTER. The statistics for the year-they are not final as yet, but they seem to indicate that it has been reduced about 10 points during this past year, and that is with a very inadequate corps of workers, and whereas it was last year 100 it is this year 90, and the reason that we are keenly anxious that this bill should go through is because it will make it so much easier for us to develop our work, to increase our own State appropriations, and because it will be possible

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