Gov. Everett J. Lake, of Connecticut, under date of March 29, 1921, said:

I have your letter of March 25 relating to two classes of bills pending before Congress as follows:

1. Bills providing Federal aid to the States for medical care on condition that the States appropriate an equal amount.

2. Bills tending to Federalize public health work.

In matters pending before Congress, I feel inclined to take the position that our Senators and Representatives who are on the ground can act with more accurate information on this and similar questions than one removed as I am, especially when I can not have all of the facts on all sides of the question. I am disposed, therefore, to let the position of the State of Connecticut be determined by our Senators and Representatives.

As a general proposition, however, and speaking personally, I may add that I have sympathy with the sentiment of the resolution approved by Gov. Lowden as printed on a bulletin, entitled "Bulletin No. 36," inclosed with your letter. The tendencies referred to in the resolution and the accompanying letter of Gov. Lowden are apparent to everyone and I do not feel that they should be further encouraged. The CHAIRMAN. Are you endeavoring to show that Gov. Lowden is opposed to this legislation?

Mr. ANDERSON. Well, it would indicate that Governor-well, that Gov. Lowden recognizes the tendency toward centralization in medical affairs and is opposed to that tendency.

The CHAIRMAN. Do you not know that he has indorsed this legislation, that Gov. Lowden has indorsed it?

Mr. ANDERSON. Well, if you take these various letters on this subject and analyze them, it is a question whether he indorses it or not.

The CHAIRMAN. But suppose that he refers to a particular bill and says that he is for it; you would believe that he was for it, wouldn't you, if he refers to this particular bill in his letter?

Mr. ANDERSON. If he says that he is in favor of an exact bill, then I believe that he is for it, in case that he says that he is in favor of the bill, which conflicts with other statements where he indorsed a resolution passed by the Illinois Medical Association.

The CHAIRMAN. Is that it, or does it conflict with your interpreta tion of it?

Mr. ANDERSON. Well, this is the passage that I had reference to by Gov. Lowden, and which seems to substantiate my position. At the hearing before the House Committee on Interstate and Foreign Commerce, December 20 to 29, 1920, bill 171, Mrs. George M. Kenyon quoted a communication by former Gov. Frank O. Lowden, of Illinois, in which he stated that "if the present tendencies toward centralization in Washington go on, all vitality will go from the several communities and States of the country in the management of their own affairs," and he also commended a resolution passed by the Illinois Medical Association, which condemns the principle of Federal State aid and calls attention to the growing tendency in our National Congress to invade the authority of the States by the introduction of bills authorizing various department of the Federal Government to exercise public health functions and duties properly belonging to the States.

The bill now under consideration is one of those bills on the FederalState plan.

The CHAIRMAN. Since you refer to Gov. Lowden, let me call your attention to an article appearing in Good Housekeeping of January 27, 1921, in which he says that he favors this bill

Mr. ANDERSON. He does not say that he favors the State-aid plan. The CHAIRMAN. He says that he favors this bill. You had better read this letter over before you argue that Gov. Lowden is against this bill. If you have any letter there showing that he has changed his mind, we will be glad to have it.

Mr. ANDERSON. That was a communication appearing in the Illinois Medical Journal, and it was following that date.

The CHAIRMAN. What was the date? You have no letters yourself from him about it?

Mr. ANDERSON. But I have these other letters that I have read. The CHAIRMAN. You do not claim that he referred to this bill particularly in this article, do you?

Mr. ANDERSON. The best that I can do is to call your attention to the

The CHAIRMAN. I do not think that it is quite fair for you to cite Gov. Lowden's opinion in regard to this bill. There is not much use. of telling us that he is opposed to this measure unless you have something to show it, after the date of this letter.

Mr. ANDERSON. He recognizes the danger of this tendency toward centralization.

The CHAIRMAN. He also says in this letter that he heartily indorses the idea.

Mr. ANDERSON. This letter that I referred to is dated May 25, 1920, and states:

I beg to acknowledge the receipt of your letter

This is written by the secretary of the Illinois State Medical Society

with resolution inclosed. I am glad that your society has taken this action, as I have been for a long time in full sympathy with the views expressed in the resolution. If the present tendencies toward centralization at Washington go on, all vitality will go from the several communities and States of the country in the management of their own affairs. I congratulate your society on the good work that it is doing. Then the resolution states in the last paragraph

Resolved, That we deem the furnishing of Federal State aid as pernicious and dangerous, and that it is an encroachment on the functions of the State rather than its development.

Senator PHIPPS. What is the date of the resolution?

Mr. ANDERSON. The date of the letter is May 25, and the resolution was

Senator PHIPPS. What year?

Mr. ANDERSON. 1920. Then I had a letter from Gov. Samuel R. McKelvie, of Nebraska, under date of March 28, 1921, in which he says:

Acknowledging your letter of March 24, I have to advise that in making up the State budget I did not include in it items to ineet Federal aid for any medical purposes. In this, my action was an expression rather contrary from the position that I had formerly taken, for about a year ago I recommended to our Representatives in Congress that the appropriation be continued for cooperation with the States in the control of venereal diseases.

Now, however, I am constrained to feel that it is better for the States to make these appropriations on their own account and without regard to anything that may be done by the Federal Government. I think that the theory of Federal aid is, for most part

wrong in principle and should be discouraged aside from such matters as the development of public works, such as roads. Not only should the States discourage the imposition of increased tax burdens by the Federal Government, but they should discourage also the centralization of authority in the Federal Government, with a very few exceptions.

In an editorial item published in the Illinois Medical Journal, February, 1921, John J. Blaine, newly elected governor of Wisconsin, was quoted as follows:

The Federal Government is undermining the powers of the State by "species of bribery. "The species of bribery" to which I refer consists of legislation by the Federal Government in making an appropriation for some purpose under conditions that the State meet the appropriation with a like amount. Some of the purposes

are, no doubt, desirable, but to my mind in many cases the State might better afford to embark upon the same undertaking independently, and by foregoing the appropriation made by the Federal Government actually carry out the same project more economically.

At the hearing before the House Committee on Interstate and Foreign Commerce, December 20-29, 1920, page 171, Mrs. George M. Kenyon quoted a communication by former Gov. Frank Ŏ. Lowden, of Illinois, in which he stated that

If the present tendencies toward centralization at Washington go on, all vitality will go from the several communities and States of the country in the management of their own affairs.

He also commended a resolution passed by the Illinois State Medical Society. The resolution condemned the principle of Federal State aid and called attention to the growing tendency in our National Congress to invade the authority of the States by the introduction of bills authorizing various departments of the Federal Government to exercise public health functions and duties properly belonging to the States.

At the hearing before the House Committee on Education, January 12, 1921, on the so-called Capper-Fess bill, Judge Smith called attention to an article in the Harrisburg Patriot of December 3, in which Gov. Percival W. Clement, of Vermont, and Gov. Robert D. Carey, of Wyoming, were quoted as strongly opposed to the centralization of powers at Washington.

In addition to the opposition on the part of various medical organizations and governors to legislation of this kind there is a very strong opposition on the part of numerous medical freedom organizations throughout the country which are constantly increasing both in number and strength. Other speakers will probably discuss these organizations more at length.

The following extracts from an editorial in the Journal of the American Medical Association, February 5, 1921, previously referred to, sum up the principal objections to the bill now under consideration:

All will agree that the objects sought, namely, the care of maternity and infancy, and instruction in the hygiene of maternity and infancy, are in the highest degree commendable. There can not be too much knowledge or too much instruction of the right sort on such vital subjects. There are, however, serious objections to the methods proposed.

The bill provides funds through the apparently popular method of Federal-State aid, i. e., the appropriation of a large sum of money from the Federal Treasury to be prorated to the various States, provided the State appropriates an equal amount. Bills are now before Congress providing similar methods for the development of physical training, for improvements in education, for the treatment of venereal diseases, and

for other projects, all good in themselves, but activities which belong to the State and local authorities. It is not strange that this method has become popular with those who have pet measures to advance. It has the advantage of simplicity. It is only necessary to induce Congress to appropriate a certain sum to be divided among the various States. This prospective grant is then used as an inducement to the States to appropriate equally large sums. The advocates of this plan apparently regard the Federal Treasury as an inexhaustible reservoir, entirely overlooking the fact that such increasing appropriations will necessitate heavier Federal taxes to be matched with heavier State taxes, all of which must be paid eventually by the common citizen. That the so-called Federal-aid plan is economically unsound has already been pointed out by some of our leading financial authorities.

Another objection is centralized administration. How would the proposed plan work out? Some State, say Minnesota, would receive $10,000 for administration expenses, with its additional pro rata, probably $30,000 in all, provided the legislature appropriated $30,000. This would give the State department of health $60,000 for maternal and child welfare. Splendid! But it could not expend this sum, one-half of which is its own money, until its plans had been approved by the Children's Bureau in Washington.

The care of mother and child is a State and local, not a Federal function. All will agree that every mother and child should receive proper care. So should every mother and child receive suitable nourishment. But it is not the function of the Federal Government to provide either food or care. There are certain public health functions which are clearly national in character; others which should be performed by the State, and still others which belong to the local government.

An examination of the previous hearings on this bill shows frequent references to the number of deaths of mothers and infants but fails to offer any constructive program for preventing these deaths in case this bill is allowed to pass.

Dr. J. Whitridge Williams did refer to the use of the Wassermann test, and from the testimony so far offered efforts would probably be made to induce expectant mothers to submit to this test. The facts, however, clearly show that if this were done the harm which would result by classifying mothers as having venereal disease who did not have the disease simply illustrates the bureaucratic dangers involved in the passage of this bill.

In this connection I will simply refer to an investigation conducted at the Bellevue Hospital in New York City and reported in an article. by Dr. Symmers and others in the Journal of the American Medical Association February 2, 1918. As a result of this investigation they concluded that:

1. Depending on the antigen employed, the Wassermann reaction in the living patient, as carried out at Bellevue Hospital, gives a negative result in from 31 to 56 per cent of cases in which the characteristic anatomic signs of syphilis are demonstrable at necropsy.

2. The Wassermann reaction in the living patient is positive in at least 30 per cent of cases in which it is not possible to demonstrate any of the anatomic lesions of syphilis at necropsy.

Judging from the large amount of propaganda being sent out by boards of health throughout the country in regard to the Schick test and toxin-antitoxin it is reasonable to expect that part of the money appropriated under this bill would be used to promote that alleged preventative. This alleged preventative of diphtheria, however, is uncertain, dangerous, and offers no real hope of reducing infant mortality.

I bring these alleged preventative measures to your attention simply to show the dangers involved in the passage of this bill. These are only a few of the many alleged preventive measures which

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are being offered at the present time under the plea of protecting the public health.

The question of maternity and infancy is too important to allow bureaucratic control with all the abuses that go with it to come to pass, such as it would do if this bill were enacted into law.

I thank you.

Senator JONES. Mr. Anderson, what is your interest in this subject Mr. ANDERSON. I am secretary of this bureau.

Senator JONES. What bureau?

I was

Mr. ANDERSON. The Citizens' Medical Reference Bureau. formerly secretary of what was called the National League of Medical Freedom, an organization of close to a quarter of a million people225,000 people.

Senator JONES. Why is the organization opposed to Federal aid in this subject?

Mr. ANDERSON. Because this is one out of a great many bills tending to build up a larger and more powerful medical machine that would be used in forcing legislation on the people.

Senator JONES. In other words, you do not believe that the Federal Government should engage in this mother's aid at all?

Mr. ANDERSON. There are certain phases that it would be of great advantage, like the pollution of streams in this way along those lines. and things of that kind.

Senator JONES. Is it your objection simply-I mean you and your associates simply as citizens of the United States advocating certain policies with respect to the Federal Government?

Mr. ANDERSON. It is a citizens' movement; yes, sir.

Senator JONES. And you have no idea that the agents of the Federal Government would do anything detrimental to the question of infant mortality, have you?

Mr. ANDERSON. I believe that there is a possibility of a great deal of detrimental work being done.

Senator JONES. In what way?

Mr. ANDERSON. The Shick test is one, that is an example, and the toxin-antitoxin.

Senator JONES. You are opposed to that sort of treatment, generally speaking.

Mr. ANDERSON. There is a gigantic propaganda going on all over the country now introducing that test, and I believe that efforts will be made to make it possible

Senator JONES. Is not your objection to certain things that have been done rather than the general policy of having something done? Mr. ANDERSON. There is less danger of compulsion if this work is run locally and by the different States.

Senator JONES. What makes you think that?

Mr. ANDERSON. Because where work is carried on locally, there is more of an opportunity for one State to check another State, if the other State makes a mistake.

Senator JONES. Do you really think that? Do you think that each State acting on its own initiative and having no connection with another State, that there would be closer contact and less danger?

Mr. ANDERSON. One State naturally will compare notes with another State.