State aid, who are doing everything that the mothers need. We wan to aid mothers in our own communities who are too poor to provide for their own maintenance and care, and that is attended to amply by the charitable associations. These other societies, the Childrens' Welfare Bureau, and these national health societies are doing more or less of this work in one way and another, and there are a great number of people who are engaged in this work and similar work, and the amount of money that has been spent for it is simply stupenduous. Let the societies go on as they are doing, and let them wait a year or two for this bill to show what their results are before we put this in, and burden the Federal Government at this time, when the Federal Government has before it so many important and serious matters. Let this matter go over and see what those other societies can do. The CHAIRMAN. Do you know that the bill has been here for about four years? Miss WILLIAMS. I did not know that. Senator MCKELLAR. Have you any bill that you would like to draft Miss WILLIAMs. Oh, Senator, I assure you that I have neither the experience nor the wisdom to draft any bill. The best thing that I can see for you to do is to postpone action on this bill for a while, and let it be written in plain English that everyone can understand. (Thereupon, at 5.10 p. m., an adjournment was taken until 10.30 a. m., Thursday, May 5, 1921.) PROTECTION OF MATERNITY. THURSDAY, MAY 5, 1921. UNITED STATES SENATE, COMMITTEE ON EDUCATION AND LABOR, Washington, D. C. The committee met, pursuant to adjournment, at 10.30 o'clock a. m., at the committee room of the Committee on Education and Labor, Capitol Building, Hon. William S. Kenyon presiding. Present: Senators Kenyon (chairman), Warren, Phipps, Sterling, Walsh of Massachusetts, Kellogg, and Wolcott. Also present: Senator Morris Sheppard; Mrs. Mary G. Kilbreth, representing National Association Opposed to Women Suffrage; Mr. T. F. Cadwalader, Joppa, Md.; Dr. Charles O'Donovan, Baltimore, Md.; Dr. Alfred H. Quessy, Fitchburg, Mass. The CHAIRMAN. We are proceeding with this hearing this morning for those who are opposed to this bill, and we would like to hear all who want to be heard to-day. Are there any people here now who desire to be heard against this bill? STATEMENT OF T. F. CADWALADER, JOPPA, MD. The CHAIRMAN. What is your name, please? Mr. CADWALADER. T. F. Cadwalader, and I live at Joppa, Md. The CHAIRMAN. And will you please tell us who you represent? Mr. CADWALADER. I was aked to come here by the officers of the National Association Opposed to Woman Suffrage. I understand that they are interested in defeating this bill in its present form. The CHAIRMAN. And were you asked to come here by the officers Mr. CADWALADER. I was asked by Mrs. Kilbreth. I am receiving any retainer or salary for this. The CHAIRMAN. And what is your business? not Mr. CADWALADER. My business is attorney at law, and also farming. My idea of raising the babies is purely practical, and I do not think it will be interesting to the committee. The CHAIRMAN. What do you want to say about this bill? Mr. CADWALADER. We object to this bill, sir, and I would like to suggest some views to the committee in regard to it, and my opposition is briefly this: As I understand the bill, it proposes to appropriate an amount of money to send over the country a number of Federal agents, men and women, who will be sent from the authorities at Washington with very broad powers and go into the people's homes and communities, rural and urban communities, and instruct them in what they ought to do in regard to the health and their way of living and everything else. The CHAIRMAN. Do you think that that is what this bill does? Mr. CADWALADER. Yes, sir. The CHAIRMAN. We do not understand the bill in that way at all. You may be right, and we shall be pleased if you can show us where the bill does that. Mr. CADWALADER. I understand that the purpose underlying the bill is to promote sanitary health, and maternity, and childhoodexpects to take care of the children in the districts of the country which they have not received in the past or have not shown themselves able to grapple with those subjects independently. I understand that Senator Moses has introduced an amendment or a substitute bill for the promotion or the establishment of rural hospitalsThe CHAIRMAN (interposing). And are you for that bill of Senator Moses? Mr. CADWALADER. Not in its present shape, but I want to make a suggestion in regard to that, and that is this, that if the Federal Government is going to help rural communities to establish hospitals, all well and good, provided it goes upon the theory that it is trying to build up a self-reliant independent spirit in those communities to do their own work, and allow them to put their hands in their own pockets to do the necessary work and improving the health conditions by themselves, with the advice that a central authority or bureau representing the medical profession and the best medical thought of the country can give them. I realize that there are many backward rural communities where the conditions are bad and have been for many years, and along this line I suggest a measure carrying out the idea of Senator Moses's bill, but doing it in a somewhat different way. I would like to read this to you, Mr. Chairman. The CHAIRMAN. Why not put it right into the record? Mr. CADWALADER. I will do so. (The suggested bill is here printed in the record in full, as follows:) Be it enacted, etc., That whenever there shall be established in any State, either upon private foundation with the written approval of the State board of health or similar official body charged with the State-wide supervision or control of matters of public health, hygiene, sanitation. or vital statistics, or upon public foundation subject to the jurisdiction of such State board or any official body appointed by or under the authority of the executive or legislative authority of the State. (1) a system of hospitals for the service of rural communities, (2) a system of instructive visiting nursing for the benefit of such rural communities, (3) a system of county or district institutes to promote the cooperation of local physicans, health authorities, and citizens in the spread of improved ideas of home sanitation and nursing, and especially the care of mothers and infants, such fact may be certified to the Surgeon General of the United States Public Health Service by such State board. Upon receipt of such certification. the said Surgeon General shall cause an investigation of the character, extent, and financial support of such systems of hospitals, nursing, and county institutes of hygiene, and if satisfied that they conform to such standards of efficiency in the prospective or actual promotion of general health, hygiene, sanitation, and the welfare of maternity and childhood as he may approve he shall so certify to the Secretary of the Treasury. SEC. 2. Upon the receipt of such certificate from the said Surgeon General the payment of a sum not to exceed $10,000 in any one year is authorized to be made by appropriation out of any money in the Treasury not otherwise appropriated to the Treasurer of such State or States for the use of such systems of hospitals, nursing and institutes of hygiene, or any of such systems, provided that said funds be expended subject to the approval of such State boards of health or similar State official bodies. for the purposes set forth in Section 1 of this act. and provided that in all cases at least an equivalent amount be provided by State or local authority or by private benevolence approved by such State boards or similar bodies. SEC. 3. The Surgeon General of the United States Public Health Service is authorized to designate and appoint from among the qualified physicians resident in the several States, a number of special agents of the Public Health Service not to exceed in number the number of representatives in the House of Representatives to which such States are respectively entitled, who shall be deputed to instruct the local boards of health, medical authorities, boards of county commissioners or similar local governing bodies, medical associations, improvement associations, and the local communities in general, in the advantages and importance of the establishment of such systems of rural hospitals. rural nursing organizations, and rural institutes of hygiene, to the end that rural communities may be enabled by sufficient knowledge of their needs and abilities to avail themselves through their State boards of the benefits provided by this act. The sum of $400,000 or such part thereof as may be needed is hereby appropriated for the fiscal year ending June 30, 1922, for the payment of the salaries and expenses of such special agents, and the appropriation annually thereafter of a similar sum is hereby authorized: Provided. That no person be appointed or continued as such special agent against whom any State board of health may protest in writing to the said Surgeon General. SEC. 4. That for the purposes of this act the word "system" when applied to systems of hospitals, nursing or institutes of hygiene shall be construed to include the establishment of one or more model institutions of such character in rural communities selected by the State board of health or similar State official body with the approval of the said Surgeon General. SEC. 5. That the Secretary of the Treasury shall include in his annual report to Congress a full account of the administration of this act and of the expenditure of the moneys herein authorized. Mr. CADWALADER. I would like to say briefly what this contains, though, in order that the committee may understand what I am talking about. It provides that whenever a community, either by private funds or by public funds, but in each case with the approval of the State board of health or other constituted State health authorities, undertakes to establish a system of local rural hospitals, hospitals to serve rural communities, or a system of instruction of visiting nurse societies for rural communities, and lacking the power or means to establish either of those things, at least a system of local medical institutes to promote the cooperation of local physicians, health authorities, and citizens generally in the spread of information on improved sanitation and nursing, and especially the care of mothers and infants; when that has been established, with the approval of the health board, and the health board shall certify that to the Surgeon General, who will then make an investigation himself and see if the scheme is a good one; whether it is backed by sufficient financial support to make it possible for it to succeed, and whether it is based on sound lines. When he is satisfied that the standard that he made was lived up to, then the health authorities to certify that fact to the Secretary of the Treasury, and an appropriation of $10,000 for each State, for such State or States, and not exceeding that sum, will be available to help the medical authorities in the establishing of such system. In order to develop the local sentiment that would be necessary to be aroused to establish such a system, our proposition is that the Surgeon General shall designate from among the physicians of the different States-physicians of their own States, not physicians sent out from Washington-to educate the people in the States who are known in the communities, to pay them a certain salary, and perhaps for any individual $1,000 would be ample to cover his expenses and pay for his time, which would not be all his time, but to take a man of standing and a regular physician and let him go around to ascertain the sentiment of the local communities, to tell them what they need, and do what I understand this proposes shall be done by persons deputed from the Central Government. These physicians should be limited, I think, to one for every congressional district. The city districts would not need them. The rural congressional districts are the part of the country that we are to look out for. I say that the cities do not need them. I do not mean to say that the health conditions are ideal in all of the cities, but the large cities of the country, the centers of the population, the people are of the kind that have medical care, and are able unaided to find in themselves. the initiative for solving the health problem, and if I believed that that was not the case I would despair of the Republic. If they can not do it, then it is impossible for Congress or the Federal Government to help them out, but with the scattered communities, people living remote from communication need this education in regard to health. Therefore, my scheme is to give them that help by means of people whom they know something about, who have a standing in the community, and whose time can be paid for and whose expenses can be paid, in part at least, by the Federal Government. I would not limit the choice of local physicians, and if any of them become obnoxious to the State health authorities I would say that his name should be taken off the list and somebody else put in his place. You will note that I have used the words "system of hospitals' for the service of rural communities, and "a system of instructive nurses for the benefit of such rural communities," and so on. What I mean by that is this, that it may be possible in a certain State to establish in a certain county a model rural hospital, and that county will contribute a large sum to the State, and, perhaps, if the Federal Government should pay it $10,000 a year it would be able to give it a substantial boost. Now, then, that hospital may serve more than one county. It may be an object lesson to a whole section of the State, and it may be, in the case of succeeding years, that other counties will say, "Why, that is fine, a fine thing, and we will have to adopt something like this." Therefore, I say that the word "system" should be used in the establishment of things of that kind. We have now in Maryland two rural hospitals, and it is my understanding that they are doing a great work. One of them is in Montgomery County and one of them is on the Eastern Shore, at Cambridge. The fact is that in our State the State itself has done most, if not all, of the work of improving, in making the rural conditions of life better for the people without Federal aid, and I believe that our State is not alone in that respect, but that other States will do the same, and at least the newer States, where perhaps there are not as many people who have time to give to public affairs would do it if the idea was put up to them. As it has been said. the dynamic idea was supplied by a competent board from Washington. Now, what should nat competent board be? It seems to me that, without claiming to be an expert in this matter, that the United States has a Public Health Service under its Surgeon General which has been in operation some 12 years or more, and I think that that Public Health Service is the proper board to handle this matter, or should be made so. If for any reason it is not per |