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handicapped by lack of funds. Others are so feebly organized as to be doing very little State-wide work. It seems to me very logical to have a director of the division of child hygiene in each State having such a division under the State department of health, as the person who would be appointed to represent the State board of health on this new maternity and infancy board.

Mr. Nolan. Have you been connected with the Children's Bureau since its inception?

Dr. RUDE. No, I have not. Last year I did field work for the bureau and have been in my present position since July 1, 1918.

Mr. NOLAN. Were you connected with it when it made an investigation in Johnstown; I believe that was one of the first?

Dr. RUDE. No; I was not.

Mr. NOLAN. Have you ever made any investigation of the large cities since you have been connected with the bureau ?

Dr. RUDE. No; not since I have been connected with the bureau.

Mr. NOLAN. Do you know whether the result of those investigations has awakened the local authorities or the State authorities so that they themselves put into effect any efficient organization in those particular cities, or States, or localities, to take care of this work along the lines suggested by the Children's Bureau.

Dr. RUDE. Wherever a survey or study has been made, it has been very stimulating. We get letters and reports from those different cities stating what has been accomplished; milk stations have been established or infant welfare centers or other welfare organizations, which date back to our work.

Mr. Nolan. Have they put in organizations molded along the lines suggested by the Children's Bureau of the Department of Labor specialists who are particularly well qualified to take care of the work in the community? Do you know of anything like that?

Dr. RUDE. I could not answer that. Usually of course they have to avail themselves of local material. I think the important effect is the stimulation.

Mr. NOLAN. Has the Children's Bureau made any second surveys after a period of time to see what results have been accomplished ?

Dr. RUDE. I think somebody who has been connected with the bureau longer than I have been might be able to answer that.

Miss FLEMING. I think Miss Lundberg can answer that.

Miss LUNDBERG. I can not answer along that line; we have not made any studies that far back.

Mr. NOLAN. You made an investigation pretty nearly six years ago in Johnstown.

Miss LUNDBERG. The bureau has kept in touch with the Johnstown conditions through correspondence and through information from the local people.

Mr. NOLAN. Have they themselves benefited and profited by it?

Miss LUNDBERG. We feel they have by the reports we have. It is very difficult to credit any definite thing.

Mr. NOLAN. It seems to me the bureau itself might attack that matter and see whether the result of their investigation in a locality after a period of years, would be beneficial, to see whether the infant mortality in that section might be reduced.

Dr. RUDE. That is one of the unfortunate things about Government work. I know I have felt when leaving a community that I should like to be able to do some follow-up work.

Mr. Nolan. Of course the expense involved would be so much less in getting the statistics as to the cause of death, and so forth, than the first investigation would be, that I think it would be worth while.

Miss LUNDBERG. I think Mrs. Gaffney can give you the figures and definite facts.



Mrs. GAFFNEY. The Johnstown infant mortality rate showed an unusually large reduction as compared with other cities in Pennsylvania in the years immediately succeeding the investigation of the bureau there. An infant mortality committee was appointed by the chamber of commerce, as is recorded in the third annual report of the Children's Bureau. Various reports from Johnstown indicate that great interest in children's welfare was aroused by the study, which was expressed in many permanent forms, such as the securing of infant welfare nurses, a baby welfare station, an improved milk supply, and in renewed effort for a complete sewerage system,

Mr. Nolan. I was interested in finding out what benefit from the unfavorable publicity given a city of that kind would be.



Mrs. KELLEY. I speak as the secretary of the National Consumers' League, of which Secretary Baker is the president. In the service of that organization I have had occasion to live in the most congested industrial centers in two great cities--the first four years at Hull House, Chicago, and afterwards at the Nurses' Settlement on the east side of New York City. I have been much impressed by the fact that in the reduction of infant mortality, which I have watched at close quarters, it is the children of the aliens for the most part whose lives are saved. It is the alien mothers, the newly arrived strangers, whose appeal to pity has led to the creation of great nursing associations, so that large numbers of them have more skilled care both at birth and also for illness in their families than the better situated native American working-class families in the same city. And as I travel through the country I find the forgotten children and the forgotten mothers are in large part the Americans, the native women, the old stock people, who are living a rural life. Particularly is this true in the South; it is also true in the Northwest and in New England. All over New England there is admirable visiting nursing and hospital care in the cities for foreigners, but not in the country. For instance, where I have spent my summers for many years, in one of the counties of Maine, we find Uncle Sam caring most solicitously for the young lobsters; our waters have fresh supplies of young lobsters at intervals of three years; but the American mothers there must depend for assistance on their rural neighbors. The number of children born is very small, indeed, and the death rate of the newly born is appalling. It is remarkable that Uncle Sam should care so much for the young lobsters and so little for the American children.

I talked with the Chief of the Children's Bureau about this bill before she sailed. She wished it made clear that, if the question arose, there is no conceivable objection to having cities embraced within the scope of this bill. The word “rural” was put in for two reasons: First, because Uncle Sam seemed to be more completely oblivious of his rural children than of the urban ones. In the cities we have various agencies of assistance, educational and others, and we have just recently had a crusade carried on by the Federal Government to assure, as far as it is possible by its intervention, that the children born in the future shall be free from taints which have affected children in the past. But rural folk on the whole have been meagerly treated. In the second place, it was thought that inasmuch as the Government had never done anything along this line for mothers and babies before, it might continue to be niggardly, as it was at first with the Children's Bureau. The Children's Bureau started with a pitiful, paltry sum of $25,000.

There is no conceivable objection to as generous an appropriation as Congress may be moved to give to take care of all children in the cities as well as in the country districts. I know there will be no opposition to that.

Coming from New York, and having seen the admirable work of Dr. Josephine Baker, of the New York City Department of Health, for the alien children there, I wish to go on record and express my astonishment at the absence of both Dr. Baker and the president of the American Public Health Association, Dr. Frankel, who is also the head of the greatest funeral insurance company that has ever existed anywhere on this planet. I can not conceive of any public meeting that could occur to-day more important than this hearing.

May I add to what I said before in relation to Mr. Nolan's question? I think the work of the Children's Bureau in those cities where they have studied infant mortality has resulted in ways quite unforeseen and is of even national significance; and that we shall be able to go back to those cities at the end of 10 years and show what the stimulus of the investigation did for them. I know from Miss Lathrop that numbers of cities have asked to have investigations made, and they have had to be refused where they were not within the registration area, because the material for study was not available. It is indispensable for finding out how many children die of a thousand born that records should be kept both of the children who are born and the children who die. The impetus toward starting birth registers and death registers in the States which are not urban has been a most significant result of these inquiries.


Tuesday, January 28, 1919. The committee met at 10.15 o'clock, a. m., Hon. Jeff. McLemore ()

There were also present Representatives Almon, Robinson, Hersey, Zihlman, and Miss Jeannette Rankin.

Mr. McLEMORE. I believe there is a Mr. Frankel wishes to be heard.
Mr. FRANKEL. Dr. Baker wishes to be heard first.
Mr. McLEMORE. All right. We will hear Dr. Baker.

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Dr. BAKER. Mr. Chairman, I am appearing here in my capacity as president of the American Child Hygiene Association, which has a membership of about 1,200 people who are interested in child welfare movements. These members come from 41 States of the Union, and there is also a small membership from the other American countries. At a meeting of the executive committee of our association held last week, I was instructed to appear before your committee, if possible, in regard to House bill 12634.

Mr. FRANKEL. Mine is Senate bill 4782. I think it is the same bill.

Dr. BAKER. The American Child Hygiene Association wishes to place itself on record as favoring the purpose of this bill. It believes that the extension of maternity and infant welfare nursing is a matter of fundamental and vital importance to the welfare of the people of the United States. It wishes, however, to register a protest against the machinery of this bill. In order that there may be no misunderstanding as to the lateness of our protest, may I say that in July I brought this matter to the attention of the Chief of the Children's Bureau, regarding just this protest against the machinery of the bill, and have an answer from the Chief of the Children's Bureau to the effect that she considered my position a strong one and felt that the bill could be amended. Since that time nothing has been heard from the bill until the notice was received for the hearing, as far as I am concerned.

Our position is that it is fundamentally and basically wrong to create in each State a new board to care for this work when there is in each State of the Union, actually or potentially, a board of health with its own machinery and power and legal authority to carry out all the functions of this bill; that in 11 States of the Union there are already established divisions of child hygiene whose main purpose is the care of infancy and infant welfare, and nursing; that if this bill is passed and a new board created in each State to care for this work it will tend in effect to wipe out these divisions. Practically all present divisions of child hygiene have started with infant welfare work. If this part of the work is taken away from them it, in effect, retards the movement and development of child work welfare all over the United States to a very appreciable extent. I believe that the purposes of the bill could be just as adequately met by transferring its power of enforcement to the State boards of health by means of a special division or special committee, if you choose, possibly with the same personnel that this committee has, but nevertheless working through the already organized bodies in the State departments.

We do not believe that the machinery of this bill will result in the best good to the children of the country. We believe that it will have a detrimental and harmful effect in a large number of States, and we believe that if the State's board of health can be substituted for the special and additional board, that it will be an incentive for the States boards of health to extend their child welfare work and make it much more effective than it is at the present time. We also feel very strongly on any one of these subjects relating to this that it is wrong to create additional boards. May I call attention in my own State to the fact that the governor of New York has recently sent a message to the legislature asking that the recently established board for the control and use of narcotic drugs be abolished, and that its functions be taken over by the State board of health that is legally authorized to do that work. I feel that the policy of my own State and the policy of nearly all the States at the present time is toward more centralization instead of constantly forming new boards to do work that can be 'better done by boards already in existence. We believe it is selfevident and not only economic but for the greater good of the children of the United States that the machinery of this bill should be amended.

Mr. HERSEY. Will you tell me the extent of the jurisdiction of your association ?

Dr. BAKER. It represents 1.200 members coming from 41 States of the Union. They are all either active child welfare workers or much interested in child welfare work. My action in speaking here to-day is by authorization of the executive committee of that organization, the American Child Hygiene Association.

Mr. HERSEY. An organization in 41 States.

Dr. BAKER. No, sir; one national organization with a membership representative of 41 States.

Mr. McLEMORE. Would this bill affect your organization, the way it is? In what way would it affect your organization?

Dr. BAKER. It would not affect our organization in any way whatever. Our organization is simply to cover child hygiene organizations interested in the problems of child welfare.

Mr. McLEMORE. It would not impede or interfere with your work at all then, would it?

Dr. BAKER. I think there is some misunderstanding. We are not an administrative or executive organization, Mr. Chairman. We are an organization interested in problems of child welfare all over the country. We are not ourselves, as an organization, administra'tively responsible individually; practically every one in the organization holds some position which would be more or less interfered with by that bill.

Mr. McLEMORE. Admitting all that, still would your organization be hampered in any way in the world should this bill become a law ?

Dr. BAKER. We feel practically the things we stand for would be so retarded in development by the passage of this bill, that the present, that is, the present administration machinery, that we are emphatic in regard to it. We thoroughly approve of the bill, simply the method of administration we object to, that it would practically retard child welfare work throughout the United States, and in the opinion of the executive committee of the American Child Hygiene Association would be exceedingly detrimental to the ultimate value of child welfare work, and the ultimate results. As we are much interested in the development of child welfare work, it would naturally retard our progress to that extent.

Mr. HERSEY. You work through the health boards of your State ? Dr. BAKER. Yes, sir. I shall be very glad to submit a short brief. Mr. McLEMORE. Yes.

Mr. HERSEY. I move that the brief to be submitted be put in the hearing, as a part of the statement.

Mr. McLEMORE. Could you submit a list of the cities represented in your organization?

Dr. BAKER. Yes, sir; may I submit that later?

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