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Mr. HERSEY. I understand the brief statement by the lady will appear in the hearing?

Mr. McLEMORE. Yes; and you will supply the list of cities, Dr. Baker?

Dr. BAKER. The brief you refer to is regarding Senate bill No. 4782,. entitled “A bill to encourage instruction in the hygiene of maternity and infancy and to extend proper care for maternity and infancy; to provide for cooperation with the States in promotion of such instruction and care in rural districts, to appropriate money and regulate its expenditure; and for other purposes.

The executive committee of the American Child Hygiene Association have asked me to appear before your honorable body in regard to Senate bill No. 4782.

The American Child Hygiene Association has a membership of 1,200 persons who are directly interested in child welfare work. This membership is made up of representations from 41 States of the Union.

The executive committee of this association have directed me to present a definite statement in regard to this bill. They wish to record themselves as being heartily in favor of the purpose of the bill in question, as they believe that instruction in the hygiene of maternity and infancy and proper care for maternity and infancy are matters of supreme importance for the welfare of all of the people of the United States. They wish, therefore, to commend the purposes of this bill and to record their approval of the furtherance of its object by action of Congress. They wish, however, to express a decided protest against the machinery which is created to carry out the purposes of this bill, and on their behalf I am presenting herewith a copy of the amendments which they desire to have made in this bill. These amendments would, in effect, eliminate all references to the creation of State boards of maternity aid and infant hygiene and would provide in place thereof that the provisions of the bill be carried out by the State boards of health. They believe the machinery of the present bill to be undesirable and harmful and the substitution of State boards of health for State boards of maternity aid and infant hygiene to be desirable and proper for the following reasons:

There is in each State of the Union a health board or health department which is created to care for public health. In 11 States, divisions of child hygiene have been created under the State health authorities. The functions of these divisions of child hygiene are mainly those which promote the welfare of infants through the establishment of local divisions of child hygiene for the care of infants and young children, with a particular view to reducing infant illness and death.

The creation of a State board of maternity aid and infant gygiene, entirely distinct from the State board of health, would take away from the latter the incentive to organize child welfare work and would, in the opinion of the executive committee of the American Child Hygiene Association, mean the practical destruction of these divisions of child hygiene and the elimination of the incentive for each State to carry out proper work for

the conservation of child life through the State board of health. While the bill provides for maternity aid and infant nursing, it is not probable that State boards of health will

undertake the health care of older children without the stimulus which would be provided if they already had under their supervision the health care of infants and young children. The said executive committee believe that the work of child hygiene is of such vast importance to the future of this country that this bill should not be passed, except with the amendments suggested because of its possible detrimental effect in this direction.

There is no necessity of creating this additional board, as each State has, actually or potentially, the power to carry out the work outlined for the State board of maternity aid and infant hygiene. It is contrary to public policy to establish additional boards to carry on work for which adequate machinery already exists under existing State institutions or departments. It allows duplication of effort, leaves the way open for conflict of authority, and greatly increases the overhead cost of administration. The executive committee of the American Child Hygiene Association therefore earnestly petitions your honorable body not to report this bill in its present form but to amend it so that State boards of health will be substituted in each instance for State boards of maternity aid and infant hygiene.

(The list submitted by Dr. Baker is printed below).



The American Child Hygiene Association was organized November 13, 1909, under the name of the American Association for Study and Prevention of Infant Mortality as a result of a conference called by the American Academy of Medicine. The scope of the Association has gradually been extended to include prenatal, maternal, infant, and child care.

The name was changed to the American Child Hygiene Association January 18, 1919, as a result of recommendations made and approved at the 9th annual meeting held at Chicago December 5-7, 1918.

The association has a total membership of about 1,200. Organizations as well as individuals are eligible for membership, and the total enrollment includes 175 organizations engaged in some form of infant, maternal, or child welfare work, and about 1,025 individual members. Included in these organizations are infant or maternal welfare societies, health departments, nurses' associations, and other organizations dealing with some phase of the health of children. The individual membership, in turn, includes children's specialists, obstetricians, general practitioners, health officers, nurses, social workers, educators, and lay members who are interested in some phase of infant conservation.

Forty-one Stat s, the District of Columbia, Hawaii, Philippine Islands, Panama, Canada, China, England, and New Zealand are represented in the membership.

The States referred to are the following: Alabama, Arkansas, California, Colorado, Connecticut, Delaware, District of Columbia, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Missouri, Montana, Nebraska, New Hampshire, New Jersey, New York, North Carolina, Ohio, Oklahoma, Oregon, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Utah, Vermont, Virginia, Washington, West Virginia, Wisconsin. Also, Canada, Chile, Hawaii, Panama, Philippine Islands, England, and New Zealand.



Mr. FRANKEL. Mr. Chairman and gentlemen, I am appearing here on behalf of the American Public Health Association, of which I have the honor to be president. This association is 47 years old. It was originally organized by the prominent health representatives


of the United States, and the organization eventually extended to include health men from the Dominion of Canada, the Republic of Cuba, and Mexico. In other words, it is an international organization. It has a very conspicuous and honorable history. Practically all of the work that has been done in the United States in the last 40 years in the direction of reduction of deaths from preventable diseases and particularly the extermination of diseases like yellow fever and cholera have been the work of members of the American Public Health Association, which includes in its membership men like Surgeon General Gorgas, Dr. Welch, of the Army, who is now vice president of the association, and men of that type. It has a membership of approximately 2,500, and I may say has in its membership practically every representative State health official, municipal health official, city and township health officials in the United States, including a large membership from the United States Public Health Service. It includes as well practically every representative bacteriologist, sanitarian, epidemiologist in those countries to which I have referred.

I am directed, as the result of the special meeting of the executive committee of this association, called for the purpose, to practically repeat to you what Dr. Baker has just said with respect to her organization. The association in principle favors anything that may be done for the protection of child life and, in particular, for the reduction of maternal mortality. It may be safely said that the earliest development in this line emanated from the American Public Health Association, that its proceedings and transactions show for a long period of years the great interest that this society has had in the reduction of infant mortality and maternal mortality and that it would favor any comprehensive movement that would lead to the reduction of these incidences. On the other hand, realizing that its membership is made up of public health officers representing particularly the State organizations and municipal organizations, it believes that the present method of administration referred to in the bill under consideration is injudicious and inadvisable and will not tend to proper coordination of work. As Dr. Baker has stated, there are to-day 11 States with their efficient State health organizations, and under these subdivisions we have devoted very considerable time and thought to the development of infant hygiene and child hygiene.

Mr. McLEMORE. That is about all they have offered—thoughts. They haven't done anything practical along these lines.

Mr. FRANKEL. The eleven Štates to which I refer are doing rather excellent work in this direction. The other States have probably as yet no thorough organizations directed toward infant welfare and maternai welfare. On the other hand, every State in the Union to-day has a State board of health, with the exception of New Mexico, which at the present is in the throes of organization, and it appears that the new contemplated State board of health and such publichealth organizations in that State will become one of the most efficient that we have. The point we raise is this, that the creation of special, separate boards for this purpose simply means duplication of effort, and duplication of effort means waste of effort; that the States have certain very distinct functions in this respect which can not be taken away from them. It is a question there between States' rights and Federal rights which immediately comes into play.

Mr. McLEMORE. I want to ask you a question: Where have we any States' rights left? The word has lost its meaning. We have no State rights any more.

Mr. FRANKEL. Presumably under our organization, our constitutional organization of the United States, there are certain functions vested in the States, and, particularly, there are certain police powers. I take it that there is practically no one in the United States to-day who by law has more arbitrary police power than the health officer of a State, a municipality, or of a county. He may do things that are almost forbidden to anyone else. He has the right to enter your home forcibly, to remove you forcibly under the police powers that are given to him by the average municipality and by the average State in the exercise of his duties. Now, these are powers that he can not delegate and that can not be delegated by him. In other words, we have created to-day a piece of machinery whose purpose it is to administer health laws and to create health agencies. I would not for a moment attempt to discuss the value of the proposed measure. My personal record is very clear. I have for years advocated the extension of governmental aid for maternitynot as a charity, but as a pure matter of right and as a matter of wise public policy. If it were in our power to-morrow, every woman should have the right and to demand out of the hands of the authorities care during her maternal period, care during her prenatal period, and care, and, if necessary, even financial support and assistance during the postnatal period.

These statistics on this are so clear that I need not refer to them here. If you desire further data, I would be very glad to refer you to a paper that I read some years ago upon maternity insurance, in which I recounted the experience of quite a number of countries other than the United States along these lines. It is quite clear that a period of rest is needed by the average woman prior to the birth of her child and subsequent thereto, and it is only a matter of time until we in the United States accept that proposition, which we ought to encourage to the utmost. On the other hand, I feel keenly and voice the sentiments of the executive committee of this association that since we have created State boards of health that to them should be delegated the power of administration of such a law as is proposed here. It would seem to me a very small thing to amend the bill as it now reads to include practically everything that is desired by the introducer thereof and bring in all the men and women representing other departments of the State into this work, particularly to develop the educational features of this bill along with the purely health administration, and yet place the responsibility for the main administration of it where this administration distinctly and legitimately belongs, namely, in the hands of the constituted State officials, the State boards of health. I voice in this respect, as I say, the opinions of the men connected with this organization, which includes in its membership practically every secretary of the State boards of health in the United States, and practically every representative of local, municipal, and county health department in the United States.

Mr. McLEMORE. Are not the functions of the State boards of heal being gradually taken over by the National Government?

Mr. FRANKEL. I have not seen that in all the work that has thus far been attempted under the auspices of the United States Public Health Service along purely Federal lines. The effort there has been made by the service to appoint local representatives whose work has been altogether in cooperation and through the State organizations, particularly the State board of health. The Smith-Lever bill and the Lever bill now before Congress contemplates an enlargement of rural sanitation. While it may not be specifically provided for in that bill, it is intended to develop there in connection with this bill that rural sanitation and hygiene, the idea of care of infants and of mothers. That bill proposes practical cooperation and subsidy of State boards of health along lines similar to those proposed in the bill under consideration here. I would like to add just one word, Mr. Chairman, · with respect to the attitude of the American Public Health Association in this matter. There is no animus back of this attitude on our part, but I am interested primarily in the development of efficiency in the health administration of the United States. At the present moment there are in addition to State health organizations, Federal health organizations, and municipal organizations; as Dr. Vincent, of the Rockefeller Foundation, put it a few weeks ago, 57 varieties of health associations in this country; every imaginable type of organization, and there can be no doubt, and it is admittedly so, that many of these organizations are duplicating each other's work-are stumbbling over each other—and there is waste and inefficiency as a result. Among the things that we are planning to do at this very moment is the call of a conference in the immediate future of representatives of these organizations to see whether we can not bring about better coordination and better cooperation, and possibly in some instances the actual absorption and consolidation of organizations.

We are planning not merely for to-day, but for the future. We are trying to build up in this country what we would think is an efficient health standard. Whether this will possibly establish itself into a department of health of the Federal Government with a health minister or not, no one is at present able to say. This has been in view, as you are aware, for a number of years, and probably nothing is so much needed here at the present moment as such a department of health. But the American Public Health Association is standing at the present moment for needed coordination and cooperation for the prevention of waste and improvement in efficiency. For that reason, it believes that the creation of new agencies, unless they are specifically indicated and unless no other agencies are in existence that can not de equally as good work, is not a thing which they want to encourage or that they want to countenance.

Miss RANKIN. You also represent an insurance company; do you not?

Mr. FRANKEL. Yes; I am vice president of the Metropolitan Life Insurance Co.

Miss Rankin. That company has used nurses for advertising their insurance; have they not?

Mr. FRANKEL. No; they use nurses to look after their policies. Miss RANKIN. In what way?

Mr. FRANKEL. It gives a visiting-nurse service to its policy holders in case of illness with special reference to the care of mothers and of infants, and particularly to maternity care.

The result of that

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