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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 States 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 maternal 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

service has been that in five years, 1911 to 1916, where the mortality from causes due to maternity in the United States has practically stood. stationary, the mortality of the company has reduced 121 per cent.

Miss RANKIN. Is this a charity or a part of the business?

Mr. FRANKEL. The service is paid for out of the premiums of the policy holders. It is everything but a charity. It is a service to policy holders.

Miss RANKIN. Your work in that respect is not in connection with your work for the American Public Health Service?

Mr. FRANKEL. None whatever.

Miss RANKIN. How is this executive committee of the National Public Health Association formed?

Mr. FRANKEL. It is elected by the organization. This executive committee was elected at the meeting held in Chicago in December last.

Miss RANKIN. Is that a representative committee or is it a small committee from New York?

Mr. FRANKEL. The committee is a committee elected out of the board of directors by the board of directors, the board of directors being elected by the association. The board of directors has representatives in practically every State of the Union. The executive committee is elected out of that composed of officers and certain particular members elected to serve on the executive board and to act for the board of directors in the interim between meetings.

Miss RANKIN. How many men would compose a quorum at this executive committee meetings?

Mr. FRANKEL. I think five or seven.

Miss RANKIN. Are there any women on that board?

Mr. FRANKEL. To my recollection there are none on the board; no. There are women, of course, represented in the membership. Miss RANKIN. You speak of eleven States where they have child welfare work done; could you name those States?

Mr. FRANKEL. I have here a list of nine. I was only notified of this hearing yesterday by telegraph. They are Connecticut, Florida, Illinois, Kansas, Massachusetts, New Jersey, New York, Ohio, and North Carolina. You take the State of North Carolina, for example. I do not know of a State that is doing a better piece of work at the present moment than North Carolina's health department along the lines of rural hygiene. They are quite advanced and have a very efficient State health officer, Dr. Rankin. They have gone so far as to organize dental clinics for the population of the State. and altogether their child hygiene is a distinct contribution, particularly along educational lines among women and babies, in the United States. It would seem a pity to me to go into that State and create a new agency that would take the work from them.

Mr. ROBINSON. Right along that line is a letter which you can make a part of your remarks.

Mr. FRANKEL. This letter is addressed to Mr. Robinson. I will read it:

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NORTH CAROLINA STATE BOARD OF HEALTH,
OFFICE OF THE SECRETARY,

Raleigh, N. C., January 24, 1919.

Hon. L. D. ROBINSON,
United States Congress,

Washington, D. C.

MY DEAR MR. ROBINSON: I desire to direct your official attention to House bill 12634 which makes a Federal appropriation conditioned upon supplemental appropriations from States for infant hygiene in rural communities. The bill provides, as I understand it (not having seen a copy of it) that this Federal general appropriation shall be expended through some new agency to be created in the State government. Infant hygiene work is strictly public health work and it seems to me that the public health work of the United States Government should be carried on under the United States Public Health Service and not through the Department of Labor. I have not attempted to argue that side of it at all because I do not think it has any bearing on this particular bill.

In other words that this entire measure should come under the Public Health Service and not under the Federal Children's Bureau.

Moreover, I am opposed strongly to the idea of creating a new division of the State government to look after certain health interests, reproducing within the State the mistake of the Federal Government in dividing its health work between a number of agencies or bureaus. I would appreciate very deeply your giving your attention to this bill, and using your influence partciularly against the provision of the bill that creates a new agency within the States for public health work.

Thanking you for any consideration you give this matter, I am, with the highest esteem,

Very sincerely, yours,

Miss RANKIN. Let me ask this question. with any work done in North Carolina?

W. S. RANKIN, Secretary.

How could it interfere

Mr. FRANKEL.. It would mean practically one thing or the other, if I may give my own personal views. If the Federal Government is to go into the subsidy and the State is to cooperate in getting a subsidy, it means the creation of a new agency who are going to look after infant hygiene and maternal hygiene. That work is to-day being done by the States.

Miss RANKIN. Just in New York State?

Mr. FRANKEL. As a practical case of what I mean, in North Carolina.

Miss RANKIN. They have done work for maternal aid?

Mr. FRANKEL. Yes.

Miss RANKIN. In what way?

Mr. FRANKEL. They have not, of course, gone to the extent this bill contemplates, of actually furnishing hospital care, for example, and medical care for pregnant women or for the care of the baby during or immediately after confinement, but they have taken up the whole educational side of infant welfare and child welfare work by the distribution of pamphlets and leaflets by sending nurses and physicians into the homes; by having the whole State organize public health nursing service with a supervisor traveling through the State attempting to organize in every community public health nursing work through cooperation of the communities with the State board. of health, and they have taken the State from one end to the other. It has been largely rural work, for the reason that there are comparatively few cities of any size in the State of North Carolina.

Now, their work has simply been a phase of their general health work, and after all you can not detach or separate the care of the mother and the baby from the general health work of the community.

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