Dr. WALL. Yes, sir.

Senator DONNELL. The mere fact that you are in favor of a program which would indeed might require everybody to take treatment for venereal disease, or tuberculosis because it might spread like a fire over a great city. That does not mean, does it, Doctor, that there is any logical inference to be drawn that you would be in favor of providing medical service by which a child suffering from cuts, burns, boils, or children's diseases, or measles, or mumps would be entitled to free care the year round? That inference does not follow at all, does it?

Dr. WALL. Not in my opinion.

Senator DONNELL. That is the distinction as I understand you were making in your testimony. Is that correct?

Dr. WALL. That is what I tried to make clear.

Senator DONNELL. Now, Doctor, in regard to this matter of need, the means requirement, the means test, the Social Securitiy Act, while it does not define need, it leaves it to the States to define what is "need," does it not?

Dr. WALL. It does, yes; particularly the welfare part of the act. Senator DONNELL. Take this old-age assistance in my State, or the aid to dependent children. The Federal Government contributes money, but my State of Missouri, the legislature passes on and sets up a definition in the statutes that you can go there and read as to what constitutes "need" within that State, within the idea of the legislation. That is the way that is handled.

Dr. WALL. That is my understanding of it, Senator.

Senator DONNELL. There may be a different need, may there not, in the State of Arizona, where there is a sparce population, and the need in the State of New York where there are so many people you can hardly get around?

There is a different situation that may make one need apply in one State and another in another.

Dr. WALL. There would be a wide difference.

Senator DONNELL. And that is one of the reasons why you favor the idea of having that matter of need determined and defined on the State level rather than have one definition which, as the Senator so clearly points out, is so difficult and perhaps impossible to phrase, on the basis of a national definition.

Dr. WALL. That is our belief.

Senator DONNELL. For instance, I notice in this very committee report that the Senator presented here, in the very paragraph in which he read about these voluntary insurance plans and compulsory insurance plans, and so forth, that the final sentence in that very paragraph, No. 6, is this:

The determining factor should be the situation existing at the local level, and undoubtedly a combination of the various methods of financing may be needed in many cases.

Now, that is the general view that you have taken, is it not? Dr. WALL. I think that is true, and it is a reasonable view. Senator DONNELL. So that is the basis of your views, as I understand it, with respect to defining these matters on the basis of local levels rather than undertaking to pass Federal Act that because of

the impossibility, at least, in part, of defining what is "need" from Maine to Florida, and from Florida to Oregon, undertakes to give this money to everybody indiscriminately, regardless of need. That is your thought, is it not?

Dr. WALL. That is my thought.

Senator DONNELL. That is all.

Senator PEPPER. Dr. Wall, you did not understand that I advocated that the Federal Government would lay down the standards of the means test, did you, or that that bill does?

Dr. WALL. That was my feeling when you said what is the

Senator PEPPER. This bill does not have any means test at all in it. The thing is that it does not allow anybody to define a means test. That is what you were complaining about.

Dr. WALL. We were complaining because the bill does not contain a means test to be defined by the individual States.

Senator PEPPER. Exactly. The bill says that these facilities and services shall be available to all who elect to take advantage of it. Dr. WALL. That is what we object to.

Senator PEPPER. That is what I thought, but I wanted to make it clear that I was not advocating that the Federal Government advocate any means test. This bill does not even allow the States to define a means test, let alone define the means test for itself.

Now, Doctor, is it not a fact that the Veterans' Administration is now contracting with State medical societies to pay commissions for medical care rendered to veterans without a means test?

Dr. WALL. To pay for services rendered veterans, I presume you mean, Senator.

Senator PEPPER. Yes; without a means test.

Dr. WALL. That is true so far as I know, because veterans are supposed to be cared for by the Veterans' Administration.

Senator PEPPER. But without a means test.

Dr. WALL. The means test consists of the fact that they are veterans of the war. Their eligibility is determined by the fact that they served their country.

Senator PEPPER. But is it your idea that the means test relates to the ability to buy it yourself without public funds?

Dr. WALL. Yes.

Senator PEPPER. That is not the standard applied in that case.

In some remarks I made in the Senate, Doctor, I pointed out that "infants that could have been saved in 1943 of all States have had Connecticut's infant mortality rates," and the conclusion was that 31,029 infants could have been saved in the United States had Connecticut's infant mortality rate, which we thought meant if all States could have had substantially the same services rendered to children as were rendered in Connecticut.

On the same page we pointed out that 2,972 mothers could have been saved in the United States in 1943 if all States had had Minnesota's maternal mortality rate. I just gave that to emphasize that this bill is intended to make it possible for all States to reach a high level of care for their mothers and children.

Senator, do you have any further questions?

Senator DONNELL. No.

Senator PEPPER. Thank you, Doctor.

I ask to be incorporated in the record at this point the statement by Dr. Richard Bolt, M. D. and Dr. P. H., lecturer in public health, University of California, a letter dated June 18, 1946, in which he gives his approval of this measure.

(The information is as follows:)

Hon. CLAUDE PEPPER,

UNIVERSITY OF CALIFORNIA,

SCHOOL OF PUBLIC HEALTH, Berkeley 4, Calif., June 18, 1946.

Senate of the United States, Washington, D. C.

DEAR SENATOR PEPPER: Supplementing my statement of November 28, 1945, on Senate bill 1318, may I emphasize that I am still of the opinion that the bill is sound in principle and that if enacted it would be of great benefit for the health and welfare of our mothers and children throughout the entire country.

I have followed the organization and work of the United States Children's Bureau since it was organized in 1912 and have found that its influence and services have increased year by year in conserving the lives of our mothers and children.

I have had opportunity to consult the Children's Bureau from time to time and have always received the most courteous and helpful assistance. As a young private physician specializing in obstetrics and pediatrics, I had occasion to secure helpful literature in prenatal care, infant care, and child care which was distributed to my patients with excellent effect. Later when I came into the field of public health I found that the influence of the Children's Bureau had spread to practically every part of the United States and our possessions. As director of the American Child Hygiene Association and later as medical director of the American Child Health Association I had occasion to travel widely in the United States and observe the effects of the educational campaigns, consultations, and postgraduate courses sponsored by the United States Children's Bureau.

As director of the Cleveland Child Health Association for 16 years I kept in close touch with the work of the United States Children's Bureau and found that it had not only been of great service to the State health departments in organizing and promoting their bureaus of maternal and child health, but also in helping to meet the needs of local organizations in our large cities and small towns.

As a public health educator in Johns Hopkins University, Western Reserve University, and the University of California I have had an opportunity to review the excellent reports and helpful literature put out by the Children's Bureau over the last 33 years, and have made wide use of their literature in my instruction. I have always found the Children's Bureau open to advice and even anxious to secure the best possible advice from professional groups and advisory committees to the Children's Bureau.

It would be a great catastrophe to this country to have the long and experienced services of the United States Children's Bureau done away with or hampered in any way. It seems to me with such experienced and trained personnel as the Bureau has succeeded in getting that the work of the Children's Bureau should be broadened and carried into every nook of our country.

In any plans for reorganization the fundamental functions and services of the Children's Bureau should be preserved and extended. As I have said before, I feel there is only one criticism to bear upon this situation, and that is that the Children's Bureau has never had enough money to do the complete work that is necessary in this postwar, difficult period and I sincerely hope that your committee will favorably recommend the bill to Congress and that it will be passed with ample provisions for the United States Children's Bureau to continue its unparalleled services to our mothers and children.

Respectfully yours,

RICHARD ARTHUR BOLT, M. D., Dr. P. H.,
Lecturer in Public Health.

Richard Arthur Bolt: Bachelor of arts, and doctor of medicine, University of Michigan; doctor of public health, Johns Hopkins University and University of California. Lecturer in School of Public Health, University of California; formerly director of bureau of child hygiene of Cleveland, Ohio, and director of Cleveland Child Health Association; general director of American Child Hygiene Association and medical director of American Child Health Association; associate in public health and hygiene and in pediatric departments of Western Reserve University; lecturer in child hygiene at Johns Hopkins University and assistant professor of child hygiene at University of California; specialist in maternal and child hygiene.

For details of career see: Who's Who in America, Who's Who in World Medicine, Who's Who Among Physicians and Surgeons, and American Men of Science.

Senator PEPPER. I also want to incorporate in the record a letter dated November 28, 1945, from Richard A. Bolt, from the School of Public Health, in Berkeley, Calif., giving his experience in maternal child health service, and his approval of the bill.

(The information is as follows:)

Hon. CLAUDE C. PEPPER,

UNIVERSITY OF CALIFORNIA,

SCHOOL OF PUBLIC HEALTH, Berkeley 4, Calif., November 28, 1945.

United States Senate, Washington, D. C. DEAR SENATOR PEPPER: Inclosed you will find a brief statement of my convictions regarding your Senate bill 1318. I am also inclosing a brief statement of my experience in maternal and child health services throughout the country and also several of my reprints which bear directly and indirectly upon the subject you have under consideration.

With sincere good wishes,

Respectfully yours,

RICHARD A. BOLT.

Hon. CLAUDE C. PEPPER,

BERKELEY, CALIF., November 28, 1945.

Senate of the United States, Washington, D. C.

DEAR SENATOR PEPPER: I have had the opportunity of going over in detail Senate bill 1318 which you and your colleagues presented to the Senate on July 26, 1945, and which is now in the hands of the Committee on Education and Labor for their consideration. As I have had the privilege of working in the field of maternal and child health for over 30 years and have studies carefully the outcome of various acts of Congress for the health and welfare of mothers and children, I thought your committee might welcome my observations.

In the first place your bill is framed upon the sound principle of Federal aid to the States which has been an established and legitimate means of cooperation between the Central Government and the States from the founding of the Republic right up to the present date.

To my mind the following acts of Congress based upon this principle have proved of inestimable value to the citizens of all States, especially to the mothers and children.

1. The Morrill Act of 1862, donating lands for colleges of agriculture and mechanic arts.

2. Smith-Lever Act of 1914, providing cooperative agricultural extension work between the land grant colleges and the United States Department of Agriculture.

3. Chamberlain-Kahn Act of 1918, for the prevention of venereal disease.

4. Smith-Hughes Act of 1917, for promotion of vocational education.

5. Sheppard-Towner Act for maternity and infancy (1921) in effect from 1922 to 1929.

6. Social Security Act of 1935 with certain titles for maternal and child health, medical services for crippled children and child-welfare services for rural children.

7. Maternity and infancy care program for servicemen's wives, 1943.

There is no logical or practical reason why the principle of Federal subsidies to the States should not be extended to meet the post-war problems of maternal and child health. Your bill embodies the essentials and provides for suitable safeguards so that the poorer and less fortunate States are given an opportunity commensurate with the more fortunate. It also makes possible the extension of well tested methods for the health and welfare of mothers and children to the rural and sparsely populated localities as well as to large centers of population. In the second place I am convinced that the administration of your Act has provided the proper channels through which to secure prompt, efficient, and cooperative services to the States. I have followed step by step the organization, development, administration, and services of the United States Children's Bureau since its founding in 1912. From my experience I can state that the United States Children's Bureau has been the one most potent and influential Government agency to influence and promote progressive and effective measures for the health and welfare of mothers and children throughout the entire country. It is only necessary to study the reports and other literature issued by this Bureau from year to year to substantiate my opinion. If there is any criticism to be leveled at the present bill it is not in its purposes or administrative provisions but in the amount of money it proposes to appropriate. With the birth rate rising, the return of service men and women, the building up of new family units and the heavy responsibilities of family life, the appropriation should be doubled or tripled.

If your committee desires more detailed data and information which I am able to give on the development of maternal and child hygiene for which bill S. 1318 provides, I shall be only too happy to furnish it.

Respectfully submitted,

RICHARD A. BOLT, M. D., Dr. P. H.

Dr. Richard Arthur Bolt, M. D., Dr. P. H., lecturer in the School of Public Health at the University of California at Berkeley; formerly director of the Cleveland, Ohio, Child Health Association; Director of the American Child Hygiene Association; Specialist in Maternal and Child Hygiene; Director of Bureau of Child Hygiene of Cleveland, Ohio; Associate in Public Health and Hygiene and in Pediatric Departments of Western Reserve University; and Assistant Professor of Child Hygiene at the University of California. For details on career see Who's Who in America and American Men of Science.

Senator PEPPER. I have a telegram dated June 21, of this year, from H. F. Helmholz, Rochester, Minn. I would like to read this telegram. It says:

I sincerely regret that absence of two of my associates makes it absolutely impossible for me to get away at this time in answer to your request to submit a statement. I wish merely to point out what I consider the most fundamental section of bill S. 1318 and the one that has received the most adverse criticism from the medical profession. I refer to subsection 3, section 103, title 1 prove that as services and facilities are furnished under the plan they shall be made available to all mothers and children in the State or locality who elect to participate in the benefits of the program and that there will be no discrimination because of race creed color or national origin and no residence requirement. This is the first time that a bill has carried this broad concept of national interest in the health of children that will make available to all children the best of prevention and curative medical care.

The present study of child-health services now being conducted by the American Academy of Pediatrics with the help of the Public Health Service and the Children's Bureau had as its objective "to make available to all mothers and children in the USA all essential preventive diagnostic and curative medical services, of high quality which used in cooperation with the other services for children will make this county an ideal place for children to grow into responsible citizens this survey should show that what and where personnel and facilities are needed and S. 1318 should make it possible to meet these State and local needs by Federal grants in aid to these States that need help the right of every child to an education has been accepted universally for many years but let no one suppose it did not raise tremendous opposition from the private school at the time of its introduction. Just as every American child has a right to an education so S. 1318 states for the first time that every American child has a right to health.