that it was to keep people healthy; and I have always remembered that. My idea of doctors is to help us when we are bedridden, but yet, the primary job of doctors is to keep us healthy. Also, when I was in the Governor's office in Massachusetts, I was astounded to see the long lists of young people waiting to get into our schools, our State institutions, particularly for the feeble-minded. That, perhaps, is not right up this alley, but it comes into the problem. If we look after our children when they are young enough, they can look after themselves when they get older, and they do not become State or Federal charges. In the same way here, if we make young people healthy, they are going to be more useful citizens; and that is why I see General Hershey here, because I know what he was up against in the Selective Service during the recent war, and the number of unhealthy young men he found. Now, I follow the thoughts of Congressman Howell. I made a brief statement on this subject in the Senate. There are people here who are more experienced in health matters than I am. I give you these reasons why I am interest in being a sponsor on this bill. We have before Congress, as you know, Mr. Chairman, several bills on the health problem. Some of them are very far-reaching, and there is a great deal of controversy about them. This bill appealed to me particularly because there can be no great difference of opinion about the need for it, and also, it is not so expensive from a Government point of view. It goes to the heart of the problem, because it deals with children. There are just three very brief points that I would like to make. This bill does not put the Federal Government into administering health in our States. It offers Federal assistance, but leaves it to the State and local authorities to carry out the problem and administer it. Secondly, it addresses itself where it is most needed. It gives funds to the States interested in providing matching funds. It goes further than that, giving proportionately more money to the States where the need is the greatest among children of 5 to 17. There is always the question of how far to go, and how the Federal Government can spend its money fairly. We tried to work out a specific formula for distributing the grants using the number of children and per capita Federal income taxes as factors. Now, the amendments that Congressman Howell mentioned that I would like to suggest to you for your consideration change that formula, which is in the second part of this bill, from a Federal income-tax formula to a Federal income per capita formula; and also to 3-year averages instead of 1-year figures so that it would be steadier and could be worked out over the years with less year-to-year variation in the amount of the State grants. I find that several of these bills that have been presented and have become law are based on the Federal income theory rather than the Federal income tax. Under the income-payment system, change in our tax law will not disrupt the program. I think we have heard something about this situation in this Congress. The Federal income basis will not change so quickly under those circumstances. Now, wide open is the question as to whether the health authorities or the educational authorities in the States should administer and should advise on the bill. That was deliberately left open, be cause of the controversy, and we thought that it would be helpful to have the hearings and then decide after hearing both sides. The health commissioner in Massachusetts does not approve of that provision, because he thinks it is his job and not that of the department of education; and I think that any one of us who have been in Congress or State government know that there is a certain amount of jealousy between the two agencies, just as there is jealousy as to whether the House or Senate shall start an appropriation bill. Mr. DOLLIVER. I am afraid you are getting into constitutional questions. Mr. PRIEST. You would not want to say what your own view is on this administrative problem? Senator SALTONSTALL. No, sir; I am a politician. I will not say that until I have to cross that bridge. Mr. PRIEST. You are very wise. Senator SALTONSTALL. There is one other point that I would like to make. This does not provide just an examination of the child, it provides some follow-up. The question, of course, of how far to follow up is a serious problem, but it seems to me that we have got to leave that to the local administrator. My main feeling as a former State official, and now as a Government official, is that the Federal Government must in these days give financial assistance to local and State governments on certain social problems, to use the word in its broadest sense; but I hope and trust that when we pass these laws, we will not try to tell the local administrator just how he shall do it, but we shall give him advice. If he lives up to certain standards, then he gets our help. From there on, he goes it alone and he goes it in a way that he thinks is the best for his State and for his locality. Mr. Chairman, that I think, expresses the background and gives you the reasons why I am glad to be a sponsor of this bill. I have bad six children myself, and I know something of the problems of children's health. I have been in close touch with General Hershey, as Governor and then as Senator, so that I know the general physical condition of our young people throughout the country. Mr. DOLLIVER. Thank you very much, Senator. Is it your desire that the letter of Senator Baldwin be introduced n the record? Senator SALTONSTALL. Yes, sir. Mr. DOLLIVER. It is so ordered, Mr. Reporter. Senator SALTONSTALL. Thank you very much. (The letter is as follows:) Hon. JAMES I. DOLLIVER, Chairman of Subcommittee, UNITED STATES SENATE, COMMITTEE ON ARMED SERVICES, July 15, 1947. House Committee on Interstate and Foreign Commerce, MY DEAR CONGRESSMAN: I am pleased to hear that the subcommittee of which you are chairman will start hearings tomorrow on H. R. 1980, a companion bill to S. 1290, which was introduced in the Senate by Senator Saltonstall for himself and several other Senators including myself. The national school health services bill would authorize Federal grants-in-aid to States and Territories to improve health facilities for school children. Under this bill, the States would be assisted to provide and maintain school services for prevention and diagnosis of physical and mental defects and conditions; provide for training of personnel for State and local school health services; integrate new services provided by the bill with existing community services; establish a School Health Services Board to work with the Children's Bureau in approving State plans; establish a National Advisory Committee on School Health Services appointed by the President. The initial appropriation for this program would be $10,000,000. Ten percent of this would be earmarked for training personnel, for demonstrations, and for Federal administration. Half of the remainder would be matched dollar-for-dollar by the States. The other half would be allocated on an unmatched basis according to a formula based on Federal income-tax payments and the number of children between 5 and 17 in each State. After the first year, appropriations would be raised to $15,000,000. An important aspect of the bill is that planning for the proposed school health services and the actual administration of the program would be left entirely to the States. Of course, Federal standards would be set, but that is all. This program seemed to some of us in the Senate a good approach to the problem of the unsatisfactory condition of our youth's health, evidenced by the 28 percent rejected by Selective Service, by the Children's Bureau report that three-fourths of the Nation's children need dental care, and by the fact that thousands of our communities have no provisions for early detection and treatment of mental disorders. I sincerely hope that your committee will be able to take favorable action concerning this pressing social problem. Yours very sincerely, RAYMOND E. BALDWIN, Mr. DOLLIVER. First, we will hear from Dr. Vlado A. Getting, secretary-treasurer of the Association of State and Territorial Health Officers. Dr. Getting. STATEMENT OF DR. VLADO A. GETTING, SECRETARY-TREASURER, THE ASSOCIATION OF STATE AND TERRITORIAL HEALTH OFFICERS, BOSTON, MASS. Dr. GETTING. I have prepared a short statement of qualifications, if the committee desires to have such a statement. Mr. DOLLIVER. That will be inserted in the record. (The matter referred to is as follows:) TRAINING AND EXPERIENCE OF VLADO A. GETTING, M. D., MASSACHUSETTS COMMISSIONER OF PUBLIC HEALTH EDUCATIONAL Graduate of Johns Hopkins University, bachelor of arts, 1931. Graduate of Harvard University Medical School, doctor of medicine, 1935. Received master's degree in public health, magna cum laude, Harvard, 1939. Received doctorate in public health, cum laude, Harvard, 1940. PROFESSIONAL Assistant resident, Mattapan Sanatorium, Boston, 1935 (3 months). Contract surgeon, United States Army, Fort Ethan Allen, Vt., 1935 (4 months). Intern, Worcester City Hospital, Worcester, Mass., 1935-37. Assistant epidemiologist, Massachusetts Department of Public Health, Boston, 1937-39. Technical Director of Mosquito Survey, Massachusetts Department of Public Health, Boston, 1939. Epidemiologist, Massachusetts Department of Public Health, Boston, 1939-40. Assistant District health officer, Massachusetts Department of Public Healto, 1940-41. District health officer, Massachusetts Department of Public Health, Boston, 1941-42. 66168-47- -3 Commissioner of public health, Worcester, Mass., 1942–43. Commissioner of public health, Massachusetts Department of Public Health, Boston, 1943 to date. Research assistant in epidemiology and preventive medicine, Harvard School of Public Health and Harvard Medical School, 1939–40. Assistant in epidemiology and preventive medicine, Harvard School of Public Health and Harvard Medicine School, 194–42. Lecturer on public health practice, Harvard School of Public Health, 1943 to date. Senior Surgeon, United States Public Health Reserves, 1944 to date. MEMBERSHIP IN MEDICAL AND EDUCATIONAL ASSOCIATIONS Phi Beta Kappa (Hopkins). Delta Omega (Harvard). Delta Omega Honorary Public Health Fraternity. Fellow of the American Medical Association. Fellow of the American Public Health Association. Member of Massachusetts Public Health Association. Member of American Academy of Science. PUBLICATIONS Progress of Milk Regulations. The Commonhealth, 1938. Massachusetts Mosquito Survey. Training Course for Field Personnel, 1939. Report of Medical Progress: Some Epidemiological Considerations of Diphtheria. New England Journal of Medicine, October 31, 1940. Special Report of the Department of Public Health Relative to Varieties and Prevalence of Mosquitoes in the Commonwealth, December 1940. A Survey of the Mosquitoes of Massachusetts With a Discussion of the Relation of Mosquitoes to Disease. Final report, 1940. Outbreak, Follow-Up of Cases and Report of Mosquito Survey. New England Journal of Medicine, June 12, 1941. Civilian Public Health Problems in Wartime. Medicine, January 7, 1943. New England Journal of Insects and Rodents in Relation to Public Health in Wartime. Pests, May 1943. Epidemiologic Aspects of Food-Borne Disease. New England Journal of Medicine, June 10, June 17, June 24, 1945. Food-Borne Streptococcus Outbreaks. October 1943. American Journal of Public Health, A Food-Borne Streptococcus Outbreak-The Differentiation of Staphylococcus Enterotoxin From Toxic Substances Produced in Minced Tissue Media by Homolytic Streptococci and Other Agents. American Journal of Hygiene, November 1943. Upgrading of Hospital Care Is the Goal of Massachusetts Licensing Law. Hospitals, March 1944. Tropical Diseases in New England. Science Education, March 1944. Tropical Disease and Global War. American Journal of Medical Sciences, March 1944. Malaria in Massachusetts. New England Journal of Medicine, March 23, 1944. Staphylococcus and Streptococcus Carriers. American Journal of Public Health, August 1944. Food-Borne Disease-Food Infections and Food Poisoning. Oxford Press, 1944. Seventy-five Years of Public Health in Massachusetts. Norfolk Medical News, November 1944. Schools of Public Health-Whither and How. Harvard Alumni Bulletin, 1944. Insect Vectors of Disease. New England Journal of Medicine, March 1945. Fluorine and Dental Caries. New England Journal of Medicine, June 1946. Education and Infantile. The Massachusetts Teacher, January 1946. The Commonwealth's Health Program. New England Journal of Medicine, in press. Indispensable Functions From Viewpoint of the State Health Commissioner. Proceedings of National Conference on Local Health Units, Journal of American Public Health Association, January 1947. Dr. GETTING. The Association of State and Territorial Health Officers wishes to express to this subcommittee of the Committee on Interstate and Foreign Commerce its deep appreciation for having been given this opportunity to present its views on H. R. 1980, a bill entitled "The National School Health Services Act of 1947." Our association is composed of the health officers who are in direct supervision of the health programs of the States and Territories of the United States. At the present time this organization is composed of 52 members, representing all the States and Territories. With one exception, all are doctors of medicine, who are members of their respective professional organizations. The primary purpose of the Association of State and Territorial Health Officers is to express through its officers the opinions of the organization on various matters pertaining to health. In some States this administrator is appointed directly by the governor as health commissioner. In other States the administrator is appointed by the State board of health and serves as the executive officer and secretary of the board. The health programs administered vary greatly from State to State. Some State health agencies have several thousand employees, expend millions of dollars in State funds, and administer both preventive and curative medical programs. Others are small and limited both in personnel and funds. However, all State health agencies carry on to some extent activities pertaining to the school health program. The Association of State and Territorial Health Officers at the beginning of this presentation wishes to endorse in principle H. R. 1980 as meeting some of the greatest needs of the health program in several States. These States are greatly encouraged by the possibility of obtaining additional facilities to meet the health needs of a coming generation. This bill would enable us to provide and maintain school health services not only for the diagnosis of but the prevention of many physical and mental defects. Moreover, it would enable us to perform physical examinations more thoroughly and at predetermined intervals on all school children. This would assure us that these children are developing normally and that physical and mental defects which may occur would be detected in their early incipient stages before major and permanent disabilities were allowed to develop. This bill would assist the States to provide for follow-up treatment of such defects and conditions, especially in rural areas and areas of severe economic distress where the need is obviously most pressing. Provision is made in this bill for demonstration and for the training of personnel for both State and local school health services. Moreover, this bill provides for close integration of the health activities of the schools with the health activities of the community program. Because of these added additional facilities, the bill must obviously receive the endorsement of all persons interested in the promotion of the health of the school child. On April 12, 1945, the Association of State and Territorial Health Officers adopted the following resolutions on school health programs: Whereas school-health programs in most communities are poorly organized, limited in scope, and in general unproductive of better health; and Whereas there is a great confusion as to the division of responsibility between health and education departments for school-health programs; and |