72D CONGRESS 1st Session

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SENATE

REPORT No. 429

TO CONFER TO CERTAIN PERSONS THE BENEFITS OF HOSPITALIZATION AND THE PRIVILEGES OF THE SOLDIERS' HOMES

MARCH 14 (calendar day, MARCH 16), 1932.-Ordered to be printed

Mr. MCGILL, from the Committee on Pensions, submitted the following

REPORT

[To accompany S. 1328]

The Committee on Pensions, to whom was referred the bill (S. 1328) proposing to confer to certain persons who served in the Quartermaster Corps or under the jurisdiction of the Quartermaster General during the war with Spain, Philippine insurrection, or the China relief expedition, the benefits of hospitalization and the privileges of the soldiers' homes, having considered the same, report back to the Senate with the recommendation that the bill do pass without amendment.

The bill provides that those who were discharged for disability while in the Government service in line of duty be held to have been honorably discharged from the military or naval forces of the United States and grant them the benefits of the Soldiers' Home, the National Home for Disabled Volunteer Soldiers, the Naval Home, and hospitalization.

These men, though technically civilian employees of the Government, were under stringent military discipline and served in uniform and were under hostile gun fire in both the Spanish and Philippine insurrections.

The cost of this legislation would be comparatively little. The indigent few who would take advantage of such an act as this should be assured of medical treatment or a home and would not displace former soldiers needing hospital care.

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Federal agencies over the actual expenditure on individual projects of the funds to be made available for use in the States. A budget system used by the Public Health Service has worked very satisfactorily in the administration of the appropriations for studies and demonstrations in rural sanitation. The use of this system has made possible careful supervision over the expenditure of Federal funds and has been otherwise advantageous to both the Federal and the State agencies in the conduct of the work.

I have been advised by the Director, Bureau of the Budget, that the expenditures contemplated by this bill would not be in accord with the financial program of the President, but would not be in conflict therewith if amended so as to authorize an appropriation of $1,000,000 for the first year and $2,000,000 for each year thereafter, to be divided equally between the Public Health Service and the Children's Bureau.

Very truly yours,

Hon. HIRAM W. JOHNSON,

United States Senate, Washington, D. C.

A. W. MELLON, Secretary of the Treasury.

JANUARY 13, 1932.

MY DEAR SENATOR: In reply to your inquiry of December 14, concerning S. 572, a bill to provide that the United States shall cooperate with the State in promoting the general health of the rural population and welfare and hygiene of mothers and children, I have the following to submit:

I am informed by the Director of the Bureau of the Budget that the expenditures contemplated by this bill would not be in accord with the finance program of the President but they would not be in conflict therewith if amended so as to authorize an appropriation of $1,000,000 for the first year and $2,000,000 for each year thereafter, to be divided equally between the Public Health Service and the Children's Bureau.

The general plan of the bill meets with my approval. It provides for the renewal of the cooperation of the Children's Bureau of this department and the State departments of health in promoting the health of mothers and babies, and for expanding the resources of the Public Health Service in promoting rural health organization. I note that the Joint Federal Health Coordinating Board has the same general powers and the same membership as the Federal Board of Maternity and Infant Hygiene of the act of 1921. This board will prevent any possible confusion as to the work to be undertaken in the Federal administration of these two services.

As Secretary of Labor I am particularly interested in the maternal and child health provisions of the act, which are to be administered by the Children's Bureau of this department. In renewing Federal and State cooperation in this field, it is possible to proceed on the basis of experience. The maternity and infancy act of 1921 proved to be of great assistance to the States in promoting State and local services for mothers and babies and in reducing maternal and infant death rates. In its provisions relating to maternal and infant health this bill is in all important particulars the same as the act of 1921.

Cordially yours,

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W. N. DOAK, Secretary.

MARCH 14 (calendar day, MARCH 15), 1932.-Ordered to be printed

Mr. BINGHAM, from the Committee on Commerce, submitted the

following

MINORITY REPORT

[To accompany S. 572]

The undersigned members of the Committee on Commerce, dissenting from the action of a majority thereof in approving the bill (S. 572), to provide that the United States shall cooperate with the States in promoting the general health of the rural population of the United States and the welfare and hygiene of mothers and children, as amended, submit herewith the following minority report thereon: The report of the committee recommends that all after the enacting clause in S. 572 be stricken out and that there be substituted therefor language that excludes all distinction between rural and urban communities. That limits the purpose of the bill to the authorization of Federal subsidies to promote the health and welfare of mothers and infants. To the elimination of discrimination between rural and urban communities the minority agrees. That there was and is no justification for any such discrimination was abundantly shown in the course of the hearings. If Federal subsidies are to be paid to the several States for the protection and promotion of health at all, such subsidies and the corrolated State appropriatons should be available wherever death rates denote the prevalence of sickness to an unusual extent, whether in rural communities or otherwise.

It is significant that medical societies, including the American Medical Association, and physicians from Texas to Minnesota oppose this legislation, as is shown by the statements made before the committee at the hearings. The opponents range from doctors high in the councils of leading medical organizations to what one witness described, in speaking of himself, as the "common garden variety of physician." This significance is all the more marked because it is known that the doctors who belong to these societies give more than half their time to the poor without price and without considering their time. The most distinguished surgeons, members of these

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organizations, go to the hospitals in their cities and in their communities, day after day, week after week, and year after year, operating to save the lives of poor people without charging 1 cent for their services. If there is any body of men in the community, if there is any body of men in the United States which is interested in health and welfare it is these physicians and surgeons who give of their time freely to the poor of their cities and towns. It is they who are opposing this legislation.

A few citations from the record will serve to emphasize their attitude. Dr. George W. Kosmak, of New York, is an officer in the American Gynecological Society; a member of the Association of Obstetricians and Gynecologists; a member of the Joint Committee on Maternal Welfare, which is nation-wide, and editor of the American Journal of Obstetrics and Gynecology.

Doctor Kosmak summarizes his objections to this legislation as follows:

(1) It is uncalled for; (2) it will further undermine the rapidly diminishing conception of State rights; (3) it will interfere with, rather than promote, much desired community activities; (4) it will entail a needless drain on the Federal Treasury; (5) it is based on false and illogical premises; and (6) it will not accomplish the object sought because of the ineffectiveness of the methods proposed. Then he goes on:

As a member of the profession, I firmly believe that little or nothing will be accomplished in the maternal and infant welfare field by legislation of this type in helping mothers in their problems, because in the machinery created by this measure attention is largely focused on the less essential features of maternal care while the really important factors that have to do with our high maternal death rate are almost totally ignored. During the 7-year period in which the SheppardTowner Act was in effect, no improvement in maternal and infant care was devel veloped that could be attributed to the same and millions of dollars were disbursed without any commensurate return in lives saved whether of mothers or infants. I base that statement on the fact that we have had practically no reduction in the death rate of mothers.

Community responsibility for health matters will decline; there will be less incentive to stimulate local effort when the funds for this work come from, and in the end the expenditures directed by, Washington. We want decentralization of activities that concern more particularly the local communities, for the spirit of this country is essentially individualistic, and this applies equally to the practice of medicine. Any Federal measure whose aim is direct affiliation with and final control of local interests will eventually destroy that individualistic relation between patient and doctor upon which satisfactory medical care depends. And the problem under discussion is a medical problem which the medical profession and not the Federal Government must solve.

Dr. C. B. Wright, representing the American Medical Association and the Minnesota State Medical Association, sets forth the attitude of the medical profession in Minnesota thus:

I think there were fundamental mistakes in the Sheppard-Towner Act. Unless you can get a local community under the guidance of the local doctors interested in a health program, I will frankly state that, in my experience, it can not be put over successfully. Where it has been attempted independently of the local medical profession, it has interfered with the proper education of that community in health matters. I am perfectly willing to stand on that. That represents the ideas of the medical profession in my State.

Dr. William B. Chapman, physician and surgeon in the railroadshop town, Silvis, Ill., who declared he was "a common garden variety of physician," characterized the Sheppard-Towner Act as "a lethal menace." He said:

Extraneous health advice comes to all communities, and all people, and all legislatures, and the National Congress from very many sources. This is one. I think that I qualify as one of the legislative objectors. I have been objecting since 1916, before the Sheppard-Towner Act was born. The Sheppard-Towner Act was one of a group, and this is one of a group, which I think-and I am thoroughly and honestly convinced-carries a lethal menace to this country.

It will kill the country if enforced as permanent legislation and maintained among our laws. It is only one of a group. We have been bothered with them, especially since 1915, and we have hoped that there would come a time when public opinion would so organize them that this danger to our Republic would be removed. The danger lies in the paternalistic change in the form of our Government.

That the Sheppard-Towner Act operated to the detriment rather than to the benefit of the State of Texas appeared from the testimony of Dr. J. H. Florence, of Houston, former State health officer, submitted in a letter presented by Dr. Holman Taylor, secretary of the State Medical Association of Texas, as follows:

With reference to the operation of the Sheppard-Towner Act, let me say that when I was the State health officer, I administered the money provided by this law. I tried to carry out conscientiously the provisions of the act, but as time went on I found the regular health budget for the department was invariably cut by the appropriation committee of the legislature, because it was felt that we were getting outside funds for health work, when, in fact, the amount received from the Federal Government was of little material aid in the State health department. Also the publications issued to us for distribution were not always scientific or practical for the pregnant women and infant maternity welfare. I felt after a few months in office that the money furnished us was of little value. At first, I was favorable to the Sheppard-Towner bill, but my observation was that there was an attempt by the Federal authorities in charge of the distribution of the money to dominate the State health department. The State health officer was on the ground. The authorities in Washington were not, hence knew nothing of our real needs. In a theoretical way, they demanded that we disburse these funds according to their ideas, which were oftentimes vague, problematical, and loaded with sentimental nonsense. Above all of this, I found that our people resented the encroachment of Federal activities in our State, which seemed to smack of centralization and control of local government activities from Washington.

An effort has been made to justify, or excuse, the enactment of legislation of this nature by claiming that it is an educational measure and that the dissemination of information for educational purposes is a legitimate function of the Federal Government. If that claim is sound, and if this purpose is meritorious, there is no reason for making the accomplishment of this end desired by the Federal Government dependent upon the consent of the States or on State appropriations. Even if it were to be admitted that it is a proper function of the Federal Government to disseminate information concerning health among mothers and infants, it does not follow that the Federal Government is at liberty to use any and all means to that end.

The establishment of Federal dispensaries, clinics, and health centers in a State by the Federal Government may be a very effective means of disseminating information. But if the Federal Government can, without the consent of a State, establish dispensaries, clinics, and health centers within its boundaries for educational purposes, then the Federal Government can in like manner establish police departments, fire departments, schools, assessment offices, tax-collection offices, and so on indefinitely, for the purpose of educating the people of the State how they and their officers should run their State governments in the interest of the people. To state the case is to show the absurdity of the effort made to justify the pending