Then if we add to that general medical care for children and the full scope of care for crippled and otherwise physically handicapped children, we would add approximately 7 cents a day.

Now, this includes the total of all services. It does not omit the 11 projects, as we heard yesterday. It includes everything as far as we can look forward to the needs of children.

I would like to reiterate that this covers much more than we are equipped to provide today.

Some years hence we may be able to provide this care, if we have the resources to train personnel and build hospitals, but still I would like to reiterate that it is impossible to calculate it closely and accurately.

The figure that was quoted yesterday in the testimony was derived, I judge, from those figures that I included in my testimony on May 1. The figure that we have arrived at for complete health, medical and dental care for a child, each year through 18 years of age, is somewhere in the neighborhood of 45 to 48 dollars a child.

I would like to have it clear in the record that this covers not only medical care but dental care.

Senator PEPPER. That is a year, of course.
Dr. ELIOT. A year.

Senator DONNELL. Children under 18?

Dr. ELIOT. Children under 18.

Senator DONNELL. 40,000,000 is approximately the number of such? Dr. ELIOT. We estimated 43,000,000 children for the year 1947. Senator DONNELL. For the year 1947, 43,000,000. I see.

Dr. ELIOT. That I think completes my testimony except for one other point I would like to make.

The question was raised yesterday, or the statement was made yesterday, that the Children's Bureau had to be forced by the State health agencies to develop emergency maternity and infant care programs.

I was interested in that comment, because usually the statement is made the other way around, that the Children's Bureau originated the program and required the States to undertake it.

The truth of the matter is that the program started at the grass roots in the State of Washington.

The project presented to the Children's Bureau by the State of Washington was approved by the Children's Bureau in August of 1941. Very soon thereafter, many other States began to perceive that they were confronted with the same need, to take care of the wives of service

men.

And in March of 1942, the State health officers, after receiving a report from the State of Washington as to what they were accomplishing in their little project, asked the Children's Bureau whether we would be willing to set aside some of the money under title V of the Social Security Act so that some of the other States could undertake similar projects.

We were glad to do that.

We found that there was only about $200,000 that could be made available for the program at that time.

The matter was thoroughly discussed with the State and territorial health officers prior to the initiation of that very modest program in the beginning.

Late in the calendar year of 1942, it became apparent to the States and to the Children's Bureau that there was not enough money in the appropriations under the Social Security Act for these projects to go forward in the States as the States themselves wished, and so, having requested the States for their budgets in respect to how much they would need to complete the program for the remainder of the fiscal year 1943, the Children's Bureau went before the Bureau of the Budget and the Appropriations Committees of the House and Senate, and the first appropriation for the emergency maternity and infant care program was made in the amount of $1,200,000.

The project has gone forward, I think we may say, on the initiation of the States but with the warm and hearty cooperation of the Children's Bureau throughout the period.

Thank you.

Senator DONNELL. Dr. Eliot, you said the initial appropriation was $1,200,000.

Did you not say that just now?

Dr. ELIOT. Yes, Senator Donnell.

Senator DONNELL. And that expanded until in 1946 it was fortyeight million dollars-something, was it not?

Dr. ELIOT. In the fiscal year 1946, it was something over $42,000,000. Senator DONNELL. Over $42,000,000. I see.

Dr. ELIOT. We found early in the fall of 1945 that we would not need $42,000,000, and at the time the recission bill went through, $8,000,000 was returned to the Federal Treasury.

Toward the end of the fiscal year, however, we found we had given back to the Federal Treasury a little too much, and we had to come back to the Congress and ask for another $2,000,000 or so to complete this current year.

Senator DONNELL. The EMIC applied to the wives of soldiers in the four grades drawing the lowest pay?

Dr. ELIOT. That is right.

Senator DONNELL. Do you recall what those rates of pay are, Doctor?

Dr. ELIOT. I believe there have been increases recently, but I will have to quote the earlier ones.

Senator DONNELL. Yes, ma'am.

Dr. ELIOT. The buck private's pay was $50 a month, I believe. The next rate took him up to $62, I believe. The highest of the four grades was $78.

Senator DONNELL. I see.

Have you any observation, Doctor, as to what proportion of the beneficiaries under the EMIC program came from families of considerable means?

Do you have any information along those lines?

Dr. ELIOT. We have no information, because, after all, they were all accepted under the program.

Senator DONNELL. There was one other question I would like to ask you.

You referred to the fact that among the amendments which you suggest to be considered is a revision of section 105 to include a new subsection establishing a Federal Advisory Maternal and Child Health Council.

I am wondering whether you think, Doctor, that there is any reason for the creation of a council to advise the Secretary of Labor in this matter of making allotments to the several States, or do you think that it would be better to leave it as it is in the bill so that the Secretary of Labor himself makes the determination without the necessity of consulting with a council?

Dr. ELIOT. I believe that the way it is written in the bill would be satisfactory.

The Secretary of Labor, in all probability, would consult with the Children's Bureau, and the Children's Bureau would have taken up these and other matters with the Council.

That is set up in the bill.

While you were questioning Miss Lenroot on that same point, I was interested to see how the Public Health Service Act deals with the same matter, and there I find that the Surgeon General both makes the allotments and also establishes the regulation.

There is a paragraph in the Public Health Service law that points out that all regulations and amendments with respect to grants to States shall be made after consultation with the conference of the State health authorities, but it is the same individual who does the two things under the Public Health Service Act.

Senator DONNELL. That is all.

Senator PEPPER. Dr. Eliot, you have had long and intimate experience with this problem of maternal and child care in the country, have you not?

Dr. ELIOT. I have had a long experience.

Senator PEPPER. And it is your conclusion that we are not in any adequate and satisfactory way meeting the needs of the country in this field at the present time?

Dr. ELIOT. I am certain of that.

Senator PEPPER. And this is a deliberate judgment of the Children's Bureau out of all your knowledge and experience and from the wide and broad prospective which the Children's Bureau has had on these problems?

Dr. ELIOT. It is.

Senator PEPPER. This matter of leaving out the means test is not some testimony which suddenly and arbitrarily was arrived at, but was reached as a deliberate conclusion after a great deal of study had been given both sides?

Dr. ELIOT. That is true, Senator Pepper. And I would like to say, if you go back in the history of the Children's Bureau to the earliest days when Miss Lathrop was the Chief of the Children's Bureau, and read the reports made then and the recommendations on how services for mothers and children of this country should be expanded, there appears throughout the record that the policy of the Children's Bureau has been to make health and welfare services available to all children and mothers in this country.

Senator PEPPER. In the various public health programs being carried out in the country, is the means test applied in the administration of those programs?

Dr. ELIOT. Not in the public health programs as a whole.

Senator PEPPER. That is what I mean, in the public health programs.

Dr. ELIOT. Not as a rule, Senator Pepper. I think sometimes when the programs are left to the States, certain of the States may have some form of tests which define the eligibility of people for the services. Under the Social Security Act as you have already brought out in this hearing, there is no prohibition against a means test.

On the other hand, as far as our programs are concerned, many of the States have not applied a means test. Some have.

Under the crippled children's program, some of the States have in their laws provisions for court action before a child may receive the benefits of the program.

Now, in the course of that court action, sometimes the judge, sometimes the physician, and sometimes some other worker may decide whether or not a child is eligible for care.

The Children's Bureau has taken the position, and the Secretary of Labor has issued a regulation, that with respect to diagnostic services for crippled children there shall be no eligibility test, that it shall be open to all.

Senator PEPPER. Getting to the cost of the program, we have already mentioned what is set up in the bill for the first year of the bill's operation and what is proposed for the second year.

It is contemplated that the expenses of the program will increase gradually over a period of, say, some 10 years?

Dr. ELIOT. That is right.

Senator PEPPER. Before it reaches what may be called its full momentum?

Dr. ELIOT. That is right.

Senator PEPPER. But the number of children estimated for 1947 is something like $43,000,000.

If every one of them took advantage of this program and got all of the care that this program contemplated, it would cost a little over $1,000,000,000?

Senator DONNELL. Nearly $2,000,000,000.

Dr. ELIOT. About a billion and a half.

Senator DONNELL. Did you not say $48?

Dr. ELIOT. $1,600,000,000.

Senator DONNELL. $1,600,000,000?

Dr. ELIOT. Yes.

Senator PEPPER. Less than $2,000,000,000?

Dr. ELIOT. That is right.

Senator DONNELL. I do not figure it that way. Forty-three million at $48 a person.

Dr. ELIOT. That is if every child received the care. I think you are right on that.

Senator DONNELL. That is over $2,000,000,000-$2,064,000,000.
Dr. ELIOT. Now, it is not our feeling-

Senator PEPPER. That would be the cost expended by the States and the Federal Government?

Dr. ELIOT. Yes. That would be the total expenditure.

Senator PEPPER. It would be an expenditure of some $2,000,000,000 for both?

Senator DONNELL. $2,000,000,000.

Senator PEPPER. Some $2,000,000,000 it would be, then.

Dr. ELIOT. Yes.

Senator DONNELL. Yes. And of that, the States are required, under the act as written, to contribute only $5,000,000.

Dr. ELIOT. Yes; that is right. That is right, as it is written.
Now, of course, at the end of a 10-year period-

Senator PEPPER. But you would have authority under the act to require the contribution of more, if you saw fit to do so? Dr. ELIOT. I do not think the act so specifies.

Senator PEPPER. You do not think that is contemplated. The rest of it would be borne by the Federal Government?

Dr. ELIOT. It could be. Yes.

I would like to add to that point that it is inconceivable that we can provide the facilities and services to give that complete care to 43,000,000 children at the end of 10 or 15 years. It is out of the question.

Senator PEPPER. Dr. Eliot, it would stagger the imagination to calculate what the benefits to this country would be from a program that could not, under reasonable estimate, cost more than $2,000,000,000 to all the children of America, would it not?

Dr. ELIOT. Yes. I think it would stagger the imagination.

Senator DONNELL. I would like to call attention in the record to the fact that if the program should cost $2,000,000,000 a year and the State should contribute only $5,000,000 of that fund, that it would be one-fourth of 1 percent contributed by the State and 9934 percent by the Federal Government.

Senator PEPPER. So in that case it would be 9934 percent pure? Senator DONNELL. Practically Ivory soap.

Senator PEPPER. Dr. Eliot, we thank you very much.

Dr. ELIOT. Senator Pepper, before I leave, may I make one additional comment?

Senator PEPPER. Surely.

Dr. ELIOT. And that is that the cost of war for 8 days is $2,000,000,000.

Senator PEPPER. Very good.

Thank you very much.

Mr. Lawrence Gourley; is he here?

You are from the American Osteopathic Association?

STATEMENT OF LAWRENCE L. GOURLEY, LEGAL COUNSEL, DEPARTMENT OF PUBLIC RELATIONS, AMERICAN OSTEOPATHIC ASSOCIATION

Mr. GOURLEY. That is right. I am the legal counsel for the department of public relations.

Senator PEPPER. We are a little pressed for time here.

Mr. GOURLEY. I understand that.

Senator PEPPER. We appreciate your coming, and will welcome your

statement.

Mr. GOURLEY. Thank you. I will be very, very brief.

I say I am legal counsel for the department of public relations of the American Osteopathic Association, and I am also speaking for Dr. Chester D. Swope of that department.