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EXHIBIT 6

NEW YORK UNIVERSITY,

DEPARTMENT OF PEDIATRICS,

New York 16, N. Y., October 30, 1945. Hon. CLAUDE PEPPER,

United States Senate, Washington, D. O. DEAR SENATOR PEPPER: I appreciate your sending me the copy of your bill, S. 1318, which I have read with interest. I am in favor of it and I believe its enactment would represent a forward step in the medical care of children in this country.

My one criticism of the bill is that it tends to build up public-health authority in an agency that is now quite separate from the Public Health Service. The Children's Bureau has now largely become a public health agency. It should have been transferred from the Department of Labor to the Public Health Service some years ago. Despite the present cooperation which obtains be. tween these two agencies I am convinced that the program we are both interested in could only be strengthened by combining these two agencies. Sincerely yours,

L. EMMETT HOLT, JR., M. D.

EXHIBIT 7

PLAINFIELD, N. J., January 14, 1946. Senator CLAUDE PEPPER,

Senate Office Building, Washington, D. C. DEAR SIR: Please support maternal and child-welfare legislation at this session of Congress as embodied in Maternal and Child Welfare Act of 1945 (S. 1318) and National Health Act of 1945 (S. 1606).

I hope for the inclusion of the provisions of S. 1318 in title I, section B, of S. 1606.

Dr. ROBERT W. ROGERS,

EXHIBIT 8

ARMY SERVICE FORCES,

THIRD SERVICE COMMAND, Valley Forge General Hospital, Phoenixville, Pa., July 30, 1945. Hon. CLAUDE PEPPER,

Senate Office Building, Washington, D. C. DEAR SENATOR PEPPER: Thank you for having the summary of the provisions of the proposed Maternal and Child Welfare Act of 1945 sent to me.

For several years, as a member of the Advisory Committee for Services to Crippled Children, I have had the advantage of seeing the smooth-running efficiency and the excellent results of the Children's Bureau. It is gratifying to know that you are working for continuance and expansion of the work, and I shall hope to continue my association with the committee and to help in any way I can. Respectfully,

JAMES B. BROWN,
Colonel, Medical Corps,

Chief, Plastic Surgery.

EXHIBIT 9

THE UNIVERSITY OF ROCHESTER,
SCHOOL OF MEDICINE AND DENTISTRY AND STRONG MEMORIAL HOSPITAL,

Rochester 1, N. Y., January 26, 1946. Hon. CLAUDE PEPPER,

Senate Office Building, Washington, D. C. MY DEAR SENATOR PEPPER: The Senate bill 1318, a broad measure for giving health care to children, includes consideration of dental care. I should urge that this measure be supported. Very truly yours,

HAROLD C. HODGE, Associate Professor of Biochemistry and Pharmacology.

EXHIBIT 10

THE FAULKNER HOSPITAL,

Jamaica Plain 30, Mass., November 5, 1945. Hon. CLAUDE PEPPER,

The United States Senate, Washington, D. C. DEAR SENATOR PEPPER: I have your letter of October 24 with the copy of Senate bill 1318. My delay in answering has been due to the fact that I am very much interested in the subject and have taken the time to go over the bill carefully and also discuss it with others who are interested. The opinions which I give below are my own.

In addition a subcommittee of the Committee of Physicians for the Improvement of Medical Care, Inc., is working on a study and criticism of the bill. I happen also to be chairman of that committee, and eventually you will receive the feelings of that committee in regard to the proposed legislation.

Let me start out by saying that I am thoroughly in sympathy with this type of legislation.

I am a great believer in a national health program, even to the extent of developing all at one time a program similar to that contained in the WagnerMurray-Dingell bill. I realize, however, that there is great opposition to this program and I can appreciate there may be some advantage in introducing one or more new features at a time into the delivery of medical care to the American people which might eventually be included in a national health program. S. 1318 is a splendid example of such a possibility.

The success of the EMIC program during the war has made it clear that Government assistance can improve maternity service and the care of infants throughout the country, and I trust that the extension of this service into peacetime such as S. 1318 provides for will be tried out.

There is always the chance that I may not have interpreted the wording of the bill correctly, but there are certain points which I hope will be included in the final draft of the bill.

I believe that the Chief of the Children's Bureau should by law have to consult with the State health departments on all important matters rather than just on certain ones.

I believe that provision should be made so that the advice of the advisory councils can be published at the Government's expense, because in this and similar legislation public opinion is the final check on the administrator, and as the recommendations of the advisory councils do not have to be followed, it is important to see that their recommendations receive good publicity.

It should be made clear what payments go to hospitals and what payments go to physicians.

The great majority of hospitals in the country permit pysicians to have private patients in the open wards. In other hospitals it is assumed that a patient in the open ward cannot be charged a professional fee. These hospitals are limited in number and are becoming less and less as time goes on. There must not be confusion on this point. A physician should be reimbursed for the care of the patient irrespective of what accommodations the patient has in the hospital.

It must not be permitted for physicians to receive supplementary payments from patients, and this should be specifically stated if it is not.

Provision should be made for proper payment to the State advisory councils for their services.

I believe there should be one advisory council in each State rather than one for maternal and child-health services, one for services for crippled children, and one for child-welfare services. Close relationship between all these groups is essential. It may be desirable to have subdivisions of one advisory council, but care should be taken that there are not specific advisory councils quite independent of each other for each of these services.

I am sorry that fee for service as a method of payment cannot be eliminated entirely, but I realize that for special services it is difficult to pay on a salary or per capita basis, and also in instances where a physician takes on only a small number of patients receiving benefits under this law it will be difficult to pay the physicians fairly on some other basis. However, every effort should be made to have the great amount of this work done on a salary or per capita basis.

These are just a few of the thoughts which go through my mind in regard to this legislation, and I will be glad to have you use them in any way that you wish.

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I hope that the statement from the Committee of Physicians for the Improvement of Medical Care, Inc., will soon be completed and will be helpful in the improvement of this contemplated legislation and in its enactment. Șincerely yours,

CHANNING FOTHINGHAM, M, D.

EXHIBIT 11

HOWARD UNIVERSITY,

Washington, D. C., November 21, 1945. The Honorable CLAUDE L'EPPER,

The United States Senate, Washington, D. C. MY DEAR SENATOR : I have just returned from a field trip in the southern area in connection with a health survey for the National Urban League and I find your letter of October 24 with enclosed copies of the bill, S. 1318, and the speech made by you in reference to this act. I have read these with a great deal of interest and I should like to inake the following observations.

1. Since the establishment of the Social Security Act in 1935 with the provision for maternal and child health and recently through the provided by the EMIC, the United States Children's Bureau has done a commendable job to stimulate the development of programs for the protection of the health of mothers and children throughout this country. Therefore, this hill with its increased appropriations should provide the opportunity for this organization to do a more extensive and intensive job.

2. Althought the maternal-mortality rate, the infant-mortality rate, and the well-being of mothers and infants in this country has markedly improved during the past several years, yet in many sections of the country, particularly in the rural southern area, the death rate of our mothers and children are still alarmingly high for a civilized nation such as ours. 1. 3. Certain minority groups, such as Negroes, Mexicans, still are suffering from deficiencies in clinic services, hospital facilities, nursing care, and ortho pedic treatment. Therefore, there is a need of extension of these services to these groups.

4. There are certain special problems affecting all groups which have not been given sufficient attention, such as care of premature infants, the large number of stillbirths, and the high mortality of infants under 1 month which certainly must be attacked if we are going to make progress in the total field of maternal and child health.

The above observations, of course, are not the only ones, but they are sufficient to demonstrate in my own thinking that there is need for the passage of a bill such as S. 1318 so that we can remedy many of the present difficulties.

I should like to offer you and the other Senators who have joined you my commendations and my appreciation for your thoughtfulness in these efforts.

Please accept my thanks for giving me this opportunity to make these statements. Very truly yours,

PAUL B. CORNELY, M. D. Head, Department of Bacteriology, Prerentive Medicine, and Public Health.

EXHIBIT 12

SUPREME LIBERTY LIFE INSURANCE Co.,

Chicago 15, III., June 19, 1946. Senator CLAUDE PEPPER,

United States Senate, Washington, D. C. MY DEAR SENATOR PEPPER: First I want to register my complete approval of S. 1318 and to add merely a few supporting statements. These statements may be some which others may not have stressed or they may be repetitions which will serve to strengthen similar statements by other people.

I particularly wish to speak for colored mothers and colored children, and especially for those in the South where medical, nursing, dental, and hospital services are even more restricted for them than they are in the North. I cannot

single out a title which would be less important than any other in this bill. The provisions of each title bear heavily upon the needs of colored mothers and children,

Under title I there is no more desperate situation than confronts the colored mother and child than at time of maternity. The maternal-death rate for Negro. mothers in 1943 was 143 percent higher than for white mothers in the same year. The infant-lieath rate for Negro babies during their first year of life was 64 percent higher than for white babies. Three-fourths of the white babies born were born in hospitals during that year compared with only one-third Negro babies born in hospitals.

During the past a good deal of the maternal care and even early child care has been in the hands of Negro "granny midwives.” About 20 years ago the health departments began to try to supervise these untrained women. For example, during 1925 there were about 9,000 such "granny midwives” in the State of Georgia ; in 1944 this number had been reduced to 2,200. It is rapidly. going down. No replacements are being made and a serious situation confronts both white and colored mothers in rural areas where they are likely to have no care at all. Of course, some of this slack has been taken up by expanded hospital care. There is a desperate need for trained nurse-midwives to tide these situations over until more doctors and more hospital beds are available for all mothers in all parts of the country.

Under title 2: Colored children again are desperately in need of services and care for crippled conditions. Nobody knows how many colored crippled children there are because too often they are hidden under the superstitious feeling that crippling is an act of God. Certainly medical care has not been available in the past, and unless some such bill as this is passed there will be even less in the future.

Under title 3: In too many places there will be little or no care for neglected and delinquent colored children nor for the prevention of this neglect and delinquency unless some such measure as is projected becomes a law. There is hardly a place in the entire country where the foster care of Negro children is even attempted, much less being adequate. In other words, with the Negro child furnishing much too often a disproportionate share of crime and illness, I would want to use him as an example of the needs of all children. What happens to the colored child is the same thing which happens to all children in proportion to the medical care and the welfare services which are available to protect them. Yours very truly,

M. O. BOUSFIELD, M. D.,
Vice President and Medical Director.

EXHIBIT 13

HAROLD H. MITCHELL, M. D.

LONG ISLAND CITY 5, N. Y., June 20, 1946. Senator CLAUDE PEPPER,

United States Senate, Washington, D. C. DEAR SENATOR PEPPER: I have your telegram addressed to me as secretary, American School Health Association. While I am a past president of this association, I am not secretary and not able to speak authoritatively for the organization. I have wired to Dr. A. 0. DeWeese, Kent State University, the content of your telegram, as he is secretary. To express the views of an association of professional workers would, in my opinion, be misleading unless specifically authorized by a resolution of the association.

However, I should like to express a personal opinion that S. 1318 does not make proper provision for a sound Federal organization. The health functions of the United States Children's Bureau should be joined with those of the United States Public Health Service in a single Federal agency under a Cabinet officer.

Of course, I am in favor of the objectives of this bill (S. 1318) but I believe the wording of section 103 (a) (3), page 4, would jeopardize those objectives, because it would be revolutionary to make the services "available to all who elect to participate in the benefits." Of course, there should be no discrimination because of race, creed, color, and so forth, but it will take time to make the services available to all. To set up such a plan without permitting any form of means test, even at the local level with local control, must assume that the services have been organized and available. It is not enough merely to provide funds to pay for a doctor without a period of development to make those medical services worth while and of high quality.

I have read most of the testimony and discussion in favor of S. 1318 and S. 1606 and there seems to be a lack of understanding of the importance of proceeding in an orderly manner to evolve the governmental organization necessary to maintain high quality of medical service, and to provide the special diagnostic and laboratory facilities with auxiliary personnel and continued post-graduate medicaleducation facilities. To pass S. 1318 with section 103 (a) (3) as it is, would in my opinion result in such poor quality and poor reputation for the service that is financed by the Federal Government (or likewise by social insurance; e. g. S. 1606) that Federal aid would receive such a serious set-back that it would never recover. Such a revolutionary change would develop such a cleavage between the individualistic medical practitioners and public health officials who administer the service and distribute the funds that the public would have little faith in the public service. On the other hand, if good service is developed gradually, with more and better service by increasing grants-in-aid and the development of complete coverage with health departments, hospitals, and diagnostic services and the many other needs for high standards, we can develop those facilities for group practice and complete coverage that will fully meet the objectives. There must also be funds for education of the public in order that it may better know how to obtain and how to cooperate in the prevention and treatment of disease. This will require many more public-health nurses and social workers to get into the homes and carry on this education.

After more than 30 years of full-time public health experience in national public health agencies and in governmental service, I am confident that we shall make the best progress if we develop the grants-in-aid program further and strengthen local administration and not attempt with one stroke of legislation to revolutionize medical practice. We can and should change and improve medical practice, but even more urgent is the extension of those public health and preventive services that we know how to do well.

I should urge the passage of Senate Joint Resolution 137 introduced by Semator Morse on January 29 with provision for administration under a single health agency or a health and welfare department, as proposed by President Truman.

Senate Joint Resolution 137 should have inserted, page 1, under (2), "and health departments", line 9, to read "offered by schools and health departments," and also should have inserted "and other handicapping,” to read "for the correction of physical and other handicapping defects of children.”

Of course, S. 191 is essential also as a next step for orderly development of a national program for maternal and child health.

There are so many other good features of S. 1318 that I cannot write about them in detail, but I hope you may agree to a plan that will be acceptable through an orderly and evolutionary development and not allow disagreements concerning revolutionary changes to hold back progress. Sincerely,

HAROLD H. MITCHELL.

EXHIBIT 14

JUNE 24, 1946. DEAR SENATOR PEPPER: I acknowledge with thanks your telegram of June 17 concerning your bill (S. 1318).

I am in complete sympathy with the purposes of the proposed bill. I am in receipt also of the analyses of your bill and the Wagner-Murray bill (S. 1606) by the Association of State and Territorial Health Officers.

I believe that more careful consideration should be given to their criticisms of the bills as they now stand. Sincerely,

ROBERT B. OSGOOD, F. A. C. S., R. R. O. S.

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