by administrators at all levels. To refuse to work now with the Children's Bureau in peacetime pursual of worthy goals is as unreasonable as declining to eat in a Pullman diner because of wartime traveling experiences. Furthermore, the contemplated transfer of the Children's Bureau to the Federal Security Agency and ultimately to a full cabinet Department of Health and Welfare, as outlined in President Truman's reorganization plan, will make for uniformity in administrative procedures as desired by State health departments. In university as well as other hospitals, it has long been recognized that the best interests of children are served by autonomous departments of pediatrics. It would be a mistake to submerge this principle because of the desire for administrative improvements. Increased efficiency can never be obtained at the expense of quality of service. The past record of the Children's Bureau with respect to the quality of care it desires for mothers and children makes it vital that the present Bureau guide the program while simplifying administrative procedures. Point 11 calls for provision for the protection of teaching services. An aggressive approach to this problem seems indicated at once. The National Board of Medical Examiners finds marked variation in the quality of answers to pediatric questions among students from different medical schools, thus indicating considerable variation in the caliber of the teaching of undergraduate students. Since the major portion of the care supplied under S. 1318 will be provided by general practitioners, there is great need for improvement of the teaching of pediatrics at both undergraduate and postgraduate levels. Dr. James L. Wilson has outlined a plan for such expansion (Journal of Pediatrics, 28: 231, 1946), which could be started immediately without becoming embroiled in the arguments over methods of supplying direct medical care. Furthermore, under his direction, a study has been initiated in association with the American Academy of Pediatrics which will yield basic data concerning the teaching of pediatrics in American medical schools. Point 13 is perhaps the most important of all the objections which have been raised. It calls for assurance that "State plans be expanded at rates that do not exceed available administrative and professional personnel and resources, and that assurance against too rapid expansion be considered as one of the criteria of approval of a State plan by the Federal agency." Many physicians have recently had personal experiences in military service with the difficulties encountered in supplying a high caliber of individualized care when personnel and facilities were swamped by the urgencies of mobilization, training, actual warfare, and, finally, demobilization. The same situation has existed in peacetime, although not as acutely, in civilian hospitals and clinics for the indigent. The problem of supplying individualized care on a mass basis is complex, and will require wisdom and experimentation, lack of haste in the development of administrative and professional policies, and the unhurried efforts of many physicians, medical social workers, public-health nurses, and medical administrators. The following statements from War Department Circular No. 387, dated December 29, 1945, are quoted, for with slight paraphrasing, they apply to the problem of supplying mass care: "It must be clearly understood that the great majority of individuals seeking medical care do not suffer from serious conditions requiring hospital treatment, but from relatively minor sickness and injuries and from concern over personal health and welfare. If these individuals are returned [to duty] from the dispensary level without adequate examination, treatment, and reassurance, they continue to worry about their health, lose a degree of confidence [in the Medical Department], and become less effective [in their assignments]. On the other hand, if they are unnecessarily referred to the hospital consultation services or unnecessarily hospitalized, the seriousness of their conditions becomes exaggerated in their own minds and there is unnecessary loss of [duty] time and unnecessary use of hospital personnel and facilities." These statements point up the need of supplying at the initial level of care adequate numbers of well-trained physicians, medical social workers, and publichealth nurses to really give individualized care to patients. In view of shortages which will certainly exist if an extensive system is immediately established, there should be, first, an increase in the number and improvement of the training of physicians, medical social workers, and ancillary workers in the field, and, second, establishment of plans only as rapidly as local facilities and personnel permit. If, because of shortages or for other reasons, care of a low quality is supplied initially, it will lead to poor morale with further deterioration of the service. In summary, then, there is agreement on the need of legislation which will supply Federal funds for extension of maternal and child-health activities. To obtain the most efficient use of these funds in terms of high-quality care for minimum expenditure, the following three conditions seem desirable: 1. The United States Children's Bureau should be the Federal agency designated for administration of the program because of its past record and familiarity with maternal and child health. 2. Aid should be given immediately to schools of medicine, nursing, and social work for improvement in training of necessary personnel. 3. State programs should be developed only as rapidly as local facilities and personnel permit introduction of high standards of individualized care. Respectfully yours, HARRY H. GORDON, M. D., Assistant Professor of Pediatrics, Cornell University Medical College. EXHIBIT 86 Hon. CLAUDE PEPPER, NEW HAVEN, CONN., July 1, 1946. Senate Office Building, Washington, D. C.: The committee of physicians for the improvement of medical care urges that the Maternal and Child Welfare Act of 1945 as amended by the subcommittee after hearings be approved by the Senate Committee on Education and Labor and brought before the Senate at the earliest date as an initial step toward the achievement of a national health program every effort should be made to pass it at this session of Congress. JOHN P. PETERS, M. D., Secretary. EXHIBIT 87 BALTIMORE SECTION, NATIONAL COUNCIL OF JEWISH WOMEN, Senator CLAUDE PEPPER, Chairman of Child Health Committee. DEAR SIR: Baltimore section of National Council of Jewish Women has for many years supported appropriations for maternal and child health projects. At a meeting of our chapter on June 26, the entire membership went on record in support of the bill, S. 1318, and hopes for action in this session of Congress. Sincerely yours, SYLVIA C. KLINE, Secretary. EXHIBIT 88 ROSEMONT, PA., June 28, 1946. The Honorable CLAUDE PEPPER, Senate Office Building, Washington, D. C. DEAR MR. PEPPER: Your courteous telegram was duly received and it was my full intention to devote considerable time to the preparation of a statement which would comply with its request. Unfortunately the copy of the bill itself failed to reach me before I found it necessary to leave on a somewhat protracted trip from which I have just returned. It has, therefore, not been possible for me to complete analysis of the bill in time for you to receive it by June 26. Your bill, S. 1318, unquestionably makes many valuable contributions. On the other hand there are certain specific objections to it in the manner in which it now stands which prevent me from giving it complete approval. These objections coincide, in the main, with those presented by Dr. Allan Butler at the business meeting of the American Academy of Pediatrics in Detroit last Janu ary. You are doubtless familiar with the report of the committee which embodied these objections and I will not detail them again. If not, they can be found in the Journal of Pediatrics of March 1946, page 390. Please understand that I am, nevertheless, deeply appreciative of your able efforts toward the enactment of suitable medical legislation. Again with regrets at my inability to comply with your request within the time indicated, I am Respectfully, Senator PEPPER, JOHN MCK. MITCHELL, M. D. EXHIBIT 89 BATTLE CREEK, MICH., July 10, 1946. Senate Office Building, Washington, D. C.: I am opposed to S. 1318 the EMIC bill and 'would like a copy of the testimony at the hearings. Have you given all our medical societies a chance to testify? WILFRID HAUGHEY, M. D. Dr. WILFRED HAUGHEY, Battle Creek, Mich.: Reurtel July 10. WASHINGTON, D. C., July 11, 1946. Thank you for informing me of your views on maternal and child welfare bill. Doctors Howard and Wall testified on behalf of the American Medical Association and statements of some medical societies included in the record. Medical societies given full opportunity to testify on maternal and child-health provisions of S. 1606, which are similar to S. 1318. This testimony is being considered in deliberations on S. 1318. Your telegram being included in record, and you will receive copy of testimony as soon as published. Kindly forward complete address. Best wishes. CLAUDE PEPPER, United States Senate. Official business. EXHIBIT 90 CHICAGO, ILL., July 10, 1946. CLAUDE PEPPER, Senate Committee on Education and Labor, Capitol Hill, Washington, D. C.: It will mean so much to the children of this deprived and depressed area if S. 1318 is enacted into law. The same must be true for other areas of this county. DEAR SENATOR PEPPER: We have just been advised that immediate action is being considered for S. 1318 without further public hearings. Four thousand six hundred and fifty-eight active practicing doctors of medicine in Michigan represented by the Michigan State Medical Society, express unalterable disapproval of S. 1318, the proposed Maternal and Child Welfare Act of 1945. Michigan physicians believe that State health departments, whose special field is preventive medicine, have little knowledge, training, or aptitude for curative medicine such as this program contemplates; that States who cooperate under such a program will not only be required to contribute substantial funds to this Federal program, but of necessity be required to submit to rules and regulations dictated by a Federal bureau; that only those physicians who choose to participate in the program will be available for this nationalized medical scheme covering up to 40 percent of the population, which means that patients desiring their own physicians who are not partircipating will not be permitted a free choice unless they pay the service again (double taxation); and that a minimal ward-type service which pauperizes all who accept it-is provided under the present emergency maternal and infant care program of the United States Children's Bueau, which S. 1318 appears to expand and perpetuate. The Michigan State Medical Society respectfully requests that this important proposal be the subject of additional hearings with adequate opportunity for representatives of medicine to appear and express its views relative to this proposed legislation before the Senate Committee on Education and Labor. Respectfully, Senator CLAUDE PEPPER, MICHIGAN STATE MEDICAL SOCIETY, By L. FERNALD FOSTER, M. D., Secretary. EXHIBIT 92 NATIONAL CONSUMERS LEAGUE, Senate Office Building, Washington, D. C. Dear Senator PEPPER: As one of the sponsors of S. 1318, you are deeply interested, I know, in the early enactment of this bill to expand the programs for maternal and child health and for crippled children. I understand that the Senate Education and Labor Committee is considering the bill this week. Even though the time before adjournment is brief, we sincerely hope that it will be possible to get the bill reported and favorably acted upon at this session of Congress. As has been frequently pointed out to your committee, children who are sorely in need of health care cannot wait while the pros and cons of a national health program are debated over a period of months. The National Consumers League is committee to a national health program as a whole, but we are realistic enough to know that the decision on that will take some time. We hope, in the meantime, that the protection of children and mothers will be speeded ahead as it can be through S. 1318. Since Senate bill 1318 proposes to nationalize medicine for 40 percent of the population with tremendously increased cost to the Federal Government, we urge that the Senate Committee on Education and Labor hold full, well publicized hearings on this measure. We sincerely believe it is in the public interest to do so. ASSOCIATION OF AMERICAN PHYSICIANS AND SURGEONS, EXHIBIT 94 Hon. JAMES E MURRAY, FEDERAL SECURITY AGENCY, Chairman, Education and Labor Committee, United States Senate, Washington 25, D. C. DEAR SENATOR MURRAY: As the congressional recess approaches, it seems to me that we could profit by taking stock of where we stand on the national health program. This is of particular importance, since the present uncertainty of Congress's return to Washington requires immediate action if anything further is to be done with respect to any parts of this vital program. Considerable progress, I believe, has been made in specific areas of the national health program. The hospital survey and construction bill, S. 191, has passed the Senate and is in the House committee. The mental health bill, H. R. 4512, has been passed by both Houses and awaits the President's signature. The dental research bill, S. 190, has been passed by the Senate and is now in the House committee. The President's suggestion for greater concentration on the war against cancer has taken root in the Federal Security Agency Appropriation Act, where substantial sums are appropriated to the National Cancer Institute and for assistance to States. Reorganization Plan No. 2, which is still before the Senate Judiciary Committee, is also an integral part of the health program. The hearings on S. 1606 have resulted in real progress through the airing of objections and the indications of support. If we could make some partial progress at the present time both in the fields of general public health services and maternal and child health services, similar to that which we have made in the fields of hospital construction, mental health, dental health, etc., we would be that much farther along the road to consummation of the entire program. Your committee has held hearings on S. 1318, introduced by Senator Pepper, to expand and amplify the Children's Bureau's programs of maternal and child health, crippled children and child welfare. It is universally agreed that coordination of the health programs in the Public Health Service and the Children's Bureau is of major importance, and that it is absolutely essential if the Children's Bureau's health services are to be expanded. If reorganization plan No. 2 does not take effect, uncoordinated expansion in any area would not improve mutual relationships among the administrative agencies charged with carrying out the national health programs and tend to unbalance State health programs. I believe that the whole health program would gain through expansion of the general public health services and maternal and child health services. Such expansion would be in accord with the President's health message, where he said: "The Federal Government should cooperate by more generous grants to the States than are provided under present laws for public health services and for maternal and child-health Expansion of the public health services administered by the Public Health Service and of the maternal and child-health program of the Children's Bureau was the objective of title I, parts A and B, of S. 1606. In the light of the legislative status of S. 1606, however, I believe we should seek to amend S. 1318 to accomplish as much of those objectives as is feasible at this time. In doing so, of course, it is absolutely necessary to bear in mind the President's caution as to the relationship of any public health and maternal and child-health programs to a comprehensive national health program; I believe that Senator Pepper's proposed section 2 would accomplish this objective. care. In view of the limited time left for legislative action, I hope it will be possible for your committee to report out a bill strengthening our present public health and maternal and child-health program, as an interim proposition, pending adoption of the broader and more inclusive national health program. I deeply feel that much has been left out of our present programs for children which should not have been left out. Youth grows up to our shoulders and must carry on as we pass out of our plane of maximum usefulness and influence. Strong bodies and wholesome minds in childhood give promise of self-reliant manhood and womanhood for. healthier future generations and for a stronger America. Sincerely yours, WATSON B. MILLER, Administrator. |