UBRARIES

Senator Hill. Therefore you feel the Federal Government should
make those appropriations directly to your State mental health depart-
ments for mental health programs, rather than going through the
general State health departments, or in some other way?

Mr. GORMAN. In answer to that, I feel the Federal Government
ought to consider the wishes of the 48 State governors.
Senator Hill. Of all the State governors ?
Mr. GORMAN. Yes, sir.
Senator Hill. That is all, Mr. Chairman.
Senator PIRTELL. Thank you very much, Mr. Gorman.
The committee will stand in recess until 10 a. m. tomorrow, Tues-
dar, at which time we will discuss vocational rehabilitation, and
our witness will be Mrs. Oveta Hobby, Secretary of Health, Educa-
tion, and Welfare.
(The following were later received for the record :)

AMERICAN SOCIAL HYGIENE ASSOCIATION,

New York, N. Y., March 25, 1954.
Ur. Roy E. JAMES,
Staff Director, Senate Committee on Labor and Publio Health,

The Capitol, Washington, D. C.
DEAR MR. JAMES ; I hope that you received our wire of March 24, which read
as follows: "Thank you for your wire of March 22. Deeply regret that it will
be impossible for us to testify on March 29, but we will forward statement for
the record."

Let me say again that we regret that it was impossible for us to testify on
$ 2778. We hope, however, that the enclosed statement which we have prepared
on the subject of Public Health Grant-in-Aid Amendments of 1954 may be placed
before the committee and in the record of hearings.
Sincerely,

CONRAD VAN HYNING, Executive Director.
P. S.-On the chance that the enclosed joint statement on the current status
of the repereal disease control program may be of some interest to you and your
committee, I am enclosing it herewith.
STATEMENT OF CONRAD VAN HYNING, EXECUTIVE DIRECTOR, AMERICAN SOCIAL

HYGIENE ASSOCIATION, NEW YORK CITY
The pational organization, of which I am executive director, has been actively
interested in the nationwide venereal disease control program for 40 years,
during the better part of which progress has been made toward the ultimate
Qual of control, under the leadership of the Congress, which has always recog-
tized the seriousness of these diseases to our national health and strength. It
is to urge that the Congress continue to give such leadership and to suggest
a means of so doing within the framework of S. 2778 that this statement is
Progress toward the goal of venereal disease control has not been steady
during the years since World War I, when we first realized the need for nation-
wide control measures. Progress in the 1920's was

followed by a rise in rates
in the depression years of the 1930's. In World War II and the years that
immediately followed it rates again rose. Beginning, however, in fiscal 1947
with the modern control program based on active case finding, contact tracing,
and the use of penicillin therapy, brilliant successes were achieved. In fiscal
1953

, bowever, venereal disease rates rose again in 17 States and the District
of Columbia, evidence that the situation calls for continued vigilance and, in
our opinion, for continued Federal responsibility and congressional leadership,

I want to make it very clear that we believe that the grant-in-aid to the
States is an admirable device for equalizing the financial burden of control
as between the states in the case of a health problem of national significance.
I want to make it equally clear that we have the greatest confidence in the
ability of the Nation's distinguished State health officers to deal with the
problem of venereal disease within their own jurisdictions. The point that
I wish to stress in these remarks is that the veneraal diseases are national

submitted.

L'NITED STATES DEPARTMENT OF LABOR,

OFFICE OF THE SECRETARY,

Washington, March 30, 1954.

probleins in a way and to a degree that is not true of any other serious communicable disease. We believe that the vital importance of their effective control to the United States as a nation provides a strong argument for the continued leadership of the Congress in all efforts directed at their control.

Let me refer briefly to some of the factors that remove the venereal diseases from the category of limited State or local health problems :

(1) The mobility of our population: As our people move from south to north, from east to west, seeking employment opportunities or simply seeing the country, some numbers of them carry with them across State lines and often very much farther than that the spirochete of syphilis and the gonococcus of gonorrhea. The evidence of this diffusion of these highly infectious diseases is very clear in every small epidemic that is reported. Here is a problem that transcends State boundaries and becomes thereby a matter of national concern.

(2) Syphilis and gonorrhea are essentially diseases of youth: It is upon the youth of the Nation that we must depend for our defense, both in military service and in considerable part in our great defense industries, and our defenme and the factors on which it depends inust be a matter of national concern.

(3) Syphilis and gonorrhea are the most numerous of the serious communicable lineases: Gonorrhea ranks second among the leading notifiable communicable

is 315on, and siphilis third (measles ranks first). llere is a problem the very weight of volume of which calls for thoughtful consideration at the highest level, i. e., the national level.

(4) The venereal diseases move far and fast, as stated above, within the continental I'nited States. They also move undetected across international bonnd. aries and over the oceans, entering this country at our ports and across our long undefender land frontiers. Are the individual border States, the seaport cities, to hear the whole burilen of this invasion? Is it not also a matter of concern to our Feiloral fiorernment, to which all our people look when they come face.+0,face with a problem holond their ability to conirol?

Venereal-disenen control is a long job, as is the effective public health control of every serious communicable disease for which no immunizing agent is avail. alle

It is an expensive job, just as is the maintenance of other defenses aguinat danger on the other hand they are unique among our still-unsolved puhlie health problems in that the means of diagnosis and of treatment is available to our hand. The only serious problem here is locating the patient and his contacts That is a very difficult task to which our health services at every level must continue to address themselves for at least a decade to come. It cannot be nie cpssfully accomplished by one State unless all its neighbors are also at work on a parallel course. There must, in our opinion, be pational leadership, national coordination, national reponsibilita If the job is to be well and truly done.

It is apparent from the above that this association is fearful that the propad decentralization of grants in-nid for specific healih problems may be taken by the Nittion a large #* An evidence of loss of interest in the problem at the national level Viglie it theropose not be possible and desirable to write in S 97748 propinion not only for an annual report to the Congres on progress but also for an annual rive by that body or an appropriate committee on our advance toward the goal of practicable controls It Weens to ns that it is only through some such device nu tils that we as a nation mas avoid the frammentation of effort that might otherwis accompany decentralization of control.

**sx Labor and Public Welfare,
svegte, Washington 25, D. C.
** This is with reference to your request for my comments
od the Public Health Service Act, to promote and assist
spierpent of public health services, to provide for a more

pral funds, and for other purposes.
saat vuld authorize grants to the States to assist them,
xif patulic health services; (2) in initiating extension of,
coch services; and (3) in meeting the costs of projects

*ton of poblic health problems of regional or national * 2 plans would have to meet standards prescribed in regula

3 General, after consultation with State health officials luntary of the Department of Health, Education, and unt of Federal funds to be available for these grants Adical appropriations lupart mental Labor Officials from the various States has

iton of its members that this bill might adversely affect odprtinents. They fear that under the proposed formula Smeral funds, State health departments would be free to

at their activities. I understand their interest and i cadernand it is not intended that funds allocated under

daplicate the recognized functions of the State labor ne stration of laws governing conditions of employment

safety. It is my further understanding that in States er industrial hygiene units are in labor departments, the Federal funds for general health to these departments for

gene activities could be continued under the proposed

and clarify the various health and welfare grants now wortent of Health, Education, and Welfare by replacing

it irization for public health grants for venereal disease men and general health and heart disease control (in

rams for mental health and cancer control). I am in imkeh would simplify the present system of public health Tad the operation of State public health services and

Wy health problems of regional or national significance. o proident recommended in his message to the Congress on *? cuples system of grants in this field be simplified, and su te rendered to the States for projects of regional or a determining better methods for serving the health needs

is designed to effectuate these recommendations and, e son advlees that it has no objection to the submission of

1 of its enactment.

AMERICAN VrürsF ASSOCIATION, INC.

Near York 16, V Y., Warrh?). 1951 Ion PAIR SUTI,

Senate (mer Building, Washington, DC. Drar Ve Sunn: The American Nurses Axsociation, an organization of 170.000 rokimtopvel profonulunal nusup* lich constituent units in 53 States and Territoring wimbine to record its killport of 8. 2775 to amend the Public Health Service Art to promote and a wint in the extension and improvement of public health services, to provide for a more effective use of available Feral funds, and for other purta

We hellere that the shortivne a presented in this hill will provide for a more efficient administration of toleral funds allontool to Status for their public health programs Sincerely yours

EI VAREM K PORTFR, RN.

President

al committee om Labor and Public Welfare,
pinipigte, Washington, D. ('.

MIURES OF THE COMMITTEE: You will recall that I by to the passage of H. R. 7397 and S. 2778 as the medreriation of State and Territorial Health Officers.

fare nation and admiration for the courteous and underimigdal at these bearings.

of time, I'm writing now personally and as secretary

Pa to all bealth officers or even the executive com

UNITED STATES DEPARTMENT OF LABOR,

OFFICE OF THE SECRETARY,

Washington, March 30, 1954. Hon. H. ALEXANDER SMITH, Chairman, Committe on Labor and Public Welfare,

Cnited States Senate, Washington 25, D. C. Ibrar Senator SMITH: This is with reference to your request for my comments on 8, 2778, a bill to amend the Public Health Service Act, to promote and assist in the extension and improvement of public health services, to provide for a more clatire use of available Federal funds, and for other purposes.

The proposed legislation would authorize grants to the States to assist them, (1) in meeting the costs of public health services; (2) in initiating extension of, 20i improvements in such services; and (3) in meeting the costs of projects directed toward the solution of public health problems of regional or national significance. The State plans would have to meet standards prescribed in regulations issued by the Surgeon General, after consultation with State health officials and approval by the Secretary of the Department of Health, Education, and Welfare. The total amount of Federal funds to be available for these grants trould be specified in annual appropriations.

The Association of Governmental Labor Officials from the various States has Expressed to me the concern of its members that this bill might adversely affect the work of State labor departments. They fear that under the proposed formula for the allocation of Federal funds, State health departments would be free to tise this money to duplicate their activities. I understand their interest and concern. However, I understand it is not intended that funds allocated under S. 2778 would be used to duplicate the recognized funcțions of the State labor departments in the administration of laws governing conditions of employment hazardous to health and safety. It is my further understanding that in States such as New York, where industrial hygiene units are in labor departments, the practice of allocating Federal funds for general health to these departments for carrying on industrial hygiene activities could be continued under the proposed legislation

$. 2778 would simplify and clarify the various health and welfare grants now administered by the Department of Health, Education, and Welfare by replacing the present separate authorization for public health grants for venereal disease control, tuberculosis control and general health and heart disease control (including the separate programs for mental health and cancer control). I am in favor of legislation which would simplify the present system of public health ktants, improve and extend the operation of State public health services and aid in the solution of public health problems of regional or national significance.

As you know, the President recommended in his message to the Congress on health that the present complex system of grants in this field be simplified, and that Federal assistance be rendered to the States for projects of regional or national significance for determining better methods for serving the health needs of our citizens. S. 2778 is designed to effectuate these recommendations and, acordingly, I am in favor of its enactment. The Bureau of the Budget advises that it has no objection to the submission of

this report.

Yours very truly,

JAMES P. MITCHELL,

Secretary of Labor.

NORTH CAROLINA STATE BOARD OF HEALTH,

Raleigh, April 2, 1954. Subject: Personal comment on S. 2778 and H. R. 7397. Hon H. ALEXANDER SMITH, Chairman, Senate Committee on Labor and Public Welfare,

United States Senate, Washington, D. C. MR. CHAIRMAN AND MEMBERS OF THE COMMITTEE : You will recall that I recently testified in behalf of the passage of H. R. 7397 and S. 2778 as the representatives of the Association of State and Territorial Health Officers. May I express sincere appreciation and admiration for the courteous and understanding consideration accorded at these hearings.

Not having immediate access to all health officers or even the executive committee and in the interest of time, I'm writing now personally and as secretarytreasurer of the board of health and North Carolina health officer.

These proposed identical bills incorporate the wishes of a great majority of State health officers as expressed in discussions over the last several years at our annual meetings. Considerably greater freedom and adaptability to handle state and local problems is provided through H. R. 1397 and S. 277% Books keeping and auditing probleins for the six programs included in this block grant" are simplified and made more economical. I feeling of State and local responsibility for more careful planning and evaluation will be stimulated.

We sincerely hope that no specialized category proponents will feel that their program would suffer under the block grant principle and greater State and Wwwal autonomy. Those of us responsible for a well-rounded and balanced public health program have no such fears. We now have many more projerts under the heading of general health than are included in the categorical grant-in-ald programs and the freedom under the "general health" krant has enabled gratify. inprogress in the teamwork approach to dental health, other communable diseaser, hearing and vision, school bealth, hygiene of aging, occupational health. diabetes, other chronic diseases, migratory lobor, air and water pollution control, food and milk sanitation, vector control, water supply, sewage disposal, radiolo-ical health, hy iene, of housing, home accident prevention, health education, laboratory, public health nursing, nutrition, training, and vital statistics. These is therefore, no good reason to expet that services in venereal disease, tubefrt losis, mental health, cances or heart would suffer as they are gradually ineur rated in the sound and balanced general health program envisioned and provided for under Il R. 1397 and S. 2778.

Letters have been received and statements have been heard from those with a
narrow, sprialized interest in only one category advocating hilling these per
bills because of fear of losing identity or loss of support as a member of the
team rather than in standing apart. We have no 12h lack of faith and colle
denee in State and local administrators and their advisory board and councila.
Should it become desirable, however, ti drops one of the catoories from the
teamwork approach under i de proposed block erant, may we sentent leaving the
remainder intake and selling in a separate authorization and appropriation for
*? a category. Probably no, or «ertainly felser, objections would have aris
to these proposed bills in a period of increasing Federal appropriations and this
sempurnizes it 'ain the importance of maintaining the Tweral State local partner
buip support for health services in the Vation
Respectfully submitted,

J. W. R. VORTON, M. D.
Serretary and state Health Officer

», Washington 25, D.O.

!: In lieu of making a statement at the scheduled hear"Erittee on Health on H. R. 7397, I would like to present

inclusion in the record : Vap's Health of Kentucky recommends that a special ap2 the mental health grant-in-aid program, rather than

1:0 with grants-in-aid for other health purposes. cond that inental health is such a great problem that it has ...ate department to administer the hospital and clinic

1. ities previously carried on by our Department of Pub** boferred to the Department of Mental Health in order

tu o'r effort, not only to treat the mentally ill but to s* for the early detection and prevention of mental vai tim of the public in sound mental health principles. I'mategorical grants would tend to nullify these efforts 21. Therefore, we recommend strongly that the mental **as specific grants directly to the mental health au

FRANK M. GAINES, M. D.

Commissioner.

STATE OF NEW JERSEY,
a POARD OF C'ONTROL OF INSTITUTIONS AND AGENCIES,

Trenton 7, April 14, 1954.

AMERICAN PAYCHIATRIC ASHOW TATION,

Washington 6, D. ('., Ipril 8, 1955
Hon W!!TIMA, PRINTI.
Binator from ('on netticut, Senate once Building,

Waxhinviton, D. ('.
DAR SHTATOR I'T'HHT: I respectfully call your attention to this sisament lation's
oppowdon to Senate boull S. 2775, now under consideration loy the Senate Sub
committee on Health. This little one replace separate categoriat grants with
one oneral health arunt. It would wipe ont parute mental lealth grants in uid
for community servic*** tiental health chiuies).

Frueral krants in aid for community mental health serviers have been the mentemt indentimals to the dese puient of mental health clines in the various Suntes in the point decades. In the rapid development of web servers les the Iliden hos Por redning gradually the growing burden of mental hospitalization in this triuntri

If rongoroscomodighets for the utilisation of stieke money in toatferred from the "11 stau be aith a'thorities in the states to pitable health departments, it can only me in that netista benith will be planeted in a compenses juin ton with other public health 110!

This wond not fupra manter of the concern if not want fuit the treatment and care of the mentally ill in this country :il proceded anything line the ward and we line fur lantee 111 other health tips But these tool: alid until thes Ju luat melhoude met hoe utilisrel to deal with a bulir neel

Lainen toler, representatives of this and other lendua uational organizasllops and need to filed at areat length in the metal braith needs of the nativu lieu fore the Walserton committee. We belse that any member of the Congress who

* Tashington 25, D.C.
ward of control, on April 8, recorded its opposition
is the adoption of the following resolution:

kar 37 years activity in the field of mental health, both * tits and in clinical and prevention activities, had been

of institutions and agencies; and
to the subject and experience in the field had therefore

ment of institutions and agencies; and
*** *ued to require that whatever Federal matching funds

be made from Congress would have to be put in a
Sraith funds to the possible detriment of the prosecu-

baith activities in this State: Therefore be it vitu Fard of control of the department of institutions

ita opposition to the passage of H. R. 7397 and S. bese bills for including mental hygiene funds in with

ads toe omitted or amended so that the State of New Comide its own problems in this regard and carry on the at copies of this resolution be forwarded to Senators

Representatives of the State delegation, and to

as bretofore; and be it

tillealth which has these measures under consid

REEVE SCHLEY, President.

priews this testimony, now published, will agree that the meager headway
now being made in tackling mental illness should not be further jeopardized by
placing mental health needs in competition with other health needs for Federal
tunes
We should be appy to offer further testimony in support of our position.
Sincerely yours,

DANIEL BLAIN, M. D.,

Medical Director.

and in lated

ST!

COMMONWEALTH OF KENTUCKY,
DEPARTMENT OF MENTAL HEALTH,

Louisville 2, Ky., March 26, 1954.
Hot WILLIAX A. PURTELL,

United States Senate, Washington 25, D.O. DELE SEXATOR PURTELL: In lieu of making a statement at the scheduled hearings of the Senate Subcommittee on Health on H. R. 7397, I would like to present the following statement for inclusion in the record :

The Department of Mental Health of Kentucky recommends that a special appropriation de made for the mental health grant-in-aid program, rather than combining this appropriation with grants-in-aid for other health purposes.

Kentucky bas recognized that mental health is such a great problem that it has established a separate state department to administer the hospital and clinic proprium for mental health.

The mental health activities previously carried on by our Department of Publive Health have been transferred to the Department of Mental Health in order to utralize and strengthen our effort, not only to treat the mentally ill but to provide out-patient clinics for the early detection and prevention of mental lness, and for the education of the public in sound mental health principles.

The unification of all the categorical grants would tend to nullify these efforts to strengthen our program. Therefore, we recommend strongly that the mental bealsh portion be awarded as specific grants directly to the mental health authorities in each State. Sincerely yours,

FRANK M. GAINES, M. D.

Commissioner,

STATE OF NEW JERSEY,
STATE BOARD OF CONTROL OF INSTITUTIONS AND AGENCIES,

Trenton 7, April 14, 1954. Hon. H. ALESANDER SMITH,

United States Senate, Washington 25, D. C. DEAR ALEX: The State board of control, on April 8, recorded its opposition to H. R. 7:397 and S. 2778 by the adoption of the following resolution:

"Whereas for more than 35 years activity in the field of mental health, both to the conduct of institutions and in clinical and prevention activities, had been louised in the department of institutions and agencies; and

"Whereas knowledge of the subject and experience in the field had therefore been acquired in the department of institutions and agencies; and "Whereas it is now proposed to require that whatever Federal matching funds tur mental hygiene should be made from Congress would have to be put in a single package with other health funds to the possible detriment of the prosecuting of adequate mental health activities in this State: Therefore be it

“Roxolved, That the State board of control of the department of institutions amel acencies desires to record its opposition to the passage of H. R. 7397 and S. 2178 and the provision in these bills for including mental hygiene funds in with all other types of health funds be omitted or amended so that the State of New Jersey may continue to decide its own problems in this regard and carry on the mmntal hygiene activities as heretofore; and be it "Resolved further, That copies of this resolution be forwarded to Senators Sulth and Hendrickson, to our Representatives of the State delegation, and to the Senate Subcommittee on Health which has these measures under consideration." Very truly yours,

REEVE SCHLEY, President.