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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?

Jsr. 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 PURTELL. 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 ABHOCIATION,

New York, N, Y., March 29, 1957.
Mr. Roy E. JAMES,
Staff Director, Senate Committee on Labor and Public Health,

The Capitol, Washington, D. C.
DEAR ME. 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
S. 2778. We hope, however, that the enclosed statement which we have prepared
on the subject of Public Health Grant-in-Aid Amendments of 1934 may be placed
before the committee and in the record of hearings,
Sincerely,

COXBAD VAN HYSI56, Executire. Director,
P. S.-On the chance that the encloser joint statement on the current #111
of the renereal disease control program may be of me interest to you and your
committee, I am enclosing it herewith.
STATEMENT OF COSBAD Pas Hys19G, EIGNISE 11121392, AARLI A3 **145,

HYGIESE ASSOCIATIOS, Sz* Y'tuk 0:11 The national orgaz ization of which I am 167196 0,49*17, km*, ***. 44 vay internted in the Latinoide Federal CiELO, B15 14:16) Yunia, during the better påt of sbobet. *,*2!..., 4,4 goal of control alder the leader22 . 2.4. * .** ***+H. nized the serioase be awarene 24 161-7 is to arge that the CT ext*2.5*** STOP 20 a means of su diz LD DE 123:14 1.430 subrnitted.

Progress toward be a parte a 10%******* *** A***", during tbe years spre

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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 commnunicable 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 elforts directed at their control.

Let me refer briefly to some of the factors that remove the venereal diseas 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 enmployment opportunities or simply seeing the country, some numbers of them earry with them across State lines and often very much farther than that the spirochete of syphilis and the gonococcus of gonorrhea. The pvidence of this diffusion of these highly infectious diseases is very clear in every small epidemie 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 Vation that w must depend for our defense, both in military service and in considerable part in our great defense industries, and our defense and the factors on which it depends must be a matter of national concern.

131 Syphilis and gonorrhea are the most numerous of the serious communicable visespa: Gonorrhea ranks second among the leading notifiable communicable disgers, and sphilis third (measlee ranks first). Here is a problem the very weight of volume of which calls for thoughtful consideration at the highest level, 1. e, the national level.

( ) The veneseal diseases move far and fast, as stated above, within the continental United States. They also move undetected across international boundaries and over the oceans, entering this country at our ports and across our long undefender land frontiere. Are the individual border States, the seaport cities to hear the whole burden of this invasion? Is it not also a matter of concern to our Federal Corernment, to which all our people look when they come face tofnen with a problem besond their ability to control?

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

It is an expensive joh, just as is the maintenance of other defense against dungs. On the other hand they are unione among our still unsolved prible heulth problems in that the means of diagnosis and of treatment is available to our land. 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 continne to adre*** themselves for at least a decade to come. It cannot he stie. cessfully accomplished by one State unless all its neighbors are also at work on a parallel course There must, in our opinion, he national leadership, national coordination, national responsibility of the job is to be well and truly done.

It is apparent from the above that this association is fearful that the propward dseeneralization of grants in-nid for specific health problems may be taken by the 1:lion att larsson evidence of loss of interest in the problem at the national Jet Might it thereofore not be possible and desirable

to write in S. 2771 a porosiulon not only for an annual report to the Congres on progress but also for an annual retrove bu tar bodd or an ippropriate committee on our advance toward Ilie goal of pineticable controls It seems to 11w that it is only through some such derler as this that he as a nation mas avoid the fragmentation of effort that muht otherwise nocompant decentralization of control.

H. *** om Labor and Public Welfare, "y winate, Washington 25, D. C. 7. This is with reference to your request for my comments bod the Public Health Service Act, to promote and assist mitement of public health services, to provide for a more Federal funds, and for other purposes.

would authorize grants to the States to assist them, if public health services; (2) in initiating extension of, 20h services; and (3) in meeting the costs of projects • v Ition of public health problems of regional or national *** pars would have to meet standards prescribed in regula

en General, after consultation with State health officials derretary of the Department of Health, Education, and Dont of Federal funds to be available for these grants Cual appropriations. miettinental Labor Officials from the various States has Ketin of its members that this bill might adversely affect rip dartments. They fear that under the proposed formula rral funds, State health departments would be free to Hate their activities. I understand their interest and

Ederstand it is not intended that funds allocated under s! duplicate the recognized functions of the State labor

Lustration of laws governing conditions of employment limfety. It is my further understanding that in States Toppe industrial hygiene units are in labor departments, the Funeral funds for general health to these departments for typene activities could be continued under the proposed

hand clarify the various health and welfare grants now wertinent of Health, Education, and Welfare by replacing islarization for public health grants for venereal disease into and general health and heart disease control (in

terims for mental health and cancer control). I am in eh would simplify the present system of public health ***Ifend the operation of State public health services and

health problems of regional or national significance. ident recommended in his message to the Congress on * vtiplex system of grants in this field be simplified, and

te rendered to the States for projects of regional or ar dutermining better methods for serving the health needs

is designed to effectuate these recommendations and,

4,12 of its enactment.

» Podzet advises that it has no objection to the submission of

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AMERICAN Vrrupe ASSOCIATION. Inc,

Noir York 16. Vy, March ? $. 1951 Ion ANDER SUTII

$11.148 amor Buling, Washington, DC. Prax VR SHITJr. The American Nurses Association, an organization of 170.00 rociniopoul proposemfonal nurses with constituent unles in 53 starne und Territorima, wish to rozvopil itu kilport of 8 2775 to amend the Publle Health Service Act to promote and a swint its the effension and improvement of public health services, to provide for a more effective use of available Federal funds, and for other pu***,

We hellove that the oblastives as presented in this wat will provide for a more eficient administration of leveral funds alloated to State Poriheir public health programs Sincerely yours,

El 17 ARRTH K Porter, RN.

President

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sop's Pommittee om Labor and Public Welfare, Sinagte, Washington, D.C.

MEMBERS OF THE COMMITTEE: You will recall that I

of the passage of H. R. 7397 and S. 2778 as the

Lowulation of State and Territorial Health Officers.

pomem lation and admiration for the courteous and under

2239.pded at these hearings. *** Aires to all health officers or even the executive comSogn of bralth and North Carolina health officer.

****t of time, I'm writing now personally and as secretary

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UNITED STATES DEPARTMENT OF LABOR,

OFFICE OF THE SECRETARY,

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

United States Senate, Washington 25, D. C.
DEAR SENATOR Smith: This is with reference to your request for my comments
01 S. 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
fa tive 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,
and 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 regula-
tions issued by the Surgeon General, after consultation with State health officials
and approval by the Secretary of the Department of Health, Education, and
Welcare. The total amount of Federal funds to be available for these grants
would 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 Use this money to duplicate their activities. I understand their interest and concern. However, I understand it is not intended that funds allocated under $ 2778 would be used to duplicate the recognized functions of the State labor departments in the administration of laws governing conditions of employment bazardous 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 (in-
cluding the separate programs for mental health and cancer control). I am in
favor of legislation which would simplify the present system of public health
Tants, 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,
acorrdingly, I am in favor of its enactment.
The Bureau of the Budget advises that it has no objection to the submission of

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this report.

Yours very truly,

JAMES P. MITCHELL,

Secretary of Labor.

NORTH CAROLINA STATE BOARD OF HEALTH,

Raleigh, April 2. 1951.
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.
JR. 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 under-
standing consideration accorded at these hearings.
Not having immediate access to all health officers or even the executive com-
mittee and in the interest of time, I'm writing now personally and as secretary-
treasurer of the board of health and North Carolina health officer.

now published, will agree that the meager beadway 3 iling mental illness should not be further jeopardized by

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 keeping and auditing problems for the six programs included in this "block state and local problems is provided through H. R. 7397 and S. 2778. Book. #ds in competition with other health needs for Federal

der further testimony in support of our position. grant" are simplified and made inore economical. A feeling of State and local responsibility for more careful planning and evaluation will be stimulated.

DANIEL BLAIN, M, D., We sincerely bope that no specialized category proponents will feel that their

Medical Director, program would suffer under the block grant principle and greater State and local autonomy. Those of us responsible for a well-rounded and balanced publichealth program have no such fears. We now have many more projects under

COMMONWEALTH OF KENTUCKY, the heading of general health than are included in the categorical grant-in-aid

DEPARTMENT OF MENTAL HEALTH, programs and the freedom under the "general health" grant has enabled gratify. ins progress in the teamwork approach to dental health, other communicable

Louisville 2, Ky., March 26, 1954. diseases, hearing and vision, school health, hygiene of aging, occupational health, diabetes, other chronic diseases, migratory labor, air and water pollution control,

vagte, Washington 25, D.O. food and milk sanitation, vector control, water supply, sewage disposal, radio- STE!: In lieu of making a statement at the scheduled hearlogical health, hygiene, of housing, home accident prevention, health education, amittee on Health on H. R. 7397, I would like to present laboratory, public healih nursing, nutrition, training, and vital statistics. There for inclusion in the record : is, therefore, no good reason to expect that services in venereal disease, tubercu. + Vental Health of Kentucky recommends that a special aplosis, mental health, cancer or heart would suffer as they are gradually incorpo- ': the mental health grant-in-aid program, rather than rated in the sound and balanced general health program envisioned and pro- vain with grants-in-aid for other health purposes. vided for under 11 R. 1397 and S. 2778.

...mind that mental health is such a great problem that it has Letters have been received and statements have been heard from those with a narrow, specialized interest in only one Category advocating hilling these good

sie department to administer the hospital and clinic bills because of fear of losing identity or loss of support as a member of the team rather than in standing part. We have no sul lack of faith and conti

tiities previously carried on by our Department of Pubdence in State and local administrators and their advisory board and councils.

eruleferred to the Department of Mental Health in order Should it become desirable, however, t drops one of the categories from the

tn our effort, not only to treat the mentally ill but to teamwork approach under the proposed bloch Brant, may well-west leaving the

220 for the early detection and prevention of mental remainder intact and setting up a separate authorization and appropriation for

in varion of the public in sound mental health principles. *11011 a category. Probably no, or certainly feller, oblections would have arisen

'be categorical grants would tend to nullify these efforts to these proposed bills in a period of increasing Federal appropriations and this

J. Therefore, we recommend strongly that the mental emphasizes atain the importance of maintaining the Frlerai State local wrtner.

odred as specific grants directly to the mental health auop support for health services in the Nation Respectfully submitted, J. W. R. Norton, MD,

FRANK M. GAINES, M. D.
Serretary and state lealth Officer.

Commissioner.

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

Trenton 7, April 14, 1954.

AMERICAN PSYCHIATRIC ASSOXTATION,

Washington 6, D. ('., 'pril 8. 1955. lion WINTIM A. PURIIII., Senator from Connecticut, Senate opice Building.

Washinnton, D (. DEAR SAVAIOR L'UTIL I re-purtfully call your attention to this issuintion's op po 100 to Senate bill S 277s, now imdes commiseration loy the Senate Subcommittee on Health Thun ull would replace separate categorhead grants with one general health want. It would w pevnit separate mental health grant- in-ald for community were thenti balth cimiesi.

Foderal grants in aid for community mentnl health services have been the greitet alleie stimulus to the development of mental health clinics in the various Slot in the past deco In the rapid development of 06h services lies the That i hope for renina gradually the growing burden of mental hospitalization in this country

Il rapulamislity for the utile:1101 of the di moners is transferred from the 'mentai booth authorities in the Station to police health departments it can on the in thout thenital health will be placed in a competitive pain Lion with other Jullie health 1

This woud not be a matter of the cheeru 1 landared for the treatment and care of the mental's ill in this country approar ber anything like the standards he tithe pur tanto in other leath his but they sin not; alid until they du slimlar methods I live uited to deal wiha likular nerel

Last October, representatives of this and other leading national or anizations and akende tomlitoloot wreat lenathin the metal health needs of the nation lies fore the Wollerton committee. We bel ve that any member of the Congress who

Washington 25, D. C.
.Kw kioard of control

, on April 8, recorded its opposition
Et has the adoption of the following resolution:
sa 42: 37 years activity in the field of mental health, both
*** tions and in clinical and prevention activities, had been

ve institutions and agencies; and

if the subject and experience in the field had therefore * POLIPOT of institutions and agencies; and

used to require that whatever Federal matching funds ad be made from Congress would have to be put in a ther health funds to the possible detriment of the prosecuestal bealth activities in this state: Therefore be it

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Na de Biate board of control of the department of institutions has to record its opposition to the passage of H, R. 7397 and S.

in these bills for including mental hygiene funds in with alth funds be omitted or amended so that the State of New

decide its own problems in this regard and carry on the

That copies of this resolution be forwarded to Senators Swa, to our Representatives of the State delegation, and to

tee on Health which has these measures under consid

aktivities as heretofore ; and be it

REEVE SCHLEY, President.

1

nepiews 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
tuods.
We should be appy to offer further testimony in support of our position.
Sincerely yours,

DANIEL BLAIN, M. D.,

Medical Director.

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COMMONWEALTH OF KENTUCKY,
DEPARTMENT OF MENTAL HEALTH,

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

United States Senate, Washington 25, D, O. DEAR SENATOR PURTELL: In lieu of making a statement at the scheduled hearines 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 ap-
propriation be 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
program for mental health.
The mental health activities previously carried on by our Department of Pub-
lic Health have been transferred to the Department of Mental Health in order
to entralize 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
illness, 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
bealth portion be awarded as specific grants directly to the mental health au-
thorities in each State.
Sincerely yours,

FRANK M, GAINES, M. D,

Commissioner.

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

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

United States Senate, Washington 25, D. C. DEAR ALEX: The State board of control, on April 8, recorded its opposition to II. R. 7397 and S. 2778 by the adoption of the following resolution:

"Whereas for more than 35 years activity in the field of mental health, both
in the conduct of institutions and in clinical and prevention activities, had been
londged 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
for 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 prosecu-
tion of adequate mental health activities in this State: Therefore be it

"Resolved, That the State board of control of the department of institutions
ani agencies desires to record its opposition to the passage of H. R. 7397 and S.
2778 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
mental hygiene activities as heretofore, and be it

Roxolved further, That copies of this resolution be forwarded to Senators
Suitb and Hendrickson. to our Representatives of the State delegation, and to
the Senate Subcommittee on Health which has these measures under consid-
eration."
Very truly yours,

REEVE SCHLEY, President.

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