Salaries and expenses, maternal and child welfare, Social Security Act, Children's Bureau 1

Mr. HARE. The appropriation for 1946 was $417,365, with a deficiency of $64,925 under Public Law 106, making a total available for 1946 of $482,290. The estimate for 1947 is $516,800, or an increase of $34,510.

Will you justify this increase for us?

Mr. DODSON. I want to call your attention to the fact that we have combined the national defense appropriation and regular appropriation to get the total of $417,365. There is nothing requested for 1947 as a national defense item.

Mr. HARE. But you are including in the appropriation the salaries and expenses of national defense.

Mr. DODSON. We have combined the two into one. It is the same practice that we have used in the other estimates that you have considered up to this point.

Mr. HARE. In the past the committee made a mistake if it separated national defense appropriations from regular appropriations.

Mr. DODSON. I want to say that the Bureau of the Budget made the decision that all of the appropriations would come up as one item and not in two parts.

Mr. HARE. It also made the decision that all persons carried under the national defense program should be transferred and included in the regular activities.

Mr. DODSON. I would not say that they went along on all persons or all positions.

Miss LENROOT. This amount does include for 1947 the $37,646 shown on page 152, but excludes $5,000 available to the Children's Bureau in the national defense appropriation this year and transferred to the Department of Labor travel fund for next year.

Mr. HARE. On page 152 the item previously carried as a national defense appropriation is eliminated as such and carried in the regular appropriation for the Bureau.

Miss LENROOT. That is right, except for the $5,000 which is carried in the travel fund of the Department.

NEED FOR ADDITIONAL FUNDS

Mr. HARE. Do you think it is absolutely necessary to have this additional force, or this additional appropriation to carry on the normal activities of the Bureau, independent of the defense program? Miss LENROOT. Remember we still have the responsibility for the emergency maternity and infant care program. Part of this money provides for four auditors for that program. We had to increase our auditing staff in order——

Mr. HARE. Do you mean to say your maternity and child welfare work has increased to such an extent that you will have to have four additional auditors?

Miss LENROOT. Not additional. We are not asking for four new ones. I was simply explaining when the emergency maternity and infant care program was put into effect, we were given a small amount of money as an additional appropriation to administer it, about $38,000, and most of that money went to increasing our auditing staff, because the amount of money that had to be audited was very much greater with the emergency maternity and infant care appropriation, amounting to millions of dollars, than it had been with the title V appropriations.

Mr. HARE. Should we discontinue the maternity and infant care appropriation, would that decrease the number of auditors?

Miss LENROOT. At the present time, for this current year, we have a backlog for auditing, so that we will need the present staff, and we estimate we will need one more auditor in 1947, in order to get up to date and to overcome the backlog.

Mr. HARE. I can understand that probably your auditing work for emergency maternity and infant care would vary very little whether you have $40,000,000 to look into or $20,000,000, because you have the same processes to go through with at all times.

Miss LENROOT. Yes; we have to go through the same number of States, the same number of agencies..

Mr. KEEFE. But the number of items is reduced.

Mr. DODSON. But there is a backlog of items. In the $40,000,000 that we will put out to the States, there may be a lapse of anywhere from 7 to 9 months before the actual payments are made to the doctors and hospitals, and then it becomes an item for auditing. Mr. KEEFE. That word "backlog" is one that is used every day before this committee; it is a well-known terminology. (After discussion off the record:)

INCREASE FOR DIVISION OF HEALTH SERVICES

Miss LENROOT. The increase for the Division of Health Services. includes a specialist in infantile paralysis and a pediatrician who is a specialist in rheumatic fever to increase our ability to advise the States in regard to the best methods of dealing with infantile paralysis and rheumatic fever. Approximately one-third of the 400,000 crippled children listed on State registers are those afflicted with poliomyelitis, and the States are requesting advice and assistance in setting up their programs in order to meet epidemics, plan ahead, and get the machinery in motion as quickly as possible to deal with epidemics of infantile paralysis.

Mr. HARE. Will this work be merged with the Public Health Service?

Miss LENROOT. This work is covered under title V, part 2, of the crippled children's program.

Mr. HARE. Of the Social Security Act?

Miss LENROOT. Of the Social Security Act.

Mr. HARE. And this phase will not be merged with the Public Health Service when this Bureau goes over to the Federal Security Agency?

Miss LENROOT. We do not know what will happen when it goes. over to the Federal Security Agency.

Mr. KEEFE. I just happened so be wondering about that. Does this title authorize or justify that type of service as part of the Children's Bureau?

Miss LENROOT. Infantile paralysis, you mean?

Mr. KEEFE. I mean taking care of and providing remedial measures for outbreaks.

Miss LENROOT. We give money to the States for this purpose; then the State crippled children's agency is naturally responsible within the State for mobilizing the resources to deal with infantile paralysis. Title V, part 2, of the Social Security Act authorizes this money to

be used both for the care of crippled children and for children suffering from conditions that may lead to crippling, and poliomyelitis comes within that class, as does rheumatic fever that leads to heart disease.

In order that the States may spend the money and get the maximum returns from it, they will ask-one State will ask, "Well, what do you think is the best way; what have other States found to be the best way to deal with an infantile paralysis epidemic, or what have other States found to be the best way of providing care for children with rheumatic heart disease?" We need one person in each field. We do not have anybody specializing in each field now, constantly keeping informed about the latest scientific developments and the best experience in the States, and passing the information on to the State agencies administering the funds under title V.

Dr. ELIOT. We have very many requests, Mr. Keefe, from the State crippled children's agencies to give them help. advice, and assistance of all kinds in these various fields of care that come under the crippled children's program, and, so far, we have not been able to meet many of the requests that the States have made. They look to us again and again to give them what you would call technical consultation in the various areas of this work. It is similar to the technical consultation that may go from the Public Health Service to the States on other types of programs. The crippled children's program has always rested with the Children's Bureau under title V of the Social Security Act, and this form of advice and help to the States we believe-and I think the States would concur in thiswould improve the effectiveness of the programs in the States. I think there is little doubt that it is a service that the Bureau can render to the States to the betterment of the care of crippled children in this country.

Mr. KEEFE. I certainly do not want anything I may say with respect to this item to be construed as in opposition to furnishing every bit of scientific information, aid, and clinical advice that can be given to the States in attempting to deal with this dread disease which so vitally affects not only children, but affects adults as well.

Dr. ELIOT. That is right.

Mr. KEEFE. So it cannot be limited strictly to children.
Dr. ELIOT. No.

POSSIBILITY OF DUPLICATION OF FUNCTIONS OF PUBLIC HEALTH SERVICE

Mr. KEEFE. I am quite familiar with the provisions of title V of the Social Security Act and I realize the function of administering these grants-in-aid to the States for these child welfare aids is placed with the Children's Bureau; but again we are going to be up against the same question and the question with me is whether in that field there is a duplication of effort along these lines.

For example, I read in the press of a severe outbreak of the disease in the city of Rockford, Ill. I noted there the Public Health Service went into Rockford and utilized DDT as a spray and every other thing in that city.

Dr. ELIOT. That is right.

Mr. KEEFE. They were dealing with an epidemic of poliomyelitis in the city of Rockford, and all of the publicity that I saw in reference to it related to the research and work of the Public Health Service. I did not see the Children's Bureau mentioned in that situation.