But, what we want to do is to create in the minds of the Members of Congress, within the limits of our appropriations and I might say this, that what is being appropriated now, of course, is due to the emergency-the $52,500,000 for the nurses' training; the additional amount that you get from the Lanham act on venereal diseases and some others that the total appropriations that we have contributed to the public health from the Congress has not been so much, after all. If we give them the funds, they can do the work. But, we have got a little education to do in the meantime. Mr. REECE. I do not think the Congress requires so much education. Mr. BULWINKLE. I am talking about the country. Mr. REECE. I have not observed any great reluctance on the part of Congress to appropriate funds for these purposes. I think Dr. Parran will bear that out. Mr. BULWINKLE. I remember this, in connection with the first venereal disease control bill the House Appropriations Committee cut down the appropriation below the authorization. We had to put it in the Senate. Mr. REECE. I am heartily in favor of the venereal work, and I have expressed myself on that many, many times. Mr. BULWINKLE. I am in favor of not only doing that work, but doing the work in connection with tuberculosis just like we are doing with cancer. I think we have got to come to it, especially after this war is over. There is going to have to be something like that. Mr. PRIEST. Mr. Chairman, may I ask Dr. Riley one question? Mr. BULWINKLE. Mr. Priest. Mr. PRIEST. Doctor, on page 28 of this bill, paragraph (f)—Dr. Parran discussed that yesterday-with reference to the formula by which these grants-in-aid are made to the States. In speaking for the State health authorities, this has proved satisfactory, has it not? Dr. RILEY. On that Dr. Parran asked for advice from State health officers and they agreed upon a certain formula for the distribution of these funds. So if it is not satisfactory to the States it is their own. fault. They had a chance. Mr. SCOTT. Referring to what you were saying a moment ago, I would like to get this view of mine on the record, and that is, I believe the best answer to much agitation on socialized medicine is an adequately implemented public health service. You agree with me, Doctor? Dr. RILEY. I really do. So far as my experience in Maryland is concerned, I have said that if we set up laboratories where doctors can get service in the counties readily and provide some X-ray facilities which are being done-and we are doing the laboratory work-we have got a very extensive laboratory program and probably provided a great many biological products that doctors need and sometimes have to buy if patients get them-that has been the case in connection with antitoxin-that a great deal of this agitation will disappear. I think if there is a god job done in each county of the State by the public-health authorities that there will not be so much clamor, I am certain in Maryland. for socialized medicine. And, we are doing everything we can in Maryland to prevent that. I do not want to see socialized medicine until we have been given an opportunity to do all we can through the health department. Mr. Scort. Take for instance the chairman's reference to tuberculosis and the extension of public education in the matter of that terrible disease. My own mother died of tuberculosis when I was 5 years old. I have the feeling that had there been more education and more information in the hands of physicians in those days, she might have been saved; but I would not have any conviction at all that her chances of survival would have been any greater had she had a Governmentemployed doctor attending her. That is the distinction I want to make. Dr. RILEY. Well, Dr. Parran insists that this money allotted to the States shall be used to increase the present activities and go into other fields in each county in the State. Before Federal money became available many of the counties of many of the States had no health department of any kind except a part-time health officer who was practicing medicine and giving very little thought to the preventive end; but since that time, most of the States have full-time health departments and all of the counties are carrying on this health gospel to the doorsteps of the people. They are really getting something. Mr. REECE. Doctor, I feel a little guilty about having precipitated this discussion; but the statement that brought it to my mind was the optimistic statement that you made about the progress that public health had made in this country, and I agree with you, and Major Bulwinkle, and Dr. Parran, and everyone else, that it has made great progress; but it has made minor progress in comparison to the need for the service, and our public-health units-and I think you will agree with me-in large areas of this country, in many counties of the country, are wholly inadequate to meet the needs of the communities. Dr. RILEY. Yes. Mr. REECE. And I think that is a reflection upon all of us who are in positions of responsibility, when we are making large expenditures for purposes that do not reach this problem that you had in mind. I think we should consider very carefully the needs, the relative needs, for this expansion and development of health service among the people in the various States. I think it is appalling that a country such as this one which has made the progress that it has made in many lines and has the resources and has expended the resources which we have expended, that we should have such a deplorable publichealth condition in such wide areas in this country which is affecting the virility of the manhood of America, which is exemplified in the physical examinations of the men going into the armed services; and that speaks louder with reference to the need for public health than any other one thing. I do not know exactly the best way to go about it, but I think that is a problem that ought to be given consideration. In going through certain areas—and they are not isolated areas, but wide areas of this country-one cannot help but be appalled at the need for public health. So again I want to express myself that we have not solved the problem. We have not yet met the problem. Dr. RILEY. I think we are in entire agreement. We have gone a long ways, but there is much to do. Mr. REECE. This is not a reflection on the Public Health Service. The Public Health Service has done a wonderful job. I am 100 per cent for the Public Health, and what I have to say is not in any way in criticism of the Public Health or any official of the Public Health. Dr. RILEY. Much remains to be done. I can agree with that. Mr. BULWINKLE. I think, Doctor, you will agree that we have a pretty efficient committee here. Dr. RILEY. I think you have. I wish all of the States could have men in the legislative bodies of the type we have on this committee, and I think then what you are saying would not be necessary. I think we could go ahead, because I do know-I have been in three Statesand I do know that the politicians in many of the States have always made it hard for the health authorities. I mean in the legislative bodies they have slighted the health work and have failed to respond. When we requested them for appropriations they have not responded to a remarkable degree. I do not know hat Dr. Parran's experience is, but it seems to me the last thing to get consideration-not so health in Maryland but in many States. Mr. REECE. Do you not think, Doctor, that the one thing that is needed, which is manifest to the legislative bodies, National, State, and particularly the county legislative bodies, is the leadership on the part of the public-health officials. I mean, when I say leadership, I should not say on the part of public-health officials, but on the part of some one to advance the program and outline the importance of the program as well, and the needs for it. My observations have been back among the counties that when someone who was well advised on the subject came into the counties, and went before the legislative bodies of the counties and discussed this problem and outlined a program they usually met with reasonably sympathetic response. Dr. RILEY. I think that is true. I believe we have given a demon+ stration over the whole United States that public health is something that is worth while, and I believe now we will have less trouble with getting local appropriations and support than we have ever had in the past, and I think if we could appear here 10 years from now you would say that you have noticed a great deal of progress. I think we are going to continue and we are training leaders to go into every area of the country, and I believe we will get a kind of response that we are entitled to; but much does remain to be done, I can assure you, even in Maryland, with all of our advantages. We are near the Public Health Service, we have fine hospitals, and we have fine traditions, medical traditions, and yet much remains to be done even in that State, and I know what it is further west and southwest. Mr. BULWINKLE. Doctor, we thank you very much for coming over. (See letters on page 157 from I. C. Riggin.) STATEMENT OF ALANSON W. WILLCOX, ASSISTANT GENERAL COUNSEL, FEDERAL SECURITY AGENCY, ACCOMPANIED BY MISS MARY E. SWITZER, ASSISTANT TO THE ADMINISTRATOR, FEDERAL SECURITY AGENCY Mr. BULWINKLE. We will hear Mr. Willcox, assistant general counsel, Federal Security Agency. He and Mr. Calhoun, of the Federal Security Agency, and Mr. Perley, of the House drafting service, are the ones who worked on this bill, so far as the lawyers are concerned. Mr. Willcox, you may proceed. Mr. WILLCOX. Mr. Chairman, we have sent to the committee this morning the report of the Federal Security Agency on this bill. I have here a copy of it if you care to have me hand it up to you. Mr. BULWINKLE. I have not had a copy. Mr. WILLCOX. We were not able to get it until late yesterday, because of rather protracted discussions with the Budget Bureau about the report, and what we have done here is to prepare a report and to attach to it a copy of the letter from the Budget Bureau commenting on certain provisions. Now, I propose to mention those comments as we go through this thing section by section. Mr. BULWINKLE. I wish you would get copies of it for each member of the committee. Mr. WILLCOX. Do you wish the letter to be put in the record at this point? Mr. BULWINKLE. Yes. (The letter referred to is as follows:) Hon. CLARENCE F. LEA, FEDERAL SECURITY AGENCY, March 1, 1944. Chairman, Committee on Interstate and Foreign Commerce, DEAR MR. CHAIRMAN: This is in reply to your request of October 6, 1943, for a report on H. R. 3379, a bill to codify the laws relating to the Public Health Service, and for other purposes. On August 24, 1942, after advice from the Bureau of the Budget that there would be no objection to the submission of my proposal to the Congress, I sent to the Speaker of the House and the President of the Senate a draft bill accompanied by explanatory letters which pointed out the necessity for internal reorganization of the Public Health Service and for certain personnel legislation. I also pointed out that the difficulties ensuing from the cumbersome organizational structure of the Service, and from certain restrictive statutory provisions relating to temporary promotions of commissioned officers of the regular corps and the distribution of grades in the Reserve Corps, had been intensified by the additional wartime responsibilities of the Service. H. R. 7716, introduced in the Seventy-seventh Congress, and H. R. 649 and S. 400, as introduced in the Seventy-eighth Congress, were identical with the draft bill submitted to the Congress. On January 27, 1943, I reported favorably to your committee on H. R. 649 and to the Senate Committee on Education and Labor on S. 400. These bills, based on the draft submitted to the Congress, included only the most urgently needed administrative and personnel provisions. They did not attempt to clarify the maze of statutory provisions (relating to functions of the Service as well as to personnel and organizational matters) which had accumulated through 144 years of piecemeal legislation. At the suggestion of the Honorable Alfred L. Bulwinkle, of your committee, the preparation of a Public Health Service Code was undertaken and an effort was made to bring together in H. R. 3379, introduced by Mr. Bulwinkle on October 4, 1943, all the laws relating to the Public Health Service as well as the changes proposed by the legislation previously introduced. It was hoped that its enact ment would provide the Public Health Service with a clear, comprehensive charter of its duties and responsibilities, as well as with an improved organizational structure and workable and equitable personnel provisions. The enactment by the Seventy-eighth Congress of Public Laws 11 and 184 has taken care of three of the most urgent legislative requirements of the Public Health Service. Public Law 11 authorized temporary promotions of regular commissioned personnel during the present war and for 6 months thereafter and removed the restriction on the distribution of grades in the Reserve Corps. Public Law 184 (S. 400, with amplifying amendments) authorizes an administrative reorganization of the Service, and provides death and disability benefits for Service personnel or their surviving dependents. However, several important objectives of H. R. 3379 still remain unaccomplished. H. R. 3379 is intended (1) to codify all existing law relating to the Public Health Service except obsolete and inconsistent provisions, (2) to harmonize and systematize related provisions of existing law which have been enacted at different times with reference to different but related functions of the Service and which create troublesome or unjustifiable variations either in substance or in administrative procedures, (3) to repeal obsolete laws, (4) to resolve certain ambiguities in existing law, and (5) to make a number of revisions which operating experience has shown to be necessary or desirable. While the bill is therefore something more than a mere codification of existing law it is not intended to expand the functions of the Service. The purpose of this bill is to make possible the more efficient discharge of its present functions. Most of the major changes proposed by H. R. 3379 have already been approved by the Congress in the enactment of Public Law 184. Some revision of H. R. 3379 will now be necessary in order to incorporate that enactment in the proposed Public Health Service Code. In addition to the new matter which became existing law with the enactment of Public Law 184, H. R. 3379 proposes several substantial changes which should be mentioned. Section 208 (a) (1) would broaden the classes of persons eligible for appointment in the commissioned corps to include those qualified in surgery, hygiene, or other specialties related to public health. Present law limits the fields of appointment to medicine, dentistry, sanitary engineering, and pharmacy. The purpose of this extension is to make possible the selection of persons with technical qualifications comparable to those of persons now eligible, but with training and qualification in related subjects rather than in any of the four specific fields mentioned in the present law. Section 212 would give reserve officers on active duty, in time of peace as well as in time of war, retirement rights for disability or age comparable to those of regular officers. We recommend that these provisions for reserve officers be restricted to accord with present law. Section 215 is designed to systematize the provisions of law concerning those regulations which require, and those which do not require, Presidential approval. The authority of the President to make the Public Health Service a part of the military forces would be broadened by section 216 to include times of emergency as well as times of actual war. Title III, part A, brings together the general grants of authority for research work found in several laws. This authorization has been made more specific and has been broadened in some respects. Section 301 (c) expands the existing authority to establish and maintain fellowships for purposes of research in connection with cancer to include research in all public-health fields. The practice of granting fellowships for purposes of cancer research has been most successful. It has permitted the selection of highly qualified personnel who may be tried out as scientific workers for a year without continued obligation on the part of the Government. It has also made it possible to assist such qualified persons to carry on their specialties by providing them with research facilities. Similarly the authority to make grants-in-aid for research projects would be extended to any field of research by section 301 (d). In section 301 we recommend that the words "diseases, defects, and injuries of man" be changed to "diseases and impairments of man," and that the remainder of the sentence ("including environmental sanitation, industrial hygiene, water purification, sewage treatment, and pollution of lakes and streams") be deleted. Section 314 would harmonize the legal provisions relating to grants to States for general public-health work and for venereal-disease-control work. Under existing law different procedures are established by separate statutes. Section 314 has been drawn to apply to both types of grants and to preserve what experience has shown to be the most desirable legal provisions. Also, somewhat greater flexibility has been provided. This appeared desirable because the present rather rigid provisions have sometimes resulted in surplus funds being available during a given year in some States while there was an acute need for additional funds in others and no means of making any adjustment to meet changing conditions within the fiscal year. In addition to these changes, section 314 of the bill would remove the maximum of $11,000,000 from the authorization of appropriations for grants to the States for general public-health purposes. This provision of law would thus be brought into accord with the provisions applicable to grants for the venereal-disease program. Sections 361 (d) and 363 would clarify the authority of the Surgeon General with respect to the apprehension, examination, and detention of individuals who are already in the United States for the purpose of preventing the spread of communicable diseases. Section 363 is effective only in time of war. The |