We are afraid it will, more or less, lose its identity, Mr. Chairman, and it will not have the strength and that strong position which it should have.

We also are very much interested in that Public Health shall not be placed at any point where it would come under political domination. We think medicine fares very much better if medical men remain more or less independent, can carry out its purposes, work out its destiny, and avoid the political possibilities.

The CHAIRMAN. Doctor, what do you mean by "political possibilities"? The Secretary of Public Welfare would be appointed by the President and confirmed by the Senate. There would be no provision in this bill that would change in any way the appointment in regard to the Public Health Service.

Dr. CARY. We are thinking of the changes that might follow. It may be true that we are all afraid of something that might not be justified, Mr. Chairman, but, on the other hand, we feel like we are in duty bound to come here and express our fears, and so on.

Senator O'MAHONEY. What reason do you have for feeling that this bill, as it stands, would lead to any political domination of Public Health?

Dr. CARY. Well, I would not like to get into a discussion of just how we view labor today.

The CHAIRMAN. May I say, Doctor, you are misinformed about that. There is nothing in the specification of the functions of the Secretary of Welfare that has anything to do with labor, unless you construe one provision that way, the "relief of unemployment and the hardships and sufferings caused thereby", but certainly what you have in mind is not affected by this relief of unemployment, relief of hardship and suffering.

Dr. CARY. We are cooperative, Mr. Chairman, and want to cooperate. We do not want medicine to lose its identity. The Senator asked me the question as to why we feared it, and I will only allude to the fact that from what we read and what we apparently hear we are afraid sometimes that medicine might become involved in the struggle between the department heads, just as we find other groups become more or less disburbed.

Senator O'MAHONEY. You must understand, Doctor, that we prefer to legislate on facts rather than on fears.

Dr. CARY. Well, at the same time, Mr. Senator, if we did not express our feelings about this question, in all probability it would not arouse any interest on your part at all.

I would like to say that Dr. Woodward is the head of our legislative bureau, and I think it would be most desirable for Dr. Woodward to continue this. I do not want to take too much of your time.

I just want to say that the medical profession would like to see the Department of Health one that will stand on its own feet. If not, we would like to see the Department of Health so surrounded with those safeguards which would make it absolutely safe and sound, and make it possible for the medical profession to feel that this work of cooperation which we have always given to Public Health will be appreciated and go forward.

The CHAIRMAN. Doctor, let me tell you that we could not agree with you on establishing another Department of Health; but as to the

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latter part of the statement, you can rest assured that the members of this committee share your views with reference to public health. We will do everything we can to promote it. We certainly will not do anything to injure it.

Dr. CARY. Thank you very much.

The CHAIRMAN. Dr. Woodward.

STATEMENT OF DR. WILLIAM C. WOODWARD, LEGISLATIVE COUNSEL FOR THE AMERICAN MEDICAL ASSOCIATION, CHICAGO

The CHAIRMAN. Dr. Woodward, to what feature of the bill do you desire to address yourself?

Dr. WOODWARD. I want to speak particularly in reference to title IV, Departments of Welfare and Conservation and National Resources Planning Board.

Dr. Cary has outlined the general policies of the American Medical Association, and I shall endeavor to confine myself to the provisions of the bill itself. If we turn to section 401 (c), on page 34, lines 16 to 23, we find the following:

"The Secretary of Welfare shall promote the public health, safety, and sanitation; the protection of the consumer; the cause of education; the relief of unemployment and of the hardship and suffering caused thereby; the relief of the needy and distressed; the assistance of the aged; and the relief and vocational rehabilitation of the physically disabled; and in general shall coordinate and promote public health, education, and welfare activities."

I think the last phrase describes succinctly the proposed purposes of this new department, to "coordinate and promote public health, education, and welfare activities."

However, if we turn to subsection (b) of the same section, on page 34, lines 5 to 15, we find the following:

"There shall be in the Department of Welfare an Under Secretary of Welfare, who shall be appointed by the President, by and with the advice and consent of the Senate, and two Assistant Secretaries of Welfare and a Solicitor, who shall be appointed by the Secretary of Welfare, all of whom shall exercise such functions as may be prescribed by the Secretary of Welfare or required by law. The Under Secretary and the Solicitor shall each receive a salary of $10,000 per annum, and the compensation of the Assistant Secretaries shall be fixed in accordance with the Classification Act of 1923, as amended."

In considering those two sections we have got to bear in mind an essential difference between the forces that have to do with public health and the forces that have to do with education, and the forces that have to do with welfare activities. The forces that have to do with public health represent practically a well-established, independent profession. When I say "an independent profession" I mean men and women who are earning their livings by their own efforts out in the community. In that way they are distinguished from men who are engaged in educational activities and men who are engaged in welfare activities, both of whom are essentially governmental groups and view their activities from an official standpoint. I will admit that there are many educators and many welfare workers who are not in the Government service, but that number is relatively small, as

compared with the whole. The contrary is true with respect to the medical profession.

Senator LA FOLLETTE. Doctor, may I interrupt you there? Are not the Public Health officers in the same position, relatively, in relation to their connection with the Government?

Dr. WOODWARD. Not numerically, by any means.

I

Senator LA FOLLETTE. I do not think you said "numerically." thought you were making a distinction between the relationship of those who were in education and those who were in public health. It was my understanding that those who were in the profession of public health were mostly employed by municipalities, counties, and States in carrying on the public-health activities.

Dr. WOODWARD. Every physician is engaged in public-health activities.

Senator LA FOLLETTE. That is true, if you take it in the broader sense, but I thought you were trying to distinguish between the publichealth profession and the profession of education, and others.

Now every city has a public-health department, has it not? It usually had it, in all instances that I know of, headed by a trained physician who was a specialist in the particular field of public-health administration and public-health work. Is that not true?

Dr. WOODWARD. No; not so far as specialization is concerned. There is a cross section, probably, in the number of municipal health officers.

Senator LA FOLLETTE. Take Dr. Parran, in New York, for example; would you not say that he is a specialist in public health?

Dr. WOODWARD. He is. He is not the ordinary municipal health officer. He entered the United States Public Health Service as assistant surgeon and has risen up from the ranks.

Senator LA FOLLETTE. Did not he do some work in New York, in connection with State work?

Dr. WOODWARD. That was when he was relieved from his duties as an officer of the Public Health Service, to accept that particular work. Senator LA FOLLETTE. Yes; but in that connection, taking him as an example, he was then employed by the State, was he not? Dr. WOODWARD. He was, in that respect.

Senator LA FOLLETTE. Are not most of the city health officers physicians?

Dr. WOODWARD. I think they are.

Senator LA FOLLETTE. They are in every instance that I know of. Dr. WOODWARD. No; not in every instance. There are some instances where so-called trained public-health officials have been appointed to work of that kind without having medical degrees. Senator LA FOLLETTE. Most of them are medical men, are they not? Dr. WOODWARD. Most of them are.

Senator LA FOLLETTE. Those that I know of are.

Dr. WOODWARD. Most of them are.

Senator LA FOLLETTE. Are not most of the State health departments staffed and headed by men who have been trained in the medical profession?

Dr. WOODWARD. That is true.

Senator LA FOLLETTE. So really, so far as any distinction is concerned, I cannot quite see the distinction between a person who is employed by a municipality, for example, as a public-health officer

and a person who is employed as superintendent of schools by the same community.

Dr. WOODWARD. I may say that I practiced medicine for probably 13 years and I was a health officer for 28 years. I was for 24 years health officer of the District of Columbia and 4 years health officer of Boston. My contacts have shown me clearly that there is a distinction between the physician who is earning a living in private practice and the official who is administering the law and educating the public. Senator LA FOLLETTE. But they perform services, as I see it, which are related, do they not? In other words, if your activity, at the time you were at the head of the medical department of a city, was effective in helping to prevent the spread of contagious diseases and to improve the sanitation of the community you were working for the general health of the community; whereas your brethen in the profession, in private practice, were working for the individual patient, whether he was a charity patient or a paying patient. In other words, is there not a distinction between public-health work as such and the general practice of medicine?

Dr. WOODWARD. There is a distinction, of course, just exactly as there is a distinction between the private school, the private college, and the State university, the public schools.

The point I make is that the bulk of the medical profession is engaged in private practice, and, incidentally, you can draw no distinction between the general health of the community and the health of the individual. There is no health officer, from the supervising Surgeon General of the Public Health Service down, who can effectively perform his work without the cooperation and support of the medical profession.

The CHAIRMAN. Doctor, admitting that, how would it be affected by the Public Health Service being in the Department of Welfare instead of the Department of the Treasury?

Dr. WOODWARD. I was coming to that when I was taken off my course. There is, it must be admitted, a certain difference in the point of view of the public-health worker, the educator, and the welfare worker. The educator commonly believes that he is perfectly competent to care for health activities within the schools.

Senator O'MAHONEY. Now, Doctor, let me interrupt you, just to get to the point quickly. The Public Health Service is now in the Treasury Department?

Dr. WOODWARD. Yes.

Senator O'MAHONEY. It is responsive to an Assistant Secretary of the Treasury. This Assistant Secretary of the Treasury has the supervision of several other bureaus also.

Dr. WOODWARD. Yes.

Senator O'MAHONEY. Are you telling us that the Bureau of Public Health now suffers by reason of that relationship in the Treasury Department?

Dr. WOODWARD. I am not.

Senator O'MAHONEY. All right. Then if it does not suffer by the relationship in the Treasury Department, how can it suffer by the relationship with other bureaus of another department?

Dr. WOODWARD. I am coming to that point, if you will allow me to proceed. There is a definite point of view on the part of the health. workers that they can operate medical and health activities, and a

definite feeling on the part particularly of the welfare workers that they are perfectly competent to deal with medical and public-health problems.

All I have to say with respect to this particular point is that you are placing in this one proposed Department one Under Secretary and one Secretary, each of whom presumably will be perfectly competent to handle the three grades, but you are providing for only two Assistant Secretaries. Now that is the point I was desirous of calling to your attention, and to suggest that if you are going to place in this Department activities covering the field of public health, education, and welfare, that you at least have three Assistant Secretaries, so that there can be an Assistant Secretary in each one.

The CHAIRMAN. As it is now you have a Secretary who has charge of all three.

Dr. WOODWARD. Yes.

The CHAIRMAN. You have an Under Secretary who can have charge of one or more, and you have got two Assistant Secretaries.

Dr. WOODWARD. Yes.

The CHAIRMAN. So that there are three purposes and there are four officials. You know the Secretary is supposed to do something there. In establishing an Under Secretary, in the ordinary course of events he is supposed to be there. Then you have two Assistant Secretaries. That is four officials.

Dr. WOODWARD. Is not the Under Secretary supposed to be one who is disinterested as between health, education, and welfare?

The CHAIRMAN. Doctor, if you have four men, a Secretary, an Under Secretary and two Assistant Secretaries, and you have three purposes for which to provide supervision, could not they give more supervision than the Public Health Service is now receiving?

Dr. WOODWARD. I think we ought to have a ranking Assistant Secretary, so we could have one Assistant Secretary for each of these functions.

The CHAIRMAN. If we abolish the Under Secretary and have three Assistant Secretaries, would you like that form better?

Dr. WOODWARD. It would be more effective. I think the Under Secretary might well be there too.

The CHAIRMAN. There never was any justification for an Under Secretary, except to give a man an additional title, an English title. We have done that work for years, until we began to appoint Under Secretaries 2 years ago.

Dr. WOODWARD. I shall be very glad to put in, as you have offered us an opportunity of doing, a brief on the subject.

The CHAIRMAN. I would be glad to have you do so.

Dr. WOODWARD. I want to say with respect to the matter of the Department, you have said that there is no likelihood of a Department of Public Health being created.

The CHAIRMAN. There has been no consideration on that subject. Dr. WOODWARD. The point has been made that that is because of the expense involved.

The CHAIRMAN. Not by me.

Dr. WOODWARD. Not by you, but that has been the reason stated. The CHAIRMAN. Dr. Woodward, there would be this reason: You have just heard some people speaking on forestry with the same zeal for their subject as you have for yours. I would not have much re