of mental retardation, where that is possible, and on stepped up treatment for retarded children everywhere.

The whole Nation can be proud that here at Peabody College, the John F. Kennedy Center for Research on Education and Human Development has been established. The buildings are made possible by a grant from the National Institutes of Health under its program for establishing centers for research on mental retardation and related aspects of human development.

As you know, matching funds are being provided by Peabody College and by the Joseph P. Kennedy, Jr., Foundation.

We can be confident that the programs of this center, its dreams, and its purposes will be of national benefit as it strengthens research, research training and scholarship in advancing the battle against mental retardation and behavior disorders in children.

H.R. 6675 gives specific recognition to the importance of the kind of multifaceted research which is going forward here and will be going forward in increasing intensity as other similar mental retardation facilities are built.

The bill authorizes grants to university-affiliated mental retardation centers to support the training of personnel, including that broad spectrum of professions which have special contributions to make in combating mental retardation. It therefore authorizes a new program of grants to institutions to train physicians, psychologists, nurses, dentists, and social workers to work with crippled children, particularly mentally retarded children and those with multiple handicaps.

During the past fiscal year, the Children's Bureau was able to support a limited amount of training in mental retardation in 27 medical institutions of higher learning. The amendments in H.R. 6675 would make possible an increase in support when the centers are in operation. One of the major functions of center staff would be to give increasing exposure to medical students, interns, and residents to newer concepts of mental retardation.

And so we can expect advancement in the whole area of training of medical and ancillary personnel. However, on the basis of our own experience with training programs in mental retardation, you might be interested in the reaction of one nurse who received training at a southern mental evaluation clinic. She reported her experience was worthwhile for several reasons:

"I was able to see the effects of retardation not only on the child, but also on the family. I was given every opportunity to observe the child during testing procedures such as psychometrics, language, and speech assessments. We have studied and learned about some of these tests, but had never had the opportunity of actually seeing them being administered. I received guidance in working with my family but was always permitted and encouraged to use my own initiative. I was made much more fully aware of the multidisciplinary approach and was able to see the various services functioning in a coordinated and interrelated manner to produce as complete a picture of the child as possible."

I know that the complex of teaching and medical centers here in Tennessee and this region of the South work closely together in maximizing their efforts to use every approach which will move us nearer the goal of positive health. The Children's Bureau is delighted that at Vanderbilt University, for example, we have been able to help finance the expansion of services in chromosome analysis which hopefully will open the door to another way of preventing mental retardation.

One of the most significant aspects of the 1963 maternal and child health and mental retardation planning amendments was the establishment of comprehensive programs of maternity and infant care for women who have conditions associated with pregnancy which increase the hazards of childbearing for themselves and for their infants and who are unlikely to receive the care they need because they are from low-income families or for other reasons beyond their control.

The increased authorizations for maternal and child health and crippled children's services contained in the House-passed H.R. 6675 give us every reason to believe that our efforts in this and many other directions can be rapidly escalated in the years ahead.

The Bureau-financed projects were established under an appropriation of $15 million for the last fiscal year. For this year, $30 million has been authorized. This will give us, hopefully, the chance to double our efforts to meet the needs of women in the high-risk, low-income sector of our population. For we know

that when they do not receive adequate prenatal care, the risks of their delivering their babies prematurely is 20 times greater than for those women who do receive high-quality care. Since the enactment of these amendments, the Children's Bureau has granted funds to establish 25 of these programs most of which offer family planning if the mothers want it.

The growth of the population of our country has been a subject of deep national thought, as well as of scientific studies. Recently, the National Academy of Sciences of the National Research Council analyzed the problems in connection with this growth and made some recommendations for research, training, and service. I think the basic conclusion of this distinguished group is timely:

"The freedom to limit family size to the number of children wanted when they are wanted is, in our view, a basic human right. The evidence cited in this report shows clearly that most Americans of higher income and better education exercise this right as a matter of course, but that many of the poor and uneducated are in effect deprived of the right. No family should be fated through poverty or ignorance to have children they do not want and cannot properly care for. Responsible parenthood requires that couples of all social strata have the ability and means to limit birth when they wish to do so, in accordance with their personal convictions. In short, this basic freedom for the individual family should be made effective throughout American society."

Years ago, when I was working in maternity and well-baby clinics in the State of Pennsylvania, I realized the dimensions of this problem in extremely personal terms and at the same time despaired at the slow pace at which our society was willing even to admit that it existed.

I saw young mothers from poor families come to well-baby clinics with their first born; their eyes shining, full of pride about their new babies, anxious to be good parents, bursting with that expectation which every new mother feels for her child's future.

But then came the second child, the third, the fourth. And these same mothers became dispirited, listless, overwhelmed by the burden of providing for a family with inadequate financial resources. Each succeeding child brought a deeper well of despair. For they knew in their hearts that they could not assure the bright future to which each child is entitled.

It is particularly heartwarming for me to know that here in Tennessee, your own conviction has spurred you on to speed your own efforts to meet the day's issue.

I know that you are spending some $75,000 for family planning under your State health department's maternal and child health program and I believe you have some 30 family planning clinics in your State alone.

It is estimated that 24 States are spending for family planning services some $1,750,000 this current year from the amounts provided from Federal and State matching funds. These services are provided as a part of comprehensive maternity care and are included in the regular doctor-patient relationship which insures that a woman who wants to plan her family can select the method which is most acceptable to her. These programs are administered by State and local health departments.

There are truly an endless number of facets in our quests for positive health. The Nation has become very aware that phenylketonuria, or PKU as it is called, is a metabolic disorder in the newborn which can lead to severe mental retardation.

The Children's Bureau was quick to seize the opportunity to use a test developed by Dr. Robert Guthrie which detects PKU in infancy before damage results. I know this test is being used here in Tennessee and I hope that its use will be expanded until it covers every newborn infant in your State. Establishing early treatment through special diet may prevent a lifetime of helplessness. Some 2,600 hospitals throughout the Nation are now using this test routinely in 49 States and the District of Columbia.

We are now using another test which Dr. Guthrie has developed to spot screen infants for such other metabolic errors as histidenmia, galactosemia, and maple sirup urine disease. Here is another breakthrough which gives promise of significant progress in additional means of early detection treatment of metabolic factors which may cause mental retardation.

In his health message to the Congress early this year, President Johnson gave specific recognition to the "great and growing needs among our children for better health services" and indicated that meeting these needs held a high priority

These

in his planning. His intent was carried forward in H.R. 6675, which authorizes special project grants for the health of school and preschool children. grants would be a part of his purpose to improve maternal and child health, crippled children and other services which have such an important effect on the lives of mothers and children. These special project grants could be made to State or local health departments, State crippled children's agencies, and to medical schools and teaching hospitals to pay to 75 percent of the costs of projects of a comprehensive nature for health services and medical care for children and youth of low-income families. These projects would not only include screening, diagnosis, preventive services, but stress treatment, correction of defects and aftercare, both medical and dental.

The gaps in child health supervision not only in the preschool years but during the regular school cycle were particularly underscored in a report on "Health of Children of School Age" which was prepared by the Children's Bureau in response to a request from the Secretary of the Department of Health, Education, and Welfare.

When he forwarded it to President Johnson recently, Secretary Celebrezze wrote:

"The material emphasizes the gaps in child health supervision in the preschool years with the resultant wide disparity in the readiness of children to begin their education; the great crowding of well-baby clinics and hospital outpatient departments in the cities; the inadequacies in the quantity and quality of medical care received by children in many low-income families; the need for more effective methods of casefinding in the presence of a shortage of physicians; the special problems of adolescents and the handicapped-all point to the need for new approaches and for concentrating our community resources where they are most needed."

It is indeed our challenge to develop more adequate ways of coping with the large burden of illness that children have and which, in many cases interferes with their growth, development, and education.

Writing in the February issue of Harper's magazine, Senator Abraham Ribicoff said:

"Today, out of an estimated half million emotionally disturbed children, only 10,000 are known to be getting any sort of treatment. In other words, we are letting 98 percent of this group slip through our fingers, condemning them to lives of futility and anguish, and society to nameless perils. The risk is, I submit, one we cannot afford to take. No one can guarantee that they can all be helped or cured. But so far, we have scarcely even begun to try."

Senator Ribicoff is determined that we must now begin to try on a national basis. He has introduced a Senate amendment to H.R. 6675 which would permit projects providing for the identification, care, and treatment of children who are in danger of becoming emotionally disturbed, including followup of children receiving such care or treatment. The projects proposed under this amendment would be coordinated to every feasible extent with community mental health centers and other State and local agencies engaged in health, welfare, or education programs or activities for such children.

Senator Ribicoff is certainly correct in saying that the Nation has dismally failed to meet the needs of emotionally disturbed children. We all know that many of them are still placed in the correctional institutions, in institutions for the mentally retarded, on wards with psychotic adults in large State hospitals, or, worse yet, are left at home with no assistance at all.

I share his enthusiasm for a determined approach to this problem. At the same time, I want to acknowledge the work of the faculty members at Peabody College and officials of your State who have developed a new pattern for the residential reeducation of emotionally disturbed children-a pattern that is economically feasible and draws upon available sources of manpower.

As a member of the National Advisory Commission for Project Re-ed, I cannot speak too highly of this project. The young people of the staff, the teachercounselors and others, backed by the best consultants in education, psychiatry, psychology, pediatrics, and other professions, are making a difference in the lives of the disturbed children of Tennessee.

By early intervention, disorders that could follow an individual through his life, often requiring hospitalization at State expense, are being prevented. I am sure that the experience already gained by the Re-ed project could be usefully adopted by many communities and States of the Nation.

If the provisions of H.R. 6675 become law, it will be the responsibility of the Children's Bureau to encourage projects which will seek out new ways of identifying children at a very early stage in the development of their emotional difficulties.

Children and their families can often be helped at the first signs of difficulty in the maternal and child health or crippled children's clinics where they are accustomed to getting advice on nutrition and other necessary components of healthy development. A large proportion of emotionally disturbed children are in low-income families, frequently dependent, neglected, or abused, in families that are unstable, poorly educated, or for other reasons come to the attention of public child welfare services.

These health and welfare programs will be working in close cooperation to see to it that each makes its maximum contribution to meeting the challenge of alleviating emotional disturbance among children which now faces us.

When the crippled children's program was authorized under the Social Security Act of 1935, the immediate demand was to do something about the visibly crippled child-the child with orthopedic conditions which hampered his healthy growth and development. Over the years, while expanding ways to meet the orthopedic needs of children, we have also broadened our horizons to deal with many other crippled conditions which are not nearly as visible, but have equally crippling effects.

I shall cite but a few. As early as 1945, the Children's Bureau recognized that the dental needs of the Nation's children were not being met adequately, and that the best approach to a solution of the problem lay in the development of special competence in the field of dentistry for children. That year, the Bureau sponsored a conference to establish guidelines and determine direction for programs designed to render dental care. In 1949, the Bureau approved a project for postgraduate training in children's dentistry, at the College of Dentistry, University of Tennessee. Dentists are still in short supply, but the Memphis project, which is still receiving Children's Bureau support, is among those teaching centers which are helping to bridge this gap. As you know, the Pedodontic Department at the University of Tennessee was host this spring to a conference to develop guidelines for dental care of mentally retarded children. And so our horizons continue to broaden.

We know that some 2,600,000 children have speech disorders of such severity as to interfere with their social and emotional growth and that about 1,500,000 children have hearing impairments. Much research is going forward to improve not only our methods but our knowledge about the most appropriate way of providing maximum helpful measures for these children. I am happy to say that here, again, Tennessee is playing an important part in the national effort to move ahead to make lives better for these children, and that the knowledge gained through your projects can be ploughed into a pool from which the whole Nation can draw.

I could not appear here in Tennessee without adding my own tributes to those of others for the significant contribution which Dr. Amos Christie at Vanderbilt has been making in his efforts to add to our body of knowledge about the distinction between tuberculosis and histoplasmosis. Here again, the whole Nation can benefit from new knowledge which makes life better for all our children. From generation to generation, we make significant medical progress in the treatment of the afflictions of mankind. But from generation to generation as well, new disease anomalies occur which, for time at least, baffle us.

This was the case, rather recently, when the drug thalidomide caused the birth of babies with congenital malformations. Fortunately, because of the watchfulness of the Food and Drug Administration of the Department of Health, Education, and Welfare, American women were spared this tragedy which did affect many women living in Europe.

But at least, once the causative agent was known, appropriate measures could be taken to end the threat, just as we have at last, through applying findings of scientific research, been able to all but eliminate the scourge of poliomyelitis, which once struck fear into the heart of every parent.

I believe that one of the most dramatic breakthroughs in our efforts on behalf of handicapped children came with the development of operations to correct congenital heart defects. When the "blue baby" operation was first performed in 1947, it opened up a whole new era which brought new hope to many thousands of children who previously had been doomed to early death.

In 1951, the Children's Bureau began establishing a chain of regional heart centers to take advantage of this surgical procedure, and to expand the number of surgeons with the necessary skills to perform this delicate operation.

Vast new vistas have opened up in this field in the meantime. With the expansion of surgical techniques, with the advent of open heart surgery, thousands more children could benefit from corrective surgery which gave them the promise of a normal life. In 1963, for example, under the partnership between the Children's Bureau and the State crippled children's programs, nearly 25,000 children with congenital heart defects were served.

Perhaps a final example could be drawn, starting with a host of contributions from surgery, physiotherapy, psychology, and culminating in the unique welding of clinical and engineering skills to help children born without one or more limbs. Drawing on the experience gained in helping wartime amputees, a number of prosthetic devices have been developed which can help these children. Perhaps the most exciting is an artificial hand which many children are proudly using to improve their dexterity.

It is developments such as these that serve to remind us all-if indeed we need it-that no minute must be wasted, no effort spared, no danger sign ignored, if all related professions are indeed to meet the needs of the mothers and children of this and succeeding generations.

I know that the thematic approach to this meeting is a look at positive health. Taken in bulk, the negative influences which still exist in our society today could overwhelm us unless our belief is strong that we have the forces, the ingenuity, the wisdom, and the patience to continue to achieve prevention at the earliest stage in ever new endeavors.

We need not only to continue but to enhance the present productive association between substantive legislation, sponsored by many branches of government, action programs stemming from both public and voluntary sources, and a mounting research effort.

We need to establish true communication each with the other, so that we can share our hopes, our dreams, our accomplishments in a way which will have the greatest impact in advancing the health of our Nation's people.

We need most of all to take full advantage of the great upsurge of interest that is mounting to make life better for our children.

EXHIBIT 212

"SALARIES AND EXPENSES, CHILDREN'S BUREAU, 1966 ESTIMATE"

(Statement given by Mrs. Katherine B. Oettinger, Chief, Children's Bureau, Welfare Administration, Department of Health, Education and Welfare, accompanied by Arthur J. Lesser, M.D., Deputy Chief, Children's Bureau; Miss Mildred M. Arnold, Director, Division of Social Services; Mr. Charles Gershenson, Associate Director, Division of Research; Mr. Gordon Fortney, Administrative Officer; Dr. Ellen Winston, Commissioner of Welfare; Mr. Roy L. Wynkoop, Executive Officer, Welfare Administration; and Mr. James F. Kelly, Department Comptroller, before the House and Senate Subcommittees on Appropriations for Labor, Health, Education and Welfare on February 24 and March 23, 1965, respectively)

Increase requested

The 1966 estimate of $4,494,000 for salaries and expenses, Children's Bureau represents an increase of $96,000 over the estimate for 1965. The increase requested is to provide annualization of new positions authorized in 1965 and seven additional positions to provide technical assistance to States and communities on juvenile delinquency legislation; family life education, especially for low-income families; services for children suffering from neglect and abuse; and staff development in the field of child welfare.

Functions of the Children's Bureau

The legal authority of the Children's Bureau for serving the Nation's children is the basic act of April 9, 1912, creating the Bureau, and title V of the Social Security Act.

Under its basic act the Bureau is charged with investigating and reporting "upon all matters pertaining to the welfare of children and childlife among all