Doctor WILEY. I certainly should not, by any means, advocate the rotation of scientific men in office, but I should want the secretary of public health to come and go.

Mr. ADAMSON. You do not care anything about the sentiment or the fad or the theory of having a nominal head of a department of doubtful constitutionality if you do not thereby increase the scientific efficiency?

Doctor WILEY. I would strain the Constitution a little if I could increase the efficiency.

Mr. ADAMSON. I believe I would rather strain something other than the Constitution.

Mr. STEVENS. Seriously, Doctor, you have had a great deal of experience. Do you not think continuity of service at the head of a great technical department of this kind is more essential than to have a lot of men following one after another, without any particular knowledge or information, or experience about the work, simply because they like to shine in some exalted position? Do you not think it will work better?

Doctor WILEY. I will answer that very seriously. I believe it is highly desirable that the Cabinet officer or the man in charge of the great executive department should follow the President.

Mr. BARTLETT. It is not so in your department. It has not been so. Doctor WILEY. I do not mean, of course, that the President may not select the same man over and over again.

Mr. ADAMSON. You and he differ about the quality of the liquor you drink, do you not? [Laughter.]

Doctor WILEY. Well, I do not know. I do not drink liquor, you know. You must mean about the quality of liquor other people drink.

Mr. ADAMSON. You talk about it a great deal, anyway.

Mr. STEVENS. Proceed, Doctor.

Doctor WILEY. I think, Mr. Chairman, that I have said about all that I wish to say.

Mr. ESCH. I should like to ask you a question. The Creager bill seeks to put under this new department the surgeons and examiners of the Pension Office. What have those examiners in the Pension Bureau got to do with the promotion of public health? They simply investigate the medical or physical status of an applicant, and then reject or allow his application. They do not write a prescription at the end of their decisions. Why should that feature be incorporated in a bureau or a department of health?

Doctor WILEY. I am utterly unable and incompetent to speak on anything of that kind. I stated in the opening of my remarks that I would not have anything to say about details of that kind. I do not know anything about it.

Mr. STEVENS. You just lay down the general law?

Doctor WILEY. I only speak to the one point-just one point; not what should go in or what should stay out.

Mr. ADAMSON. The details are what we look to you for enlighten

ment on.

Doctor WILEY. I shall be very glad, when the committee decides to create a department of public health, to come and give you all the advice I can as to what should go into it.

Mr. ADAMSON. That is your sentiment; but I want to ask you a practical question. You are a practical man, and I want to ask you one practical question.

Doctor WILEY. Yes.

Mr. ADAMSON. You are entirely satisfied with the conditions and the administration of your division. If Surgeon-General Wyman is equally satisfied with the conditions and the administration of his division, and the Pension Bureau doctors are equally satisfied with theirs, and the Surgeons-General of the Army and Navy are equally satisfied with theirs-and I dare say all of them are-where are you going to get any material to put into this new department?

Doctor WILEY. I do not know that that goes to the root of the question.

Mr. ADAMSON. That is a very practical question.

Doctor WILEY. I may be satisfied to hold an independent position. I might say that I would rather be independent than to go into a bureau and have Doctor Wyman put over me; but I will not say that.

Mr. ADAMSON. That is not what I am talking about. I say, if you are satisfied, and if each of the others is satisfied, where is the necessity of getting up a new department?

Doctor WILEY. I am satisfied to this extent: I think we have done good work. I believe the activities which represent sanitation and public health in my bureau would be more effective if they were coordinated with similar activities in Doctor Wyman's bureau. That is what I believe; and I believe it thoroughly, and after long observation and experience in conducting public business.

Mr. STEVENS. Is there anything further?

Doctor WILEY. No.

Mr. STEVENS. All right, Doctor; thank you.

Doctor SOWERS. I have just heard from Doctor Wyman, who will not be able to be here at present. We hope to hear from him a little later. If there is no objection, I will call on General Sternberg to take his place.

STATEMENT OF GEN. GEORGE M. STERNBERG, OF WASHINGTON, D. C., SURGEON-GENERAL U. S. ARMY (RETIRED).

General STERNBERG. Gentlemen, my position is very much the same as that of Doctor Wiley. I am not prepared to go into details as to just what organizations or departments or bureaus might be transferred to a department of public health. I think, without doubt, you could not have a department of public health without including Doctor Wyman's service, the Public Health Service. Naturally that is the nucleus of anything that may be done.

Mr. BARTLETT. They are doing pretty well now, are they not? General STERNBERG. You should certainly include certain portions of Doctor Wiley's work, as he has indicated. Whatever I have to say will be rather on the general subject.

The bill which has been introduced for the establishment of a department of public health has my hearty indorsement, as I believe it has that of everyone familiar with the facts relating to the great mortality in this country from preventable diseases. These facts have long been familar to sanitarians and students of vital statistics and have been well presented in the document prepared by Prof.

Irving Fisher, entitled "National Vitality: Its Wastes and Conservation" (S. Doc. No. 419). I suppose the only reason why we have not long since had a government department to look after the public health and to take the lead in instructing the people how to prevent the enormous waste of human life from preventable diseases is because our legislators have not heretofore realized the importance of this subject.

Mr. BARTLETT. You are very much mistaken about that. We had a board of public health once, and the law creating it was repealed at the next session of Congress.

General STERNBERG. I am coming to that in a moment.

After the great epidemic of yellow fever in 1878, Congress was greatly aroused upon the subject of preventing future epidemics of this disease and a national board of health was organized. But this board was not provided either with the authority or the financial support necessary to make it a success. Its members were engaged in other occupations and did not receive salaries. They were therefore unable to devote any considerable portion of their time to questions relating to the public health. They did, however, inaugurate investigations which after more than twenty years led to a demonstration of the method by which this disease is transmitted from man to man and as a result of this knowledge we have learned how to control this pestilential malady and have good reason to believe that it can never again prevail as an extended epidemic within the limits of the United States. I refer especially to this disease because I was a member of the commission sent to Habana in 1879 to make investigations with reference to its cause and prevention. These investigations were subsequently continued by me in the same city in 1888 and 1889 and in Rio de Janeiro, Brazil, and Vera Cruz, Mexico, in 1887.

Fortunately, the Spanish-American war gave me an opportunity to initiate further investigations which resulted in complete success so far as the demonstration of the method of transmission of yellow fever is concerned. As Surgeon-General of the Army, I organized the Habana Yellow Fever Commission, which, as you know, found volunteers among its own members and among the soldiers serving with the army in Cuba, upon whom the necessary crucial inoculation experiments were made. You are familiar with the beneficent results of these investigations. The great commercial and industrial development which has occurred in our Southern States since the yellow-fever epidemic of 1878 would have been impossible if these States had been subject to repeated epidemics of the same kind every few years. I call your attention to the fact that the investigations which have finally led to the practical extinction of this pestilential malady were inaugurated by a national board of health established by the Congress of the United States and have since been carried on by means of congressional appropriations.

I want it fully understood that we realize what Congress has done in the past. We do not want to belittle the work that has been accomplished under congressional appropriations, but I think we can point out the way in which very much greater work can be accomplished in the future. And when you fully realize the enormous mortality which is preventable and the fundamental fact that these people throughout the country are dying from preventable diseases, the question is, "How are they to be prevented?"

Mr. BARTLETT. A great many of them are dying from riding in automobiles, too.

General STERNBERG. That is a very small matter compared with the matters of which I am speaking.

From the point of view of the good which has resulted from these investigations, we may regard the great epidemic of 1878 as a blessing in disguise. For this was the stimulus which led to congressional action, and without such action there is reason to believe that we would still be in ignorance as to the mode of transmission and means of prevention of this infectious disease.

I desire now to call your attention to the fact that yellow-fever prevention is a small matter compared with that of tuberculosis, typhoid fever, hook-worm disease, and various other endemic infectious diseases. The great yellow-fever epidemic of 1878 invaded 132 towns and cities in the South and caused à mortality of 15,934 out of a total number of cases exceeding 74,000. But the mortality from tuberculosis within the limits of the United States is, every year, more than ten times the mortality from yellow fever during the great epidemic of 1878. In this city of Washington alone we had 746 deaths from tuberculosis in 1909. Such a mortality from an earthquake or flood or a conflagration in some distant city would arouse the sympathy of the entire nation. Probably the principal reason why in the past Congress has done little to aid in the campaign for the prevention of this disease is because the knowledge that it is a preventable disease is of comparatively recent origin and has not completely penetrated the minds of our statesmen. This knowledge is based upon the discovery, announced by Dr. Robert Koch in 1882, that tuberculosis is caused by a bacillus, which is the specific agent in the production of this disease in all its various manifestations. Sanitarians and physicians have been convinced of this fact for twenty years or more and have taken the lead in a world-wide campaign for the extinction of this scourge of the human race. It is most encouraging to know that within twenty years there has been a reduction in tuberculosis mortality of from 20 to 40 per cent in many American cities. In the city of Washington the reduction has been about 50 per cent since 1882, the year in which the tubercle bacillus was discovered, and in the last ten years it has been nearly 30 per cent. This is shown by a chart which has been prepared under my direction and which I submit for your inspection.

There are enough copies of this chart to circulate among all the members of the committee showing by five-year periods the mortality for the colored people and for the whites, and showing the very marked reduction in mortality which is continuous for the whites.

Some one may say: "If such progress is being made, why should Congress be called upon to establish a department of public health? Why not leave questions of this kind to the doctors and to philanthropists?" In reply I would say: Why not leave all educational matters to teachers and philanthropists? What is the necessity for a public-school system, with grants of land for its support and a bureau of education to look after its interests? Why not leave questions relating to improvements in agriculture to the farmers? This would be more logical than to leave the physicians of the country unaided to fight against the preventable diseases. The fact is that the doctors. have already done a great deal more than their share. Because they

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are better informed they have taken the lead in all efforts to educate the public with reference to sanitary matters and to secure necessary sanitary legislation. They have nothing to gain by such legislation. On the contrary, their clientele will be diminished exactly in proportion as their efforts in behalf of preventive medicine are successful. It is not just that the cost of preventing disease and reducing mortality should be a tax upon the time and financial resources of that small proportion of our citizens who have been instrumental in organizing associations such as the American Public Health Association, the National Association for the Study and Prevention of Tuberculosis, and various organizations having the same objects in view in many States, counties, and cities. The Association for the Prevention of Tuberculosis of the District of Columbia, of which I have the honor to be president, was organized in 1908. This association has raised funds for a vigorous educational campaign, for the maintenance of a tuberculosis dispensary, for the support of trained nurses to visit dispensary patients in their homes, for the instruction of children in the public schools with reference to the cause and prevention of this disease, etc. But we have great difficulty in raising the money for this work. A large majority of our citizens do not respond to appeals for financial support.

I may say here that as president of that association I personally signed five or six thousand letters during the past winter to try to raise the few thousand dollars necessary for carrying on this work in the District of Columbia, in the face of the fact that the efforts which have heretofore been made have had such marked success.

Mr. BARTLETT. There is no reason why Congress can not do whatever it wants to do with reference to the District of Columbia. It has absolute control here. It can appropriate money, or pass laws or health regulations of any sort, and enforce them here.

General STERNBERG. We need help.

Mr. BARTLETT. That proposition is easy. We have a right to do in the District of Columbia just what Georgia has the right to do in Georgia.

To

General STERNBERG. The burden of this work falls upon a few philanthropic and enlightened persons, while the benefits are for the community at large and especially for the laboring classes, who can not be expected to do much in support of such undertakings. obtain the best results it is evident that the General Government should take the leading part, and it is just that the cost of preserving the public health should be met by a tax upon the people generally.

I am not prepared to say how much economy there may be in a department of public health as a result of the consolidation or the coordination which you are asking for. I think it should be put on a higher ground than that of economy. I think that if it comes within proper constitutional limitations it should be put on the ground of duty, to look after the people who are unable to look after themselves the ignorant classes, especially, who suffer the most from these preventable diseases.

Mr. BARTLETT. Doctor, one moment, as long as you have said that. I agree with you in reference to the importance of the subject, and the necessity for preserving health; and I agree with you for the sake of the argument that it may be the duty of Congress to investigate these subjects and spend money for that purpose, accumu