The CHAIRMAN. Is the head of the Vital Statistics Division of the Census Office a doctor?

Doctor KOBER. I think he is, and he has rendered the most effective educational service that has been done for many years. He visitsMr. RICHARDSON. I did not hear what was said before. I was so unfortunate as to be late in getting in. I presume you take the position that you want all these different cognate works in the different departments consolidated or in one department of health, with a secretary and a seat in the President's Cabinet?

Doctor KOBER. Yes.

Mr. RICHARDSON. I am an enthusiastic advocate of the advantage and efficiency of concentration, but don't you think you could advance with much more efficiency by taking the bureau of public health as it is now found and developing it, instead of bringing that into a new bureau or department such as you suggest?

Doctor KOBER. I have already answered that by suggesting, first of all, that it does not meet the requirements of the case at all; that there are a great many health activities scattered all over the executive departments which, if concentrated into one bureau, would make that bureau an exceedingly unwieldy one.

Mr. RICHARDSON. Then you do not agree with the provisions of the Owen bill?

Doctor KOBER. I do so far as the department is concerned, either creating a new department or transferring them to one department, so that there can be concentration and coordination of the work. That is our idea. If you do not want to create a special department of health

Mr. RICHARDSON. You would not object if you could see all your purposes accomplished through the instrumentality and medium of the Public Health and Marine-Hospital Service, leaving off the name? You would not object to seeing your ends achieved under that?

Doctor KOBER. If it is possible to concentrate all the health activities under one bureau, I am satisfied. It is purely a matter of administration, that must be left to your judgment, gentlemen, but a partial enlargement of that service would not answer the purpose. In order to be effective, many of the divisions of which Doctor Wiley has now charge should certainly be in there.

The CHAIRMAN. Now, Doctor, you have consumed forty minutes of time. How much more time do you think you will require to finish your statement? The committee will want to ask you some questions afterwards.

Doctor KOBER. It will all depend on how much interruption I am subjected to. I presume ten minutes more will suffice if you do not interrupt me.

Mr. ADAMSON. I would like to have a minute or two in which to ask him a couple of questions, the time not to be charged to him. The CHAIRMAN. When you get through with your statement, Doctor, I want to ask you some questions.

BUREAU OF MINES.

Doctor KOBER. The Bureau of Mines, recently established by act of Congress approved May 16, 1910, for the study and investigation of the causes of mining disasters, explosions, accidents, and their

prevention, should very properly be included in the new depart

ment.

Mr. BARTLETT. Is there anything you want to leave out, Doctor? [Laughter.]

Doctor KOBER. When I tell you that the chief object of that mining bureau is the preservation of human life and the prevention of needless suffering, and the foreign literature on industrial hygiene already offers a rich field of preventive measures, I hope your question has been satisfactorily answered.

The CHAIRMAN. On the subject of a Bureau of Mines, do you think the health department would be the proper department to test the structural materials and analyze coals and other mineral fuel substances?

Doctor KOBER. I want to say that with the exception of the analyses of coal, all matters relating to safeguarding the lives and limbs of miners are purely questions of industrial hygiene.

The CHAIRMAN. I know; but would you answer my question, whether you think a health department would be the most efficient department to test structural materials and to test coals and other mineral fuel substances?

Doctor KOBER. Not in that respect, but that bureau could have its experts do that just as the Interior Department will have to rely upon experts. I do not see why the Secretary of the Interior should know more about it than the secretary of health.

Mr. ADAMSON. Inasmuch as we derive under the Constitution our sole authority to fool with the subject of public health at all, from the fact that it is an incident of commerce, ought we not to include in and transfer to the proposed department of public health all the bureaus of the Department of Commerce and Labor?

Doctor KOBER. That was our first proposition.

Mr. ADAMSON. What is the use of Congress anyhow if it does not take care of all the people and cure them when they are sick! [Laughter.]

CHILDREN'S BUREAU.

Doctor KOBER. A bill is now pending for the establishment of s children's bureau in the Department of the Interior, which, if enacted, should very properly be included in the new department, since its chief object is the raising of a sturdy American stock, and will deal with questions of infant mortality, the birth rate, physical degeneracy, orphanage, juvenile delinquency, desertion, dangerous occupations, accidents, and diseases of children of the working classes.

This

A bill has been favorably reported in the House providing for the creation of a commission with a view of inspecting and reporting upon the sanitary condition of federal buildings and offices. health agency, if authorized, would clearly perform its best work in the new department. It has been suggested that the library of the Office of the Surgeon-General of the United States Army, which is a national medical reference library, should likewise be transferred; and there are not a few who, like myself, can see positive advantages in transferring the health department of the city of Washington, the water supply and sewage disposal, to the new department.

BUREAU OF LABOR.

There are good reasons why the Labor Bureau should be in close cooperation with the federal health agency. A large and important part of the work of the bureau has to do with workmen's health, factory sanitation, the study and prevention of occupation diseases and accidents, the causes of fatigue, physiological hours of work, etc. It has already published bulletins on industrial hygiene, the slums, and the housing of the working people, all of which relate to the public health. Much of its work is and always will be educational, and the benefits of this bureau can be greatly extended, since many of the problems connected with the causes and prevention of industrial diseases and accidents need to be studied by trained sanitarians, and it would be extremely helpful to the Commissioner of Labor requiring sanitary services to apply to the department of health.

We are aware that remedial measures will always have to emanate from the States, but the Federal Government, after due investigation of occupation, diseases, and accidents, can at least establish and adopt a standard of industrial hygiene for all the government workshops and for the District of Columbia. It can also evolve model plans and building regulations for government workshops and office buildings, quarters of government employees, and homes for wageearners in the District of Columbia, so that no such buildings will hereafter be erected without due regard to air space, ventilation, light, heating, temperature, humidity, sanitary conveniences, and supervision. We believe that model government workshops and efforts for the promotion of the general welfare of the employees would establish certain standards and thus prove a salutary precept and example for the States and private concerns to follow.

BUREAU OF EDUCATION.

There is every reason to believe that the work of the Bureau of Education would be materially strengthened by a close cooperation with the new department, especially in matters relating to school hygiene and the physical development of children, and by the dissemination of facts concerning the prevention of disease, and the time may come when the transfer of the bureaus of Labor and Education may be considered wise and expedient. In my opinion the new department should include these bureaus and be designated the "Department of Health, Labor, and Education."

I have already indicated some of the work in which the federal health establishment may be extremely helpful to the Bureau of Labor and the working classes of this country.

Mr. BARTLETT. What is to prevent the Government from doing that now in its own government workshops, the navy-yards, gun factories, armories, arsenals, and so forth? What is to prevent the Government from establishing standards of sanitation in its industrial plants?

Doctor KOBER. Nothing, except that at present it is not doing all that should be done.

Mr. RICHARDSON. How do you propose to cooperate with the States? As I understood you to say before, you said you were looking to the States chiefly for aid and cooperation.

Doctor KOBER. By cooperation and assistance when called upon to do it in case of emergency. Whenever they need expert advice that is not at their own disposal, they should be allowed to obtain it from the Federal Government.

Mr. RICHARDSON. What is your idea: If the board of health of the State of Massachusetts determines upon a certain policy to be pursued, this national board would not interfere with it, would it? Doctor KOBER. Not at all, except in quarantinable diseases and in matters involving interstate and foreign quarantines.

Mr. RICHARDSON. Your idea is to establish cooperation between the States and the Federal Government by making uniform rules? Doctor KOBER. Yes; purely advisory. There are, however, certain problems of which I will speak that are purely matters for the Federal Government to assume, notably, the pollution of interstate

waters.

Mr. RICHARDSON. That would be purely a matter of interstate commerce?

Mr. BARTLETT. It would be a matter of disease, and not of commerce, although the diseases may be spread by interstate commerce or travel.

Doctor KOBER. One of the most important problems which must be solved by the Federal Government is the prevention of pollution of interstate waters. In the language of the North American Conservation Conference on February 23, 1909: "Facts which can not be questioned demonstrate that immediate action is necessary to prevent further pollution, mainly by sewage, of the lakes, rivers, and streams throughout North America." The prevalence of typhoid fever, dysentery, diarrheal and other water and milk borne diseases is intimately connected with water pollution. It has been estimated that the total loss in the United States from typhoid fever alone amounts to $353,790,000 per annum, and that the prevalence of this disease can be reduced fully one-half by the substitution of pure water for previously contaminated supplies.

I have a chart here which clearly indicates the value of pure water, and the baneful influence of polluted water is shown by the excessive typhoid rate known to exist not only among the cities that are supplied by our Great Lakes, but also by the cities that are supplied by our great interstate waters.

The following is an abstract from my statement "Conservation of life and health by improved water supply," before the conference on the conservation of natural resources, White House, May 13-15, 1908:

THE HYGIENIC VALUE OF PURE WATER-ANNUAL COST OF TYPHOID FEVER IN THE

UNITED STATES.

According to the census of 1900 there were 35,379 deaths from typhoid fever during the census year throughout the United States, and, based on an estimated mortality of 10 per cent, it is within reason to assume a yearly prevalence of 353,790 cases of this disease. If we calculate the average cost for care, treatment, and loss of work to be $300 and the average value of a human life at $5,000, we have a total loss in the United States of $283,032,000 from one of the so-called preventable diseases. Mr. George C. Whipple a presents some striking evidence to indicate that a loss of $10,000 for every death from typhoid fever is a conservative estimate, in which case the decrease in the "vital assets" during the census year of 1900 would amount to $353,

a The Value of Pure Water. New York, 1905 (p. 5).

790,000. Reduce the prevalence of this disease one-half (which has been accomplished in Europe and our own country) and the question of the hygienic value of pure water will be answered from an economic point of view.

MEAN DEATH RATES FROM TYPHOID FEVER, 1902 TO 1906, IN 66 AMERICAN CITIES AND 7 FOREIGN CITIES. GROUPED, AFTER FUERTES, ACCORDING TO THE QUALITY OF THEIR DRINKING WATER. THE

RATES FOR FOREIGN CITIES ARE TAKEN FROM JAMES H. FUERTES.

The CHAIRMAN. You say also of "interstate waters. you mean by "interstate waters?"

What do