Centennial Report Informing Policy for Health Care & Population Health

Transcription

1 Centennial Report Informing Policy for Health Care & Population Health

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3 Informing Policy for Health Care & Population Health The Milbank Memorial Fund is an endowed operating foundation that engages in nonpartisan analysis, study, research, and communication on significant issues in health policy. Since 1905 the Fund has worked to improve and maintain health by encouraging persons who make and implement health policy to use the best available evidence. Centennial Report Copyright 2005 Milbank Memorial Fund

4 One Hundred Years of Family Leadership From 1974 to present Samuel L. Tony Milbank From 1934 to 1985 Samuel R. Milbank From 1905 to 1949 Albert Goodsell Milbank From 1905 to 1921 Elizabeth Milbank Anderson

5 Foreword We invite you to read this report on the work of the Milbank Memorial Fund during its first century. The mission of the Fund since 1905 has been to broker practical knowledge to decision makers in health so that they can make more effective policy, especially for those people at the greatest risk of disease and death. The Fund has been a small foundation with a big footprint, the chief executive officer of a major health care organization told our board in Nevertheless, since its inception the Fund has spent $465 million (in 2005 dollars) for charitable purposes. The founders of the Fund Elizabeth Milbank Anderson and Albert G. Milbank would, we suspect, be dismayed by the world of 2005 but delighted by the Fund. They would be dismayed by the enormous global burden of disease despite a century of scientific advances and economic growth. Because they grounded the Fund in their belief that progress results from applying objective evidence to policy and practice, they would be surprised as well as dismayed by the frequent misrepresentation of evidence by interest groups and the media. Anderson and Milbank would be delighted that the Fund has maintained the mission they gave it. For most of the past one hundred years, the Fund has joined leaders in the public and private sectors and outstanding researchers on health services and systems and population health in working to improve policy for health. Most of its work has been in the United States, but the Fund has also been active internationally in each of the last nine decades. This report relies mainly on the Fund s archival records and publications. We asked the authors to avoid celebratory rhetoric in the hope of attracting readers who are interested in the history of philanthropic institutions. Daniel M. Fox President Samuel L. Milbank Chairman

6 Mrs. Anderson supported Manhattan s Home Hospital to demonstrate that patients with tuberculosis could be cared for in their homes without infecting other family members. These Home Hospital patients have fresh air year round, weather permitting, on the residence s rooftop. The Milbank Public Baths, funded by Mrs. Anderson in 1904, replaced unsanitary floating baths then available to residents of New York s overcrowded cold-water tenements. The building was deemed by public health experts so perfect in design and operation that it became the model for public baths later constructed by the city. The Milbank baths were a good example of Mrs. Anderson s view that alleviating poverty requires looking several steps back in a causal chain. In this case, she understood that environmental factors were a prime cause of illness, which, in turn, was a major cause of poverty

7 I am particularly interested in fostering preventive and constructive social measures for the welfare of the poor..., as distinguished from relief measures affecting particular individuals and families. Thus wrote Elizabeth Milbank Anderson, who endowed what became the Milbank Memorial Fund, in a letter to a New York City welfare organization in In her writings and in her works, Mrs. Anderson clearly distinguished between constructive Elizabeth Milbank Anderson philanthropy the prevention of illness, disability, and dependency and simple charity. She prioritized prevention. Elizabeth Milbank was born in New York City on December 20, 1850, the second child of Jeremiah and Elizabeth Lake Milbank. Her father was a successful wholesale grocer who made his fortune from several enterprises. In the 1850s, he financed entrepreneur Gail Borden s development of a process to manufacture condensed milk, a product that would be safe and wholesome without refrigeration. During the Civil War, Eagle Brand became a staple of the Union army and still is popular today. In 1863, Milbank Elizabeth Milbank Anderson was helped organize and finance the creation of a Midwestern memorialized by her contemporaries as keen in mind, possessed railway that became The Milwaukee Road, then turned his hand to investment banking. of sound business judgment, with Elizabeth married Colonel Abram Archibald Anderson a rare sense of humor, buoyant in a portrait painter and later a rancher and patron of aviation spirits, strong in her likes and dislikes, counting loyalty as one of the and the couple had two children. In 1886 their son Jeremiah Milbank Anderson died of diphtheria at age seven, but their supreme qualities in human relationship, fearless and ever ready daughter, Eleanor Anderson Campbell, against the conventions of the time, became a physician and later founded New to fight for the right as she saw it. York City s Judson Health Center. Her most lasting gift to the Fund, The direction of Mrs. Anderson s philanthropy indicates perhaps as important as the dollars that she took deeply to heart her son s death and, later, her so generously provided, may have daughter s career, as well as the difficult living conditions of been the pattern she set: To her it so many people in the city she loved. She was committed to was not the work that mattered, disease prevention and public health and took a strong interest in tuberculosis research and treatment. Mrs. Anderson but the results obtained. became one of the first trustees of Barnard College, one of the few institutions in the country where women could receive the same rigorous education available to men. She provided the funds to erect the college s first building, Milbank Hall, used for administration, and purchased for the college the three city blocks that became the Milbank Quadrangle, enabling the college s further development. In the latter decades of the 1800s, immigrants flooded New York s Lower East Side. They lived in crowded tenements, where conditions were unsanitary and insalubrious. Epidemics of cholera, typhus, smallpox, and diphtheria took a dreadful toll, and tuberculosis was the leading cause of death. Although many reformers in the Progressive Era were committed to preventing Informing Policy for Health Care & Population Health 5

8 and remedying illnesses linked to poverty, Mrs. Anderson took action. Her first step, in 1904, was to fund the construction of the Milbank Public Baths on East 38th Street. The construction and management of the baths was awarded to the New York Association for Improving the Condition of the Poor. In that same year, Mrs. Anderson s cousin and longtime adviser, Albert Goodsell Milbank, joined the association s board, and the Milbanks and the association worked together for years. Mrs. Anderson also made gifts to the National Committee for Mental Hygiene and many other organizations, often anonymously. Albert Milbank suggested that Mrs. Anderson establish a foundation to organize her philanthropy, which produced the Memorial Fund Association, in memory of her parents. This, the seventeenth American philanthropic foundation, was officially established on April 3, 1905, with her cousin and four friends Dr. Francis P. Kinnicutt and attorneys George L. Nichols, Edward J. Sheldon, and Howard Townsend, the last also serving as president of the New York State Hospital for Consumptives as directors. Even though Albert Milbank was twenty-three years younger than his cousin, the two were close collaborators on setting the future course of the new foundation. In her bequests, Mrs. Anderson made it possible for her support of public health and social welfare to transcend her own lifetime. She did not, however, impose any rules on the directors or their successors, recognizing, as one of her contemporaries later explained, that as society changes, as generations come and go, institutions come into being and pass on, political, social and industrial conditions alter so giving, if it is to have any real value, must alter, too. Nevertheless, her philosophy continues even today to resonate in the Fund s work, in its emphasis on public health and prevention rather than the remediation of problems after they have occurred; in the understanding that solid research should underpin action; in its continuing interest in health care, public health, mental health, and nutrition; and in its broad perspective on the interplay of factors that affect health and well-being. In its early years, the Milbank Memorial Fund continued its support of efforts to combat tuberculosis and assisted such charities as the Legal Aid Society, the Children s Aid Society, and the Henry Street Nursing Settlement. Most important, it helped establish the Department of Social Welfare within the New York Association for Improving the Condition of the Poor to prevent sickness and thus relieve poverty, [by] the promotion of cleanliness and sanitation and the securing of a proper food supply. By proper food supply, Mrs. Anderson meant not simply making more food available to the poor but making sure, through research, that the food made available was nutritious and was stored and handled safely. The Fund also supported, in the heart of the tenement district, the Judson Health Center, directed by Mrs. Anderson s daughter, Dr. Eleanor Anderson Campbell. Upon Mrs. Anderson s death in February 1921, additional bequests increased the Fund s assets to about $10 million, or $110 million in 2005 dollars, the legacy, according to the Fund s directors, of a generous and great-hearted woman, filled with human sympathy and eager to relieve suffering and distress among all sorts and conditions of men

9 Immediately after World War I, the Fund embarked on the first of its many activities in international health. Serbia, which was ravaged and destitute, sorely needed help. With the Fund s support, the Serbian Child Welfare Association found homes for orphan children, rebuilt destroyed schools, built desperately needed health centers (this one bears her name in Cyrillic letters), and, working with the Serbian Red Cross, trained many nurses. In seeking a tangible, permanent memorial for Elizabeth Milbank Anderson, the Fund s directors chose the choir of Princeton University s planned chapel. This large collegiate-gothic structure, built between 1925 and 1928, accommodates religious services and secular concerts, public commencements and private weddings. The Milbank choir serves as a more intimate chapel within a chapel for smaller events. Mrs. Anderson was a woman of deep religious convictions, and the directors believed the choir would be the chapel s crowning glory in both spiritual and architectural terms. In its center is the Great East Window, depicting the Love of Christ a new commandment I give unto you, that you love one another a fitting allusion to the aspirations of her generous life. Informing Policy for Health Care & Population Health 7

10 A smiling John Kingsbury (seated, right), chief executive of the Milbank Memorial Fund from 1922 to 1935, participates in a ground-breaking ceremony, with New York governor Herbert H. Lehman handling the spade. Kingsbury s leadership in health and social welfare activities brought him in contact with important political figures at all levels of government. He served on statelevel committees that led to formation of the Department of Labor and a comprehensive revision of public health laws, and he was a participant in a White House conference convened by President Herbert Hoover. The Bellevue-Yorkville demonstration included divisions of nursing, statistics and records, child hygiene, dental hygiene, health education and publicity, recreation, and social hygiene, as well as tuberculosis the best text a public health program can have, according to Hermann Biggs, technical board member and New York state health commissioner

11 Shortly before her death in February 1921, Mrs. Anderson advised her cousin Albert that her will promised substantial additional gifts to the Fund. These greater assets and likely increased activities meant that Albert Milbank could no longer manage the foundation without full-time professional staff, a conclusion that set in motion a number of important changes. Mrs. Anderson also asked the directors to change the Fund s name to the Milbank Memorial Fund. The directors engaged John Adams Kingsbury to write a report describing the Fund s past activities and laying out the best course for the future. Kingsbury was well known to the board through his leadership of the New York Association for Improving the Condition of the Poor a frequent beneficiary of the Fund s support and important partner in its work and as a senior official in the New York City government. Kingsbury consulted with numerous professional colleagues in preparing his report. It recommended a plan to consolidate and focus the Fund s activities in an organized program of disease prevention and health improvement. Kingsbury proposed a demonstration program in three New York State communities of differing sizes a rural area, a medium-sized city, and a section of Manhattan to show whether modern public health organization and methods could prevent disease, disability, and mortality in a relatively short time and at a per capita cost which communities will willingly bear. The demonstrations not only would be based on the best science and organizational experience available but also would generate new information about the effectiveness of various program elements and create models for other communities to emulate. The board accepted Kingsbury s recommendations and hired him to carry them out. Initially, the demonstration program s focus was on preventing tuberculosis, but that soon broadened considerably, based on the views of the experts brought in to serve on its technical board and advisory council. They argued that tuberculosis control would be more effective within the context of comprehensive, well-organized community public health programs. On the technical board were the Fund s primary governmental and charitable partners for the demonstration projects: the New York State commissioner of public health, the leaders of the New York Association for Improving the Condition of the Poor and the State Charities Aid Association the state s two major charitable organizations and state and national tuberculosis association representatives. The president of Cornell University and the dean of the Johns Hopkins University School of Public Health also served. The Fund s advisory council comprised the U.S. surgeon general and the assistant surgeon general, leaders from state and national voluntary health associations, tuberculosis experts, statisticians, leaders from business and academia, and the health officers of the three demonstration communities. Cooperation was the key. As a Fund leader stated at the time, It is impossible to reiterate too frequently or to stress too strongly the fact that the demonstrations which we are encouraging must be conducted by and not on the people in the demonstration centers.... The success of health work, in the last analysis, will depend on the interest of the people in the improvement of their own health, rather than in superimposing on them a paternalistic program. Rural Cattaraugus County in western New York, Syracuse, and the Bellevue-Yorkville section of Manhattan were selected as the sites for the three demonstration projects. Each would strive to Informing Policy for Health Care & Population Health 9

12 improve its public health organization and services. Specifically, the Cattaraugus County project would document the impact of a rural public health department and be a model for other rural locales. The Syracuse demonstration project would focus on improving the health department s ability to prevent disease Albert Goodsell Milbank by modernizing its structure and function, and the Bellevue- Yorkville site would test the effectiveness of organizing big-city public health services at the district level. As Mrs. Anderson s chief collaborator in managing the new foundation, Albert G. Milbank drew on his experience as a board member of the New York Association for Improving the Condition of the Poor. He served on the Fund s board of directors for forty-five years until his death in His long legal career culminated in his senior partnership in the law firm of Milbank, Tweed, Hope & Hadley. He worked with many leading corporations, most notably as chairman of the Borden Company for thirty-two years. He was a trustee of Princeton University, where he had been president of the class of 1896 and with Booth Tarkington founded the Triangle Club, a trustee of Pierpont Morgan Library, and a Senior Warden at St. Bartholomew s Church. For two decades, he was mayor of his home community, Lloyd Harbor, Long Island. Milbank also received international recognition for his war relief efforts in both world wars. Cattaraugus County Cattaraugus County was selected for the demonstration in November Fund staff and technical board members worked with community leaders to engage other organizations already active there. For some time, local leaders had wanted to organize a department of health in the county, led by a full-time health officer, and they moved quickly to meet the demonstration site s requirements. This was New York s first health department in a rural county. The department was established in Olean, the county s largest town. At the same time, previously decentralized school health services were coordinated under a new countywide program. Occasional opposition from the local medical society was addressed directly and effectively, and the demonstration ran from 1923 to Syracuse When the seven-year demonstration project started in Syracuse, the city already had a well-established health department, so project planners concentrated on extending and coordinating the various health services provided by the department, the city s schools, and other local agencies. They anticipated that the project could prevent tuberculosis and other communicable diseases and expand health education services. They would test whether these targets could be met affordably through the efficient organization of scientifically validated public health measures. Bellevue-Yorkville The Bellevue-Yorkville demonstration was the last of the three to begin, in 1926, but during its seven years of operation it received intense attention. Project leaders collaborated closely with New York City government officials, and the activities were carried out in the home territory of most of the demonstration program s leading participants and advisers

13 On the farm are to be found just the same evils that exist in the tenement: poverty, ill health, neglect and the rest, with only the difference that in the country these problems are unrecognized and uncared for. C.-E.A. Winslow, founder, Yale University s program in public health The Milbank Memorial Fund Quarterly Bulletin began as a house organ primarily to report on the progress and issues associated with the three demonstration projects. Starting in the late 1920s, as the demonstrations wound down and the Fund s research division was established, the Bulletin began reporting on the Fund s scientific activities. Informing Policy for Health Care & Population Health 11

14 The Bellevue-Yorkville demonstration covered a large area: north from East 14th Street some fifty blocks and from Fourth and Sixth Avenues to the East River. The original Milbank Public Baths building on East 38th Street was converted to a health center to house the program and its many clinics and services. In New York City, an advanced medical care The Milbank Annual Conferences and public health system already had done much to overcome smallpox, typhoid fever, and cholera but still In 1925, the Milbank Memorial Fund launched a series of had important work to do in addressing tuberculosis, communicable conferences, held nearly every year until the late 1960s. These meetings brought together national and international childhood diseases, and sexually experts and became a touchstone in the Fund s programming transmitted infections. Living conditions in the crowded tenements and an important expression of its philosophy. In their early years, the conferences focused on the progress and results of remained unhealthy. the three public health demonstration projects, but they soon The program s goals were to expanded into reviews of some of the most important public show that health could be improved health problems of the day: tuberculosis and other infectious in a defined geographic area by diseases, public health administration and practice, population applying the best scientific knowledge available about disease preven- studies, housing standards, nutrition, and mental health. tion and systematic management and by stimulating the community s interest in health improvement. The planners believed that by coordinating their activities with those of existing agencies, public and private, any gains could be sustained after the demonstration in the target neighborhoods and could be spread to other areas of the city. Evaluation and Research The demand for good data to monitor and evaluate the three demonstrations led to the formation of a statistical advisory committee and, in 1925, the hiring of Edgar Sydenstricker, the public health statistician of the U.S. Public Health Service and former League of Nations Health Organization official, as the Fund s part-time statistical consultant. Brought in after the first two demonstrations began, he and his research colleagues provided valuable objectivity to the project. The presence of staff researchers quickly became significant. As Elizabeth Anderson had, the Fund and its advisers recognized that the public s health depended on not only conquering infectious diseases but also addressing underlying problems, such as housing, nutrition, health care, medical services, and poverty. To do so, they needed facts on which to base action. Other Activities Starting in 1924, a series of grants to the American Public Health Association led to the development of a model public health program that reflected the country s best practices. The association created a widely used assessment tool that enabled local departments to measure their practices against the model. Combined with the experiences of the demonstrations, this project helped raise the efficiency of the nation s public health services during a critical period of their development

15 Between 1925 and 1928, public health nurses in the Fund s demonstration in Cattaraugus County traveled some 550,000 miles and made almost 99,000 home visits to provide information and counseling, identify patients with tuberculosis, and care for the sick under the general direction of local doctors. They supervised patients with communicable diseases, assisted in childbirth, provided health and nutrition education, and worked in clinics and schools. Informing Policy for Health Care & Population Health 13

16 After the death of her own young son from diphtheria, Elizabeth Milbank Anderson considered avoidable illnesses and preventable deaths to be twin tragedies menacing human happiness. She believed that preventive medicine, like the diphtheria immunization campaign supported by the Fund in the late 1920s, was equal in importance to curative medicine. What was tried out with success in [Bellevue-Yorkville], is now being extended to the whole city; what was offered there to thousands, the City is now offering to millions.... To the Milbank Memorial Fund, which made possible the additional health work done in this district, the people of this City owe a debt of gratitude. Fiorello H. LaGuardia, mayor of New York,

17 The results of the three demonstration projects began appearing during the late 1920s and early 1930s, validating the premises on which Kingsbury had organized them and showing the creativity of the many colleagues in the three communities who responded to daily challenges. Cattaraugus County The demonstration project in Cattaraugus County achieved the following results: Deaths from tuberculosis, which at that time were generally decreasing, declined more quickly in Cattaraugus County than in comparison counties, from 55 per 100,000 people in 1929 to 25 in The infant mortality rate also fell more quickly. The project launched a successful countywide school health service. County officials, persuaded of the department s accomplishments, continued its operation after the demonstration period, and other rural counties launched their own health departments. Looking back almost twenty-five years later, in a report commissioned by the Fund, Yale public health professor C.-E.A.Winslow concluded, The entire progress made in the United States in developing health services for rural areas owes its inception to Cattaraugus County. For many years, the Fund s research staff continued to study the county data and conduct research with colleagues there. These subsequent analyses were considered as significant as the original demonstration. Syracuse Noteworthy accomplishments in Syracuse that were related to the demonstration project included: Reorganizing key health department services under a full-time commissioner, doubling staff, and developing strong community support for the project Developing a sound system to track vital statistics Creating effective programs to control tuberculosis and diphtheria Expanding school health services, including dental and mental health Establishing a public health nursing department at Syracuse University Developing New York State s first system of generalized public health nursing, replacing the previous system of deploying several nurses, skilled in separate areas tuberculosis care, maternal and child health, nutrition, and so on to the same home Bellevue-Yorkville The results achieved in Bellevue-Yorkville during the seven-year study period included: A 29 percent decrease in tuberculosis deaths A 22 percent decline in infant mortality Participation in a citywide diphtheria immunization campaign run by the health department and supported by the Fund, which immunized half a million children and prevented an estimated 1,400 deaths A systematic program of school health education Creation of teaching and research relationships with the city s five medical schools Establishment of a citywide system of health districts organized around thirty health centers Informing Policy for Health Care & Population Health 15

18 Evaluation and Research Kingsbury and the demonstration project advisers appreciated the rigor that Sydenstricker and his research colleagues brought to assessing the demonstrations impact, so in 1928 they asked him to create and lead a division of research at the Fund. The division soon included experts in statistical analysis, population studies, public health nursing, family planning, infectious diseases, and health care delivery. With the demonstration projects nearing completion, the technical board, advisory council, annual conferences, and Quarterly Bulletin needed reexamination. The research division s expanded scope of activities provided the opportunity. The technical board, which was intimately involved in the demonstrations details, became a group of general advisers to the Fund. The annual conferences and the contents of the Quarterly were broadened, and the advisory council was disbanded. Although the research division commissioned some studies, it conducted most of its research with in-house staff, so that in the early 1930s, the Fund s staff was as large as it ever would be: about forty people. The social pressure and disruptions of the Great Depression stimulated epidemiologic and demographic research, and Fund staff helped survey how changes in employment and income affected health, mental health, illness, and fertility. Some of this work became the model for later U.S. Public Health Service surveys, including the landmark National Health Survey that called attention to the growing burden of chronic diseases. Bumps in the Research Road The Committee on the Costs of Medical Care was formed in 1927 to address the one great outstanding question before the medical profession : how to deliver adequate medical services to all Americans at a reasonable cost. This perennial question became even more pertinent as the effects of the Depression set in. The Milbank Memorial Fund and seven other foundations supported the committee financially, and half a dozen individuals long associated with the Fund, including Edgar Sydenstricker, were among its fifty-some members. The Fund s board supported active participation in the committee s work, such as gathering data that would show what care people needed, what they received, and how they paid for it. Although two of the committee s five recommendations endorsing public health and improved professional education received broad support, its other ideas drew fire, particularly the recommendations that medical services be provided by organized groups of practitioners and that their costs be covered on a group-payment basis, that is, funded through insurance, taxation, or both. A minority report vehemently opposed any government involvement in paying for care and the corporate practice of medicine through insurance. Sydenstricker had different objections, so strong that they prevented him from signing the final report. He believed the committee had failed to address adequately its charge, had not developed a comprehensive, actionable plan, and, in determinedly struggling for consensus, had not made recommendations warranted by the data he had provided on the incidence of disease, the availability of medical services, and the costs of care. The Fund board supported Sydenstricker s and the technical board s conclusion that these data needed further study. The staff designed this research to answer questions that would ultimately enable it to recommend creating a health insurance plan within a governmental unit, preferably a state. Thus, the medical care reforms that Kingsbury had long advocated in heart and spirit would find support from his research colleagues

19 The demonstration projects strongly emphasized nutrition. Visiting nurses taught mothers how to store food safely and prepare nutritious meals. Schools taught nutrition (and other health topics) through plays, poems, games, and vegetable parades. Measurement of results of public health work is not something that can be done by one who is wholly detached from the work, or after the work has progressed to the point when an evaluation is desirable.... If we plan and execute our work well, we shall have at hand the basic data and the conditions for proper measurement. Edgar Sydenstricker, director of the Fund s Division of Research and later scientific director. The Fund made a sizable grant to the city of New York to finance local work projects for the unemployed, which created the jobs of these two men. Informing Policy for Health Care & Population Health 17

20 President Franklin D. Roosevelt s new administration offered a chance to move health financing reform more quickly and on a national scale. The president and his immediate staff knew the Fund s work and Kingsbury personally. In fact, Roosevelt s adviser Harry Hopkins asked the Fund s research staff to lend him Sydenstricker and I.S. Falk to serve on the staff of the President s Committee on Economic Security, whose work led to the Social Security Act. Their charge was to examine ways in which other countries prevented families from being impoverished by the costs of illness and make preliminary recommendations for a national Early Technical Board Members health insurance program. This growing and highly public relationship worried members of the All of the charter members of the Technical Board Fund s board, and external criticism of served well into the 1930s and 1940s, except NY State the Fund was increasing. Organized health commissioner Hermann M. Biggs, who died in medicine, which adamantly opposed By 1935, four additional members had joined the board, any governmental health insurance during what would be its period of greatest activity. program as socialized medicine, made the Fund a target. Some doctors even endorsed a boycott of the Charter Members Hermann M. Biggs, MD, Commissioner of Health, Borden Company, whose board New York State Albert Milbank chaired. The staff s Bailey B. Burritt, General Director, New York Association public statements about their research for Improving the Condition of the Poor results invariably made the situation Livingston Farrand, MD, President, Cornell University worse. In frustration, Albert Milbank Homer Folks, Secretary, State Charities Aid Association declared, Silence is a mistake, and James Alexander Miller, MD, President, New York speech is a mistake, also. Tuberculosis Association President Roosevelt concluded William H. Welch, MD, Dean, School of Hygiene & that the intense controversy over Public Health, The Johns Hopkins University health insurance was threatening Linsly R. Williams, MD, Managing Director, his other initiatives, and he took National Tuberculosis Association the issue off the table early in John A. Kingsbury, Secretary, Milbank Memorial Fund Fissures between the board and Kingsbury widened, and he resigned Other Early Members in April. Edgar Sydenstricker was Matthias Nicoll, Jr., MD, Commissioner of Health, appointed to lead the Fund and New York State focus mainly on scientific work. Thomas J. Parran, Jr., MD, Commissioner of Health, Later that year, the Fund suspended New York State (later Surgeon General, its direct activities advocating reform U.S. Public Health Service) in medical care. John H. Wyckoff, MD, Dean, School of Medicine, New York University Shirley W. Wynne, MD, Commissioner of Health, New York City