OF THE U. S. DEPARTMENT Oo | HEALTH, EDUCATION, and | WELFARE | : i ) | | ; 5, atm a SS : GENE = ... . .°.. Region V; Chicago, Ill. James W. Doarn ..... . Region VI, Kansas City, Mo. James H. Bonp ..... . .. Region VII, Dallas, Tez. ALBERT H. RosentHat.. . Region VIII, Denver, Colo. Fay W. Hunter. ..... . Region IX, San Francisco, Calif. Letter of Transmittal DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE, Washington, D. C., December 1, 1953. Dear Mr. Preswwenr: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1953. Respectfully, Odie Rp dere - Secretary. Tuer PRESIDENT, Tue Wuire House, Washington, D.C. (2) 9S SGNV'1S1 NIDUIA “Od1Y OLYINd co) JaVITIM ONY SddI}JO pue Saliepunog jeuoisay NOIL liVvMVH QDYO yy eimrexoy @S VONGI HLIWIH 40 LNSWLYVd30 “S"N Contents mmemrretary Ss RCPO Mo Ee eee ee ak mera mectrity Administration... 2.2... 0. ee COLE SCP CO ip) 9 lyst yn ys end ee myn tn.» MEM PUNCaUON. .. a) es ct ee ce Ponteand Drug Administration. ... 2.0.6... oe ee ee ea Office of Vocational Rehabilitation..................... eee eizabeilis Hospital. >... .... 00.2. ee American Printing House for the Blind................ Columbia Institution for the Deaf..................... eet TEIVErSIty 128 00. PIS Oe OP OG ss Big eb cs ahha bgt ne Re oes A detailed listing of the contents of this report, | topic headings, will be found on pages 285 — 298 The Secretary's Report On Apriz 11, 1953, President Eisenhower signed legislation enacted by the 83d Congress creating the Department of Health, Education, and Welfare. In bringing together the somewhat loosely knit units that, since 1939, had made up the Federal Security Agency the President and the Congress assured permanent and continuing representation of the Agency’s programs at the highest councils of the Executive Branch of the Government. This action was undoubtedly the single most important event of fiscal 1953 with respect to the health, education, and welfare programs of the Federal Government. It came about as a result of Reorganization Plan No. 1 which was submitted by the President to the Congress on March 12, 1953, and represented translation into fact of action first recommended as long ago as the Administration of President Warren G. Harding. In an historical sense, the creation of the Department may also be thought of as a landmark in a concept that runs deep in American life. It is a concept embodied in the Preamble to the Constitution, and later made explicit in the body of that great document. The purposes of the Constitution are defined in the Preamble as “to form a more perfect Union, establish justice, insure domestic tran- quility, provide for the common defense, promote the general welfare, and secure the blessings of liberty to ourselves and our posterity.” Among the duties of the Congress defined under Article I, Section 8, are the “power to lay and collect taxes, duties, imposts, and excises to pay the debts and provide for the common defense and general wel- fare of the United States.” It is significant to point out, however, that this concept is stated in broad terms. While affirming the responsibility of Government, it 1 2 Department of Health, Education, and Welfare, 1953 erat anne nnneEEEn EERE EEE EEE em presumes that the specific measures through which application of this: broad principle would be made would be the responsibility of succeed- ing generations. It is significant also to note that the establishment of each of the major units of the Department is traceable to specific periods in our history when provision for the national welfare emerged as national needs. The Public Health Service, to take the earliest example, was estab- lished by Congress in 1798 to care for merchant seamen and help keep disease from the shores of the young Republic. As an outgrowth of the turbulent years of the Civil War, Congress founded Howard University in 1865, when there was a felt national need to establish higher education opportunities in an institution which made no dis- tinction on admissions because of race, creed, or color. Recognition of the importance of formal education in developing well-informed and responsible citizens also gave rise to the formation of the Office of Education in 1867. In 1906 the first Federal Food and Drug Act was passed, acknowl- edging the fact that in an increasingly complex economy, Americans were becoming more dependent on manufactured food products and means to ensure their safety and purity were needed. In 1912 the special importance of the problems of children and youth to the future of the Nation was signalized by the creation of the Children’s Bureau. In 1935, with overwhelming bi-partisan support, the old-age in- surance and public assistance programs of the Social Security Admin- istration were authorized by the Congress. Other significant dates in the history of the Department include: the establishment of Saint Elizabeths Hospital for mental illness in 1855; the founding of the Columbia Institution for the Deaf in 1857; the start of Federal support of the American Printing House for the Blind in 1879; and the first grants to the States to encourage the voca- tional rehabilitation of physically disabled civilians, in 1920. The Of- fice of Vocational Rehabilitation was founded in 1943 to carry on an expanded program in the latter field. The establishment of the Department of Health, Education, and Welfare is, of course, itself an example of response to new needs and challenges in our society. As the Nation has grown and changed, the Congress has altered or expanded the responsibilities of these specialized organizations that comprise the Department. The Public Health Service, for example, now administers a very great variety of programs. Some- times the original purpose for which these programs were established has been virtually eclipsed by the rush of events and the consequent process of amendment and improvement by Congress. Certainly their The Secretary’s Report 3 functions and activities will continue to respond to changing circum- stances, as the will of our people is made known through the Congress. Another aspect of the historical development of the programs of health, education, and welfare is noteworthy. It is the fact that, by and large, the choice of the American people for action in these fields has been through what can be described as multiple partnerships rather than exclusively through governmental action. The notable improvements that have been achieved in public health, in education, and in welfare in our history have thus been the result of the efforts, for example, of voluntary associations and private philanthropic insti- tutions working alone or with local and State governments as well as the Federal Government for the general welfare. This pattern of action, to which this Department whole-heartedly subscribes, is based on traditions of self-reliance and neighborliness that are part of the fabric of American life. The present administration of the Department assumed responsi- bility on January 20 of 1953. Two immediate tasks were undertaken. One was a thoroughgoing review of the basic legislation, policies and programs of the Depart- ment. ‘The second was a comprehensive review of the organization, staffing pattern and procedures necessary to carry out the Depart- ment’s varied programs. It was necessary to ask, it was felt, whether the legislation the De- partment was called on to administer was sufficient for the needs of the Nation in this decade of the fifties and beyond. Furthermore, it was necessary to ask whether the Department was equipped or- ganizationally to carry out the programs that had been entrusted to it by the Congress. To that end initial steps were taken in setting up task forces within the Department for each of the major subdivisions to study the pro- grams and their administration. These task forces included repre- ‘sentatives of the Secretary’s Office, the heads of the subdivisions and a staff of technicians—some from within the Government itself, others from outside Government who were able to bring to the studies ob- jectivity and a wealth of experience. As a first step toward improved internal administration of the Department came the establishment of a Departmental Council. This is made up of the heads of the constituent units of the Department and members of the Secretary’s immediate staff. It now meets weekly to consider questions of importance concerning both the machinery of operations and matters of policy. A thoroughgoing internal security program was ordered by the President for every agency of the Government.. A new Director of Internal Security was appointed by the Department and regulations 4 Department of Health, Education, and Welfare, 1953 ca at a nt een erste, Mt ine seen ei See et Aa aR were issued to carry out Executive Order 10450, and a staff was re- cruited to see that security measures, which would safeguard both the Department and the individuals concerned, were instituted and enforced. | By the close of the year covered in this report considerable progress had been made in carrying out the provisions of the Executive Order. The reorganization as a result of the establishment of the Depart- ment during the early months of 1953 had, as additional guiding principles, the need for an economy in operations which would be brought about without disruption of the many services for which the Department is responsible to the American people. The opportunity for effecting economies in the departmental budget is considerably limited by the fact that the Federal contribution to public assistance—that is for cash payments to the needy aged, the needy blind, dependent children, and the disabled—is fixed by law. Of the total budget for fiscal 1954 of $1,786,528,000 which had been recommended by the previous Administration, $1,340,000,000, or 75 percent, was made up of these “uncontrollable” items. It was possible, however, to achieve a sizeable reduction in the one- quarter of the Department’s budget that represented “controllable” expenses. Whereas the previous Administration had requested Con- gress to appropriate $486,000,000 for the 1954 fiscal year (exclusive of the public assistance grants-in-aid mentioned above), it was possible to reduce this request by slightly more than 13 percent, to $382,000,000. The Congress subsequently appropriated $468,691,261 for this “con- trollable” portion of the Department’s budget for the fiscal year 1954. Although every constituent of the Department was responsible in some measure for the saving achieved, there was no arbitrary cut “across the board.” The effective functioning of the Department remains unimpaired. As a result of these reductions and other measures of economy and efficiency, it was possible to bring about the reduction of the number of employees of the Department. At the end of the fiscal year the staff of the Department numbered 36,739 full-time employees—1,315 fewer than at the end of the preceding year. Of this decline, 1,192 separations became effective from March through June 19538. Ap- proximately three-fourths of the reduction came as the result of normally occurring resignations and retirements. Through close scrutiny of vacancies that occurred, with replacements made only in instances of clear necessity, it was possible to achieve this reduction without hardship to the great majority of the Department’s personnel. This reduction was accomplished despite the necessity for initial staffing of the new Clinical Center of the Public Health Service. When fully manned, this unique research facility itself will account for at least 2,000 of the Department’s employees. - The Secretary’s Report . mene | | 5 Although the workload in the old-age and survivors insurance offices increased continuously, a decrease was also achieved in the staff of the Social Security Administration through instituting more modern techniques and procedures. Further savings by this method appear possible through the use of electronic equipment in keeping the record of earnings of the millions of employees in the Old-Age and Survivors Insurance system. As an example, one device that is being studied can scan documents elec- tronically and automatically prepare punch cards. If it can be uti- lzed—and it seems likely that it can be—additional savings will amount to about $800,000 a year. Personnel of the Department were also encouraged to exercise indi- vidual initiative in making contributions toward the ends of economy and efficiency. During the year, 46 cash awards amounting to $4,850 were made to employees for outstanding efficiency. Two of these were group awards to 22 persons. By the end of the year a saving of nearly $68,000 had resulted from the suggestions of these employees. In addition, 178 staff members were given salary increases for - superior accomplishment and 482 cash awards totaling $8,759 were made for worthy suggestions by individual employees. The resulting improvements in management are estimated at approximately $69,000 for the first year alone. Several important legislative developments during fiscal 1953 are noteworthy. ‘They represented largely responses to immediate and pressing problems that faced the Department. ~ The first was the restoration of the power of inspectors of the Food and Drug Administration to inspect factories engaged in the produc- tion of foods, drugs and cosmetics. Under a ruling of the Supreme Court, in which the language of the Act was ruled as insufficiently clear, the power of the Food and Drug Administration to conduct these inspections was declared unconstitutional. Legislation to close this loop-hole in the law was, therefore, recommended to the Congress by the President. The measure passed by the Congress was subse- quently approved on August 7, 1953. The second was legislation providing for continuing the program of Federal assistance to the States for construction and for operation of schools in areas in which the influx of workers to man Federal installations, largely of a defense nature, had placed inordinate strain on local school facilities. Legislation recommended by the President was passed which extended this aid through June 30, 1955 for school construction and through June 30, 1956 for school support. Between the date of the institution of this program in 1950 and the close of the fiscal year, the Office of Education approved construc- tion of 1,380 school building projects, located in 44 States, Hawaii, 6 Department of Health, Education, and Welfare, 1953 Alaska, and Puerto Rico. New classrooms added, according to the Office of Education, will house 350,000 children. The third development—although it did not result in actual legis- lative proposals until after the close of the fiscal year—was an in- tensive study to carry out the recommendation of the President in his State of the Union Message, for prompt extension of the old-age and survivors insurance program to include many millions of Amer- icans not covered under existing law. As an initial step, the Sec- retary sought the advice of a group of consultants on social security with wide experience in the fields of banking, insurance, education, social work, farm and labor organizations, and industry. This group devoted the spring of 1953 to a careful study of a num- ber of possible ways in which old-age and survivors insurance cover- age could be extended to additional workers. Their recommendations were contained in a report transmitted to the Secretary near the close of the fiscal year.2 Subsequently, at the request of the President, the views of the consultants were embodied in a bill submitted to the Congress shortly after the close of the fiscal year. An important milestone in national progress in medical research was passed with the completion of the Clinical Center at the Public Health Service’s National Institutes of Health. It was constructed to serve as a center of cooperation between the clinician—the bedside physician—and the laboratory investigator. The Clinical Center is in fact a combined hospital-laboratory to serve physicians and patients throughout the Nation and to forward research in cancer, mental illness, arthritis, heart disease, and other chronic illnesses. With facilities for 500 patients—who will be ad- mitted from all parts of the country on the basis of the significance of their illness to the Nation as a whole, the Center offers promise of new knowledge that can be turned to the early prevention and control of the most hazardous and least understood diseases that at- tack the people of the Nation. The Center was dedicated by the Secretary on July 2, 1953, 2 days after the close of the fiscal year, and admitted its first patients 4 days later. 1 Reinhard A. Hohaus, New York, N. Y., Vice President and Chief Actuary, Metropolitan Life Insurance Company, Chairman; Thomas H. Beacom, Chicago, Ill., Vice President in Charge of Trusts, First National Bank of Chicago; Eveline M. Burns, New York, N. Y., Economist and Professor of Social Work, New York School of Social Work, Columbia University ; Robert P. Burroughs, Manchester, N. H., President and Treasurer of R. P. Burroughs Company, Pension and Profit Sharing Plans; Leonard J. Calhoun, Washington, D. C., Attorney-at-law; Nelson H. Cruikshank, Washington, D. C., Director of Social In- surance Activities, American Federation of Labor; Wallis B. Dunckel, New York, N. Y., Vice President, Bankers Trust Company; Loula Dunn, Chicago, Ill., Director, American Public Welfare Association; Katherine Ellickson, Washington, D. C., Secretary, Social Security Committee, Congress of Industrial Organizations; Hugh F. Hall, Washington, D. C., Amer- ican Farm Bureau Federation; Lloyd C. Halvorson, Washington, D. C., The National Grange; and A. D. Marshall, Schenectady, N. Y., Manager of Employee Benefits, General Electric Company. 2For a delineation of the recommendations, see pp. 14-29, “Old-Age and Survivors Insurance.” The Secretary’s Report 7 As is indicated in the report of the Public Health Service one of the outstanding achievements of the country during the last half century has been the lengthening of the life span from 47.3 to 68.5 years. The inevitable result has been a consistent expansion of the number and proportion of older people in our population. While the population of the country has doubled within the past 50 years, the number of men and women between the ages of 45 and 65 has trebled. The number who are 65 or older has quadrupled; and today there are _ approximately 13.5 million men and women who are beyond 65. To study, report on, and work with the States on matters associated. with the problem, the Department maintains, in the Office of the Secretary, a Committee on Aging and Geriatrics. In addition to developing and disseminating information, the Committee seeks to aid in stimulating the development of public and private services for older people. During the year, for example, a conference of State commissions and committees on the aging was held. Delegates from 15 State agen- cies took part officially and the Governors of 18 other States sent observers to the conference. Another Departmental responsibility which should be mentioned concerns the use of surplus property belonging to the Federal Govern- ment. The various laws relating to the disposal of such property assign three major responsibilities to this Department. They are: allocation of surplus personal property to the States for distribution to educa- tional and public health institutions; arrangements for the disposal of surplus real property for education and public health purposes; and protecting the Federal interest by ensuring that surplus property that is supplied to the States is properly used and may be recovered for use during national emergencies. During fiscal 1953, surplus personal property with an original ac- quisition value of $63 million was allocated to State agencies for distribution. New transfers of real property were made to 105 such institutions which acquired 233 buildings and 369 acres of land valued at almost $2.9 million. The surplus property program of the Department also supervised the return of real property valued at $50 million that had previously been transferred to the States for educational or public health use. Since the properties were required for permanent Federal use, revest- ment of title in the Federal Government was obtained in the amount of $20 million. _ Machine tools previously donated to educational institutions were returned to defense production at savings of $4.5 million. Other general items of personal property, costing $2 million, were returned from institutions and placed in defense use. The Department of 8 Department of Health, Education, and Welfare, 1953 ee re Defense was also notified of the availability of electronic equipment valued at almost $2.5 million. In the course of these activities, cash receipts totaling $1.8 million were deposited with the Treasurer of the United States. One of the duties of the Department is to assist the Department of State when an expert knowledge of the fields of health, education, or welfare is required in the development of the foreign policy of the United States. The Department is also a participant in the day-to-day work of the United Nations; in the bilateral programs of foreign technical assistance and exchange of persons supervised by the Depart- ment of State; and in the programs of the Foreign Operations Administration in health, education, and welfare. For the Secretary of State, the Department drafts “position papers” in the fields of its special competence, to serve as guide lines in deter- mining the official attitude of our Government regarding these matters. Senior officials of the Department frequently are appointed by the President to represent the United States at important meetings of international organizations, while others serve in an expert capacity on technical committees of the United Nations, its specialized agencies, and various regional international organizations. The Department cooperates in developing the health, education, and welfare aspects of the technical assistance programs in 34 of the free nations to which the United States is extending foreign aid. To this end, 426 technicians were recruited during the year for foreign assignments. Through its appropriate constituents, the Department also supervised the programs of approximately 205 United Nations Fellows who were sent to the United States for study and training during the fiscal year. All told, approximately 3,500 foreign visitors received training planned and supervised by the Department. The foregoing pages have consisted of a description of certain high- lights in the work of the Department during fiscal year 1953. The following pages contain the reports of the major sub-divisions and other institutions over which the Department exercises either direct supervision or has responsibilities in connection with their adminis- tration. | Taken together, they represent a report, reasonably detailed, of the the work of the Federal Government as authorized by the Congress in the important fields of health, education, and welfare. Their continuing objective, in essence, is the great and humane task of helping the American people help themselves toward a healthier, increasingly more enlightened, and more secure world for themselves and, in this measure, for mankind. Social Security Administration Social Security in 1953 DvRING THE PAST YEAR the social security program has continued to grow and to provide protection and benefits to increasing numbers of people. Early in his administration, President Eisenhower reaffirmed his belief in the value and general acceptance of contributory social insurance as the basic program through which the people of this country can together provide for their own retirement income and the support of their dependents. The Social Security Administration has continued to review the operations of the existing social security pro- grams and to appraise the effectiveness with which they are achieving their goal. Old-age and survivors insurance has, from the beginning, been recog- nized as the basic income-maintenance program for aged persons and for orphans and their widowed mothers. Because it provides only for those who have had an opportunity to work in covered employment, and because, up to the present time, coverage has not extended to all employments, the program has only gradually begun to reveal its full potential effect. The number of persons receiving old-age and survivors insurance benefits has increased from fewer than 250,000 at the end of 1940, the year benefits first became payable, to about 5.6 million in June 1953. Of these, 1.3 million were children and their mothers. Since 1944 the number of orphans receiving survivor insurance benefits has been larger than the number receiving public assistance through the pro- gram for aid to dependent children. Life insurance protection under the old-age and survivors insurance program is acquired after a rela- tively short period (a year and a half) in covered employment. ‘This 293171—b4—_2 9 10 Department of Health, Education, and Welfare, 1953 part of the program, therefore, very quickly became effective for workers in the industries covered. Except for workers already close to or past age 65 at the time the program was started (or when coverage became effective for addi- tional employments at the beginning of 1951), the eligibility require- ments for old-age benefits call for substantial periods of covered em- ployment and contributions. Many persons still living had already retired when the program began or had depended on the earnings of persons already out of the labor force. The number of aged persons receiving old-age and survivors insurance benefits first exceeded the number on old-age assistance in February 1951. Since that time the insurance program has continued to grow, and the number receiving old-age assistance has declined slightly. Asa result, by June 1953, 32 percent of the aged population were being supported wholly or partly by old-age and survivors insurance while less than 20 percent were receiving assistance. About 3 percent were getting both insurance benefits and supplementary assistance payments. Chart 1.—WHERE AGED PERSONS GET THEIR CASH INCOME Percent of persons 65 years and over with income from specified sources, December 1952 @ o@eeoe ee ee e ees "| EMPLOYMENT 2/ 2S Pie -> OY of 1 Some get income from more than one source; 4.5 percent also get income from private pension plans. 2 Includes wives of employed persons. 8 Includes railroad retirement, government employee retirement, and veterans compensation and pension programs. “Represents persons with income from investments and/or cash income from children and other relatives, and those with no cash income at all. Social Security Administration . ll Thus, the old-age and survivors insurance program is taking its intended place as the basic source of income for retired persons and their families and for orphaned children and their widowed mothers. It is of interest also that by June 1953 the number of persons drawing old-age and survivors insurance benefits (5.6 million) was larger than the number (5.3 million) receiving public assistance under the four federally aided public assistance programs—old-age assistance, aid to dependent children, aid to the blind, and aid to the permanently and totally disabled—and the State and local programs of general assist- ance. In addition, something over 1 million aged persons and close to 1 million widows under age 65 and orphans receive benefits under the special programs for railroad workers, for Federal, State, and local government employees, and for veterans. About 250,000 persons who are permanently and totally disabled receive insurance benefits from the railroad or Federal, State, and local government employee retire- ment systems—compared with 179,000 persons who now receive assist- ance under the aid to the permanently and totally disabled program. A few groups, notably farmers and certain self-employed persons, are still without social insurance protection. The Social Security Administration has for a number of years recommended that old-age and survivors insurance coverage be made universal. A group of consultants appointed by the Secretary of Health, Education, and Welfare in the spring of 1953 reviewed the question and recommended immediate extension of coverage to practically all employment except that of railroad workers, now covered by a coordinated system, and employees of the Federal Government under existing retirement sys- tems. The consultants deferred consideration of coverage for these two groups because special studies of their retirement protection were initiated in the preceding year by Congress. The recommendations of the consultants are described in the chapter on old-age and survivors insurance. There are various circumstances in which the community must come to the aid of families who are in difficulties that are beyond their control—circumstances not sufficiently widespread or predictable to be appropriately met through the insurance method. Need resulting from broken homes and deserting parents now brings more children to the aid to dependent children rolls than does the death of the breadwinner. During the past year the Social Security Administra- tion has continued, through its Bureau of Public Assistance and the Children’s Bureau and with the State agencies which administer the programs, to work toward the more adequate relief of children and families that are in need of income or other help, and toward the more effective provision of health and welfare services that lay a sound foundation for wholesome development of children. 12 Department of Health, Education, and Welfare, 1953 Juvenile delinquency, commonly one of the consequences of war and of persistent adult fears and tensions, has received special attention from many groups during the past year. The efforts which have been made by the Social Security Administration to study the problem and to bring together the many social, educational, legal, civic, and parental groups with a special concern and interest in it are described in the chapter on the special children’s programs. Federal credit unions again took several strides forward. During the year under review, the number of Federal credit unions in exist- ence, their membership, and their total assets reached new high levels. The Bureau of Federal Credit Unions is now on a completely self- sustaining basis, deriving its operating income from the services of supervision and examination which it provides to individual credit unions. Program Administration in 1953 On April 11 the Department of Health, Education, and Welfare came into being, with all the functions formerly carried by the Federal Security Agency. The legislation establishing the Department made no change in the responsibilities and functions of the Social Security Administration, but it abolished the position of Commissioner for Social Security, providing that henceforth a Commissioner of Social Security should be appointed by the President with the advice and consent of the Senate. With the termination on April 10 of his appointment as Commis- sioner for Social Security, Arthur J. Altmeyer completed nearly 18 years of service with the Social Security Administration. Appointed one of the three members of the Social Security Board in August 1935, he was Chairman of the Board from February 1937 to July 1946, when he was appointed Commissioner for Social Security in the Social Security Administration, which superseded the Board. On Mr. Alt- meyer’s retirement, William L. Mitchell, Deputy Commissioner since 1946, became Acting Commissioner. Other administrative changes during the fiscal year included the resignation, on May 8, of Oscar C. Pogge as Director of the Bureau of Old-Age and Survivors Insurance and the retirement on June 14 of Claude R. Orchard, Director of the Bureau of Federal Credit Unions. On June 15, J. Deane Gannon was appointed Director of the Bureau of Federal Credit Unions. During the fiscal year, all bureaus and offices of the Social Security Administration continued their efforts to improve procedures and or- ganizational structure in order to maintain a high level of efficiency in carrying increasing workloads. At the end of June the staff totaled 14,623, of whom 5,602 were departmental and 9,021 were in field, area, Social Security Administration 13 and regional offices. The departmental staff had 473 fewer persons than at the end of the 1952 fiscal year. This drop occurred almost entirely in the Bureau of Old-Age and Survivors Insurance and had to be absorbed at a time when the volume of claims to be processed for benefits was about twice the normal level. To maintain effective operations in the 512 field and 6 area offices, where claims for benefits are received and much of the work of determining claimant eligibility and benefit amount is carried on, the staff was increased by 282 during the year. Progress was especially gratifying during the year in extending the “team” approach developed so successfully by the Bureau of Public Assistance and the Office of Vocational Rehabilitation when the program of aid to the totally and permanently disabled went into operation in 1950. Several conferences were held in different parts of the country during the year to coordinate the services of related State agencies in the rehabilitative aspects of aid to the disabled. In its international activities the Social Security Administration shares with other countries its experience and knowledge in the fields of social insurance and social welfare and in return gains valuable knowledge and insight from the two-way interchange. Experts and visitors who come to this country under United Nations or United States auspices are referred to the Administration for guidance in planning and carrying out their technical training in the social security field. The Administration also recruits technicians from its own staff and from other agencies for special overseas assignments in social welfare projects, at the request of foreign governments and in cooperation with the United States technical assistance program con- cerned. During the fiscal year, training programs were planned for almost 1,000 experts and visitors from other countries. Some 60 were long- term trainees (here for periods ranging from 6 months to 2 years) sponsored by the United Nations and the World Health Organization. The long-term trainees under United States auspices included 438 who were sponsored by the Point Four program and by the Mutual Secu- rity Agency. In addition, many short-term visitors are referred or come to the Social Security Administration for periods ranging from a week to several months. Their major interests include various aspects of social insurance, public assistance, or child health and wel- fare services, social work education, and in-service training. Through the Point Four program, 24 technical experts from the Administration and four recruited from other agencies were work- ing overseas on projects administered or contracted for by the Techni- cal Cooperation Administration. Thirteen specialists were assigned to projects in Latin America, nine were in Egypt, Iraq, or Lebanon, three were in India, and one in Pakistan. 14 Department of Health, Education, and Welfare, 1953 Old-Age and Survivors Insurance In the President’s message of April 1, 1953, transmitting to the Congress his recommendations for extension of old-age and survivors insurance coverage to additional workers, he said: “Retirement sys- tems, by which individuals contribute to their own security according to their own respective abilities, have become an essential part of our economic and social life. These systems are but a reflection of the American heritage of sturdy self-reliance which has made our country strong and kept it free. . . The Social Security program furnishes, on a national scale, the opportunity for our citizens, through that same self-reliance, to build the foundation for their security. . . The systematic practice of setting aside funds during the productive years to build the assurance of basic retirement benefits when the produc- tive years are over—or to one’s survivors in the event of death—is important to the strength of our traditions and our economy. We must not only preserve this systematic practice, but extend it at every desirable opportunity.” Under old-age and survivors insurance the covered worker earns security as he works, just as he earns his wages. Through the pay- ment of old-age and survivors insurance taxes, the worker shares directly in meeting the cost of the protection furnished to himself and his family. Because benefit payments vary according to the individual’s record of earnings and of contributions, they are—in a country where earnings and standards of living vary widely as between individuals—a more meaningful and effective foundation of security than they could be if they were a flat amount and supported by a flat contribution. The individual who has earned the right to protection under the insurance program through covered work receives his benefits, on re- tirement, without regard to other resources he may have. In this way the program provides a foundation of security on which the person may build through the addition of income from private savings and insurance. In building upon his old-age and survivors insurance benefits, he earns for himself and his family a higher standard of living. Thus, his thrift, his planning, and his work bear fruit after as well as before his earnings cease. The Social Security Administration believes that the contributory system of old-age and survivors insurance, with benefits related to earnings and paid as a matter of right, should continue to be the basic method of protecting American workers and their families against dependency in old age or on account of death. Social Security Administration 15 The Significance of the Program BENEFICIARIES AND BENEFIT. AMOUNTS In June 1953 about 5.6 million people were receiving benefits under the program. Some 4.3 million of these beneficiaries were aged 65 and over—3.0 million of them retired workers and 1.3 million the wives and dependent husbands of retired workers and the widows, dependent widowers, and dependent parents of workers who had died. Of the remaining 1.3 million, some 300,000 were young widows and a million were children. Chart 2.—WHO RECEIVED OLD-AGE AND SURVIVORS INSURANCE BENEFITS, JUNE 1953 CHILDREN AND YOUNG WIDOWS Parents AGED *Includes less than 0.5 percent dependent husbands and dependent widowers; wives also include some wives under age 65 with child beneficiaries in their care. Chart 3.—AVERAGE MONTHLY FAMILY BENEFITS, JUNE 1953 BENEFICIARY RETIRED MEN WORKERS WITHOUT ENTITLED WIVES NE SSR ar pCR OI Soy PEE REE SRR ate cae Eas RETIRED WOMEN WORKERS RETIRED MALE WORKERS AND ENTITLED WIVES AGED WIDOWS YOUNG WIDOWS WITH TWO CHILDREN $108.80 ava a av a a are ay a ara arava av av ar ar avavavravavarc Vv avavavavavararaverars 16 Department of Health, Education, and Welfare, 1953 In June 1953, the average insurance benefit paid to a retired worker who had no dependents also receiving benefits was $48.20 a month. When the worker and his wife both received benefits, the average for the family was $83.60. Families consisting of a widowed mother and two children averaged $108.80. These figures reflect only partially the generally higher benefit amounts payable under the 1950 and 1952 amendments in cases in which the worker has had at least 6 quarters of coverage (roughly 18 months of covered work) after 1950. Benefits computed under the new for- mula applicable in such cases averaged $63.10 a month for a retired worker with no dependents receiving benefits, $104.30 for a retired worker and wife, and $152.40 for families consisting of a widowed mother and two children. ‘T'wenty-nine percent of all retired men on the benefit rolls whose benefits have been computed under the new formula are receiving benefits at the maximum amount of $85 a month. THE PROTECTION PROVIDED Some 90 million people living on January 1, 1953, had worked in covered employment and made contributions under the program at one time or another during the first 16 years of its existence. About three out of four had enough wage credits to be fully insured under the program; for one out of four the insurance protection was permanent. Of the 18.3 million people aged 65 or over in the United States in December 1952, 4.1 million were working or married to men who were working. Probably 1.9 million of them can now count on receiving monthly benefits under old-age and survivors insurance when their income from work stops. Of the population under 65 years of age, 62 million were insured under the program at the beginning of the calendar year 1953. Some 21 million of these people were permanently insured—that is, whether or not they continue to work in covered jobs they will be eligible for benefits at 65 and their families are assured of protection in the event of their death. An additional 41 million were insured but would have to continue in covered work for an addi- tional period to make their insured status permanent. Four out of five of the mothers and young children in the Nation were assured that they would receive monthly benefits if the father or working mother of the family died. THE COVERAGE OF THE PROGRAM During the calendar year 1953 an estimated 62 million persons will work in employment or self-employment covered by old-age and sur- vivors insurance and will earn credits toward their insurance protec- tion. At the end of the 1953 fiscal year, about 80 percent of the Nation’s paid civilian jobs were covered by the program. An addi- Social Security Administration | 17 tional 7 percent were covered by retirement systems of Federal, State, and local governments. About 13 percent of the Nation’s gainful workers—most of them farmers, self-employed professional people, or farm or domestic workers who are not regularly employed by a single employer—have no coverage under any public program. Members of the Armed Forces are not covered by old-age and survivors insur- ance, but Congress has enacted legislation granting wage credits of $160 for each month of active military service during the period after September 15, 1940, and before July 1, 1955. CONTRIBUTIONS AND DISBURSEMENTS Benefit payments during the fiscal year amounted to $2,627 million ; with administrative expenses of $89 million, the total outgo amounted to $2,717 million. Contributions totaled $4,097 million, and interest received on investments was $387 million, bringing total receipts to $4,483 million. The difference of $1,766 million represents the increase in the trust fund during the year. At the end of June 1953, the fund totaled $18.4 billion held and invested for the benefit of the contribu- tors to the program. Chart 4.—THE OLD-AGE AND SURVIVORS INSURANCE DOLLAR Distribution of income to the trust fund, fiscal year 1953 Pe -$4.5 Billion Total Income x) S520 ar 58 50, On June 380, all assets of the fund, except $549 million held in cash, were invested in United States Government securities as required by law; $2.3 billion was invested in public issues (identical with similar bonds owned by private investors), and $15.5 billion was invested in special certificates of indebtedness bearing interest at the average rate paid on the total interest-bearing Federal debt at the time they are 18 Department of Health, Education, and Welfare, 1953 en issued. ‘The average interest rate on all investments of the trust fund at the end of the fiscal year was about 2.4 percent. ADMINISTERING THE PROGRAM Although the budget for the fiscal year 1953 was curtailed, the work- load of the Bureau of Old-Age and Survivors Insurance increased 17 percent over that in the fiscal year 1952; the claims load was at a level some 39 percent above the 1952 load. A sharp increase in the volume of claims received occurred immediately after July 1, 1952. Poten- tial claimants who could have filed earlier had delayed filing until that date to take full advantage of the new computation formula provided by the 1950 amendments. July and August were crucial months. Peak weekly claims were very close to the record highs established in September 1950 immediately after the 1950 amendments were enacted. Another critical situation developed when changes had to be made in the payment rate of approximately 4.6 million beneficiaries receiv- ing monthly benefits, to put into effect the increases provided in the 1952 amendments. This had to be accomplished between July 18, when the amendments were enacted, and the date the benefit checks for September were issued. The work was completed on schedule by detailing personnel from other jobs, working overtime, and utilizing machine methods to the maximum. The systematic approach em- ployed enabled the Bureau’s area offices to keep reasonably current in their regular operations while completing the conversion to new rates. The regular fiscal year appropriation of $60,500,000 was insufficient for the workload resulting from the combined effects of the 1950 and 1952 amendments. The Bureau accordingly submitted a request for a supplemental appropriation. Pending congressional action on this request, the Bureau was authorized to spend at the annual rate of $64.5 million. In the second half of the fiscal year, Congress voted only $2 million of the Bureau’s supplemental request of $4.4 million. Since spending had been at an accelerated rate, immediate action was neces- sary to reduce expenditures to an absolute minimum. All overtime authorizations were cancelled, recruitment was stopped, and drastic curtailments were made in expenditures for items other than salaries. The necessity for these cut-backs came at a time when the pending claims load in field offices was exceptionally high. Normally the pend- ing claims load is about 65,000, but by the end of January it was at 143,700, and emergency measures were required to keep the backlog of work from increasing. By June 30, 1953, the pending claims load was reduced to 92,000. This reduction, however, was achieved only at some sacrifice of quality and service to the public, by the temporary elimina- tion or curtailment of essential functions and expenditures, and through voluntary, unpaid overtime. Social Security Administration 19 Administrative costs in the fiscal year 1953, including costs incurred by the Treasury Department for the collection of social security taxes, were approximately $90 million, or 2.2 cents out of each dollar of con- tributions collected. Costs within the Department of Health, Educa- tion, and Welfare were approximately $66 million, or 1.6 cents out of each dollar of contributions. MANAGEMENT IMPROVEMENT ACTIONS One of the noteworthy aspects of the Bureau’s management improvement efforts during the year was the degree to which savings were the result of cooperative action with other agencies. For example, a plan was adopted by the General Services Administration and the Bureau to transfer a portion of the inactive claims records to the Federal Records Centers operated by the General Services Admin- istration. The initial transfer of these records resulted in a saving of approximately $100,000; an additional transfer to be completed in the coming year will save an estimated $210,000; and annual savings are estimated at $34,000 per year after 1955. As a second example, methods were worked out with the Veterans Administration to use its files in developing old-age and survivors insurance claims filed by Philippine citizens, after a study had revealed that more than 90 percent of these claimants had already filed claims with the Veterans Administration. The use of these files not only permitted maximum economy and prevented duplication of work on the part of both the claimant and the Bureau, but also ensured greater accuracy by enabling the Bureau to use the results obtained by the substantial investigatory staff maintained by the Veterans Adminis- tration in the Philippines. Perhaps the management improvement action of greatest potential scope was contained in a proposal made by the Internal Revenue Service of the Treasury Department to integrate old-age and survivors insurance wage reporting with annual reporting of withholding taxes. This proposal, which contains significant possibilities for savings to the Government and to employers, as well as improvements in the enforcement of tax legislation, is being carefully studied by the Internal Revenue Service and the Bureau of Old-Age and Survivors Insurance. Legislation changing certain provisions of law would be necessary before the plan could be put into effect. The Bureau’s wage record operation has also furnished additional areas for administrative simplifications and economies. Last year’s report cited the plan for a new wage record certification procedure that would reduce to a minimum detailed checking of wage records back to 1986. This procedure was installed early in 1953 with excel- lent results. Recent analysis indicates that the procedure has reduced 20 Department of Health, Education, and Welfare, 1953 me ISD Sc an ct, os el de Sed TRIS NR by approximately 30 percent the cases where detailed checking of the wage record is necessary for information on earnings from 1936 to date. Research into the use of electronics in the Bureau’s wage record and statistical operations has been still another activity which is expected to yield large long-range savings. Possibilities of adaptation to the Bureau’s needs of a device which will scan printed material electroni- cally and will automatically prepare punch cards from such material are being vigorously explored. If such a device can be perfected and installed to take the place of manual punching operations, it will elim- inate a significant portion of the costs now involved in processing reports of employee earnings. In addition, tests are being run on the Bureau of Census electronic machine to determine the feasibility of carrying on some of the Bureau of Old-Age and Survivors Insurance statistical operations by electronic methods. The Bureau is also ex- ploring the longer-run possibilities of high speed “random access” files using electronic storage media. The development of such files would make it possible to carry on the major part of the Bureau’s record operations with electronic rather than punch card equipment, with the possibility of annual savings running as high as several mil- lion dollars. The development of personnel and the maximum use of their capacities continues as a major management objective. The grouping of positions into “job families” to facilitate the movement of em- ployees among positions throughout the Bureau was cited in last year’s report. During the 1953 fiscal year, additional job families were developed and this work was supplemented by the preparation of the first portion of a Job Information Handbook. This Handbook will contain detailed job information designed to acquaint Bureau em- ployees with the facts about Bureau jobs so that they can make the most of career opportunities in the Bureau, with maximum contribu- tions to the program. The Senate Subcommittee on Federal Manpower Policies: in its report on S. 3493, a bill to “provide greater economy in the use of manpower, money, and materials by the development of more. effec- tive methods for selecting supervisory personnel in the Government service,” gave special commendation to one of the Bureau’s divisions for its planned program for selecting supervisors. Congress has appropriated funds to prepare for “construction of an office building and appurtenant facilities for the Bureau of Old- Age and Survivors Insurance, including equipment, acquisition of land (including donations thereof), and preparation of plans and specifications.” At present the Bureau occupies more than 600,000 square feet of space, at an annual rental of over $700,000 in nine scat- Social Security Administration 21 tered buildings, seven in Baltimore and two in Pennsylvania. Con- struction of the new building will result in savings and improved efficiency through making possible the elimination of doubleshift operations, double-deck files, work transportation and communication difficulties, and costly work layouts forced by restrictive, widely sepa- rated and inadequate space. ADMINISTRATIVE PLANNING FOR THE DISABILITY WAIVER-OF-PRE- MIUM PROVISION The Social Security Amendments of 1952, enacted July 18, 1952, included a provision to preserve the old-age and survivors insurance rights of persons who become permanently and totally disabled before reaching retirement age. The provision stipulated that applications for disability determinations could not be accepted before July 1, 1953, and further that the amendment would cease to be in effect at the close of June 30, 1953. The statement of the Managers on the part of the House of Representatives contained the following explanation: The action recommended by the conferees will permit appropriate steps to be taken for the working out of tentative agreements with the States for possible administration of these provisions. It is the intent of the conferees that hear- ings will be held on this entire matter early in 1953 and at that time the con- gressional committees will go into the administrative and other provisions. It is intended to obtain the views at that time of interested groups on the methods of obtaining evidence of disability, under what circumstances and by whom determinations should be made, and whether or not these provisions or any modification thereof should be enacted into permanent law. Since Congress took no further action in this matter, the amendment expired at the close of the fiscal year. The provisions of this amendment would have authorized the Fed- eral Security Administrator to negotiate an agreement with each State, under which a State agency would determine whether or not individuals are under a disability as defined in the law and the date such disability began or ceased. Before it became clear that the amendment would expire, the Social Security Administration was under the obligation to conduct prelimi- nary explorations based on the possibility that hearings might be held on the provisions for entering into agreements with the States to make disability determinations. Accordingly, policies and methods for evaluating permanent and total disabilities were outlined which would be suitable for this type of program and acceptable to the States. Tentative standards were developed for measuring disability, as defined in the amendment, and methods for requesting and receiving decisions on claims were explored with several States. The Social Security Administration obtained the advice of technical consultants from a number of State agencies on the administrative problems that 22 Department of Health, Education, and Welfare, 1953 would be involved in the type of Federal-State agreements called for under the terms of the tentative law. These consultants were experi- enced in administering one or another of the three types of State dis- ability programs with which agreements might have been made: pub- lic assistance to the permanently and totally disabled, workmen’s com- pensation, and vocational rehabilitation. A substantial body of stand- ards and methods was produced and significant problem areas requiring possible legislative clarification were identified. Improving the Program While the basic characteristics of old-age and survivors insurance are sound, the program does have defects and gaps that need to be corrected. In order to ensure that proposals to correct these defi- clencies would be carefully developed, a thorough and intensive review of the program was undertaken in the second half of the fiscal year. Much progress has already been made in the development of proposals for improving the program. The problem of what groups the pro- gram should cover, for example, was thoroughly explored, and specific legislative proposals for extending the coverage were presented to Congress shortly after the close of the fiscal year. Other problem areas are in process of exploration and legislative proposals in these areas are being developed. COVERAGE In the President’s Message on the State of the Union, he recom- mended that “the provisions of the old-age and survivors insurance law should promptly be extended to cover millions of citizens who have been left out of the social security system.” Asa first step toward carrying out this recommendation, the Secretary of Health, Educa- tion, and Welfare appointed a group of consultants on social security. The group included persons with a wide variety of experience in the fields of banking, insurance, education, social work, farm and labor organizations and industry. Under the chairmanship of Reinhard A. Hohaus, Vice President and Chief Actuary of the Metropolitan Life Insurance Company, the group devoted the spring of 1953 to a careful consideration of various alternative proposals for extending old-age and survivors insurance coverage to additional groups of current workers. The recommendations of the group were contained in a report transmitted to the Secretary on June 24, 1953, and provisions to carry out the recommendations were subsequently embodied in pro- posed legislation. Enactment of these recommendations would go a long way toward making old-age and survivors insurance a more effective retirement Social Security Administration 23 program for all of the Nation’s gainfully employed workers. The coverage of the program would be extended to some 10 million addi- tional persons, who in the course of a year work in jobs not now cov- ered, and an over-all improvement would be made in the method of computing benefits, which would have the result, among others, that individuals in the newly covered groups would be able to qualify for full benefits. One of the largest groups which would be brought into old-age and survivors insurance is that of the Nation’s farm operators. About 3 million self-employed farm operators with annual net incomes of $400 and over would be covered by old-age and survivors insurance on essentially the same basis as most persons in urban self-employment are now covered. Additional hired farm workers would also be brought into the program. Under present law a farm worker, to be covered, must be “regularly employed” by one employer and receive cash wages of $50 or more in a calendar quarter from that employer. Under this pro- vision, in general, a farm worker who has worked for one employer continuously for an entire calendar quarter is covered in succeeding quarters if he works full time for that employer on at least 60 days during the quarter and is paid at least $50 in cash. Only about 15 percent of all hired farm workers and 70 percent of the persons whose major job is farm work meet these requirements. The recommenda- tions would change this provision to a simple cash wage test; all hired farm workers who are paid $50 in cash by an employer in a calendar quarter would be covered. Under this cash wage test, about 70 percent of all persons employed as hired farm workers during a year would be covered, including practically all whose major activitiy is farm work for hire. Domestic workers in private homes also must meet a restrictive test of regularity of employment to be covered under present law. Only those household workers are covered who work for a single em- ployer on each of 24 days during a calendar quarter and are paid at least $50 in cash in the quarter. In general, a household worker must work regularly for an employer on at least 2 days a week to be covered. The day test is an unnecessary complication that excludes many workers from coverage and gives others coverage for part but not all of their domestic work. The test would be eliminated by the recommendations so that all domestic workers who are paid $50 in cash by an employer in a calendar quarter would be covered. This provi- sion would extend coverage to between 100,000 and 200,000 workers in addition to those covered under present law. Another sizable group excluded from old-age and survivors insur- ance at present are the 500,000 or so self-employed people in certain 24 Department of Health, Education, and Welfare, 1953 specified professions. It is recommended that coverage be extended to these persons on the same basis as that for the other nonfarm self- employed who are now covered. On the basis of their study of the coverage provisions of old-age and survivors insurance the consultants also proposed the removal of limitations on the coverage of several comparatively small groups of workers, including internes in hospitals, certain employees in the fish- ing industry, and certain American seamen and airmen. More than 4 million persons during the course of a year are em- ployed in positions covered by retirement systems of State and local governments. Under the present law an employee in a position covered by a retirement system on the date when the group to which he belongs is brought into the old-age and survivors insurance pro- gram cannot be covered by that program. Most retirement systems of State and local governments do not provide adequate survivor protection. Furthermore, since the systems were designed chiefly for the person whose career is spent under the system, those who leave the service before retirement usually lose their retirement protection. Persons who shift from other employment to State and local government employment are in much the same posi- tion because they often lose all or part of their protection under old-age and survivors insurance. Extension of old-age and survivors insurance to this employment would fill these gaps in present protec- tion. The option of coverage under Federal-State agreements is rec- ommended for employees in positions covered by State and local government retirement systems. Special provisions of the present law permit coverage of lay em- ployees of religious, educational, and similar nonprofit organizations at the option of the employees and the employing organization. Since the adoption of these provisions in 1950, it has become apparent that many church groups now want the opportunity of electing coverage for ministers on a similar basis. A change in the law to provide such opportunity is recommended. If these recommendations are enacted in the next session of Congress, approximately 90 percent of all paid civilian jobs will be covered by old-age and survivors insurance, either actually or, in the case of employment for nonprofit organizations or State and local governments, potentially. Of the 10 percent that would still remain excluded, roughly two-thirds would be those of persons in the employ of the Federal Government, including both civilian and military service. Thus old-age and survivors insurance would be established as the basic retirement protection for practically all except Federal employment. The consultants on social security did not consider extension of coverage to Federal employees because that question is currently be- Social Security Administration 25 ing studied by a Committee on Retirement Policy for Federal Per- sonnel, established by Public Law 555, Eighty-second Congress, and consisting of the Secretary of the Treasury, the Secretary of Defense, the Chairman of the Board of Governors of the Federal Reserve Sys- tem, the Director of the Bureau of the Budget, and the Chairman of the Civil Service Commission, with a Committee Chairman appointed by the President. This Committee is expected to report to Congress early in 1954. The Social Security Administration believes that ex- tension of coverage to all Federal employees—both civilian and mili- tary—would improve the protection now afforded these employees. Another matter under study during the year was that of the coordi- nation of the railroad retirement program with old-age and survivors insurance. The Joint Congressional Committee on Railroad Retire- ment, created by S. Con. Res. 51 of the Eighty-second Congress, con- ducted a study of the railroad retirement program and its relation to old-age and survivors insurance, and completed its report early in 1958. In its report the Committee reviewed the positions of interested agencies and organizations and analyzed various factors relating to the matter, without making any recommendations, however. The Social Security Administration recognizes that, while the present coordination has improved the protection of railroad workers, it is somewhat complicated and might perhaps be improved. THE RETIREMENT TEST Old-age and survivors insurance benefits are intended primarily as a partial replacement of earnings which are lost when a worker retires or dies. In general, therefore, monthly benefits are not payable to otherwise eligible persons who are engaged in work covered by the program. The only exception to this provision is for beneficiaries aged 75 and over, relatively few of whom continue in regular employment. Their benefits are payable without regard to the amount of covered work they do. Basically, the principle of the retirement test is sound, and it is important that such a test be retained in the program. If there were no retirement test, benefits would be payable not only to those who had retired, but also to those older workers who are still employed and who have no loss of earnings. The additional benefits that would be paid out to employed workers and their dependents would add substantially to the cost of the system, and would not increase the security of those beneficiaries unable to work or unable to find employment. About 1.9 million beneficiaries would be immediately added to the benefit rolls, and the cost of their benefits would amount to $1.4 billion for the fiscal year 1954 alone. Over the long run, total money expenditures for the program would rise by about 15 percent. 293171—54—_—-8 26 Department of Health, Education, and Welfare, 1953 OF From surveys of old-age insurance beneficiaries conducted by the Bureau of Old-Age and Survivors Insurance, it seems clear that the retirement test is not a major factor in most people’s decisions to retire from full-time jobs. These surveys have consistently shown that a great majority of beneficiaries retire either because they are in il health or because they lose their jobs. Only about 5 percent retire voluntarily while still able to work. Among beneficiaries drawing benefits at a given time, a very large proportion are disabled. In the 1951 national survey of aged beneficiaries, almost two-thirds of the old-age insurance beneficiaries drawing benefits as retired workers at the end of the year reported themselves unable to work. Four-fifths of the aged widows who are beneficiaries said they could not work. At the same time, the retirement test in its present form does not fulfill its function in an entirely satisfactory way. For example, the present monthly test for wage earners probably tends to some extent to discourage retired persons from engaging in part-time employment. Beneficiaries do not want to accept jobs paying somewhat more than $75 a month if the amounts they would earn would not be as high as the benefits they would lose. Moreover, short-term or seasonal employ- ment during the year can cause loss of benefits for some months even though the beneficiary is essentially in retirement status and his work earnings for the year are relatively low. In this respect the retirement test operates more satisfactorily for the self-employed than it does for the wage earner, since up to $900 of self-employment earnings are allowed in the course of a year before benefit payments are suspended. The present retirement test also has anomalous results in some situa- tions. At the present time it applies only to earnings in work covered by the program, and not to earnings outside the coverage. This makes it possible for some persons to receive social security benefits in addi- tion to full-time employment earnings by entering noncovered employ- ment. This situation would to a large extent be automatically resolved by the extension of the program to cover most types of employment. But short of completely universal coverage, the problem will not dis- appear altogether. Another anomaly in the retirement test is that some persons enjoy a “double exemption” of their work earnings—one for wage earnings and one for self-employment earnings. A person who has both wage earnings and self-employment income may earn up to $900 a year from self-employment income and up to $75 a month in wages without the loss of any benefits. The Social Security Administration believes that the retirement test can and should be redesigned so as to remove anomalies and reinforce incentives to productive work. Methods of accomplishing this are now under study. Social Security Administration 27 BENEFIT AMOUNTS Similarly, the basic question of whether the benefit amounts pro- vided under old-age and survivors insurance assure individuals and families an adequate measure of security needs to be carefully exam- ined. Recommendations for program changes already made will result in increasing benefit amounts payable in many cases in the future. The extension of coverage, in addition to enabling many people to qualify for benefits who could not otherwise have done so, will also result in the payment of higher benefits to individuals whose working life is split between employment covered at present and that recommended for coverage. Another provision, recommended in connection with the proposal for extension of coverage, will also increase benefits payable in the future. This recommended provision would permit the omission of the three or four years of lowest or no earnings—depending on the date of coverage extension—from the computation of the individual’s average monthly wage under the program. This amendment is de- signed to remove the handicap in benefit computation which newly covered workers would otherwise suffer because of their late entrance into the system. Equally important, however, it will give to those already covered the advantage of some future protection against the lowering of the average monthly wage because of periods of unem- ployment, disability or low earnings. Thus the measures already recommended for improving the pro- gram would increase its effectiveness in terms of benefits payable. The recommended extension of coverage, in particular, would in the long run greatly improve the effectiveness of the program in rural areas and thereby reduce the need for public assistance. Further evaluation of the benefit provisions is necessary, however. Study must be given to such questions as what income from other sources and savings aged individuals and survivor families may be expected to have; and what levels of benefits must therefore be paid under old-age and survivors insurance so that retired workers and families that have lost the earner through death will not need to apply for public assistance to supple- ment the insurance benefits. Analysis is also needed of the results of the present benefit provisions, including the benefit formula, the maxi- mum on annual creditable wages, and the method of computing the average monthly wage. Continuing study is being devoted to these problems, as well as to other aspects of the program. In a dynamic economy such as ours no social insurance program can be expected to maintain a reasonable relationship to the economy of the Nation without constant study, review, and change. 28 Department of Health, Education, and Welfare, 1953 FINANCING THE PROGRAM Congress has made clear its intent that the old-age and survivors in- surance program be self-supporting, and has set the contribution rates of the program at levels calculated to attain that objective. Congres- | sional committees, however, in determining the contribution rates, have recognized the difficulties involved in making exact predictions of the status and operations of the program that reach into the distant future. For example, the Committee on Ways and Means of the House of Rep- resentatives, in its report on H. R. 6000 dated August 22, 1949, page 31, stated : ... Your committee has recommended a tax schedule which it believes will make the system self-supporting (or in other words, actuarially sound) as nearly as can be foreseen under present circumstances. Future experience may differ from the estimates so that this tax schedule, at least in the distant future, may have to be modified slightly—either upward or downward. This may readily be determined by future Congresses after the revised program has been in operation a decade or two. As economic and other conditions change it is essential that new cost estimates for the insurance program be prepared from time to time in order to take into account the latest operating experience and other newly available information. It is to be expected, of course, that any new estimate will differ somewhat from previous estimates. Normally, several different estimates are prepared, combining dif- ferent assumptions as to low and high employment, low and high cost factors, and various interest rates. No one of the estimates is consid- ered to be the most probable for the long run. Each simply represents a reasonable set of assumptions tending in one direction or the other. The assumptions used are reviewed by an Actuarial Advisory Commit- tee from outside of the Government. At present the members of the Committee are Reinhard A. Hohaus, Vice President and Chief Actu- ary, Metropolitan Life Insurance Company; Clarence A. Kulp, Pro- fessor of Insurance, University of Pennsylvania; Kermit Lang, Assistant Actuary, Equitable Life Insurance Company of Iowa; and W. R. Williamson, Consulting Actuary. The result of preparing such a series of estimates is of course a range of possible costs, rather than a single figure. It is clearly impossible, however, to base a schedule of contribution rates on a range of possible costs. Congressional committees, in the past, therefore, in determin- ing the contribution schedules, have adopted the practice of relating the contribution rates to the “intermediate” cost estimate based on the high employment assumptions. This “intermediate” estimate is merely the midpoint between the high and low cost estimates; it is not an attempt to predict the precise cost of the program and should not be regarded as such. In the fiscal year 1953 the seventh set of actuarial estimates of the cost of the program was issued. These new estimates, based on recent Social Security Administration 29 operating experience and current population data, show the cost of the program to be different from that shown in previous cost estimates. According to the last previous estimates made in 1952 (which were pro- jected through the year 2000 and assumed to be level thereafter) the level-premium cost of the program as amended in 1952, on an interme- diate cost basis, was 5.93 percent of covered payroll, which was very close to the level-premium equivalent of the graded contribution sched- ule. According to the new estimates, the level-premium cost of the program projected through the year 2000 on an intermediate basis is expected to be 6.09 percent; projected through the year 2050 it is expected to be 6.58 percent. Thus the new estimates show a higher cost than the last previous set of estimates. It should be pointed out that, if somewhat different assumptions had been used in developing the estimates, different. figures would have re- sulted. For example, assumption of a higher interest rate would show lower costs. The interest rate used in developing the level-premium cost figures indicated above was 214 percent; present interest rates are ~ somewhat above this figure. It should be remembered too, that there are a number of factors which could change the picture considerably—a further rise in interest rates, for example, or less improvement in mortality than has been as- sumed, or further increases in wage levels, any of which would result in lower costs. (It is worth noting that the experience in this country over the years has been that wage levels have risen, and the general view is that this trend will continue. ) Thus it must be emphasized that no single set of cost estimates is, or can be, “final.” Experience over the last 15 years has been considera- bly more favorable than was anticipated in the cost estimates prepared when the system was established. Despite the fact that the program has been liberalized substantially since it was originally established, the cost of the program as a percentage of payroll for 1955, for exam- ple, is expected to be very close to, and perhaps somewhat below, the cost estimated for the year 1955 in the early days of the system. Public Assistance The number of persons receiving assistance continued to go down during the fiscal year, as it has since 1950. In June 1953, for the first time since the Social Security Act was passed, fewer people were receiving assistance than were receiving benefits under old-age and survivors insurance. For most children of incapacitated and sepa- rated parents, however, and for most disabled and blind persons, there is no insurance coverage, and public assistance is the primary support for needy persons in these groups. 30 Department of Health, Education, and Welfare, 1953 Although more aged persons received insurance benefits than old-age assistance as early as 1951, the total number of recipients under all assistance programs at the beginning of 1953 still exceeded the total number of insurance beneficiaries by nearly a million. How- ever, the continuing decline in the number of assistance recipients, coupled with a substantial increase in insurance beneficiaries, had reversed the position of the two programs by the end of the fiscal year 1953. The shift in programs for the aged was especially marked. In June 1953, 32 percent of the population aged 65 and over were drawing insurance benefits, and less than 20 percent of the aged were receiving assistance. Thus, while old-age and survivors insurance is beginning to fulfill its long-term role as the basic income maintenance program, public assistance helps to provide a minimum level of living to needy persons who are not eligible for this social insurance program or whose insurance benefits and other resources are too low to meet their mini- mum needs. Today, more than 5 million persons, whose eligibility has been determined by State and local welfare agencies under the provi- sions of the States’ own laws, are dependent on public assistance for the primary essentials of daily living. As more retired persons and the dependents and survivors of insured workers become eligible for social insurance benefits, the proportion of persons receiving assistance because of disability, or because they are children deprived of parental care, has risen sharply. This shift in the composition of the assistance caseload emphasizes the need for further development of social services in public assistance agencies as well as the need for effective working relationships with other community agencies providing health and rehabilitative services. Federally, this shift of emphasis has been reflected this year in closer working relationships between the Bureau of Public Assistance and other programs of the Department, such as vocational rehabilitation, public health, and child welfare services, and also in more cooperative work with outside agencies, particularly national agencies carrying standard-setting responsibilities for institutions. Case Load and Expenditures’ About 200,000 fewer persons received public assistance at the end of the 1953 fiscal year than a year earlier. From 5.5 million in June +¥For old-age assistance, aid to dependent children, aid to the blind, and aid to the permanently and totally disabled, data on payments now include payments to the sup- pliers of medical care, and data on recipients include persons who received no money payment but on whose behalf vendor payments for medical care were made. In previous issues of the annual report, data on average payments included only cases receiving money payments and the amount of such payments. Data for earlier years have been adjusted for comparison with 1953 data. For general assistance the data continue to exclude vendor payments for medical care and the number of persons on whose behalf only such payments are made. Social Security Administration 31 1952, including those receiving general assistance, the total number declined to 5.3 million in June 1953. This represented a drop of about 314 percent during the year, and a total reduction since June 1950 of about 14 percent. High levels of employment and the increase in the number of old-age and survivors insurance beneficiaries continued to be the primary factors contributing to the decline in caseloads, though more restrictive eligibility provisions in some States were also a factor. The 1952 amendments to the Social Security Act, which made addi- tional funds available to the States for public assistance, and the con- tinued efforts of States to meet need on a more nearly adequate basis account in large measure for a 5.4 percent increase in total expendi- Chart 5.—HOW ASSISTANCE PAYMENTS ARE FINANCED * BILLIONS OF DOLLARS 1.6 3 at = LOCAL 12 STATE WW FEDERAL OAA ADC CABIRl dev APT Dots: ak GA 1 Payments in the fiscal year 1953 for old-age assistance, aid to dependent children, aid to the blind, aid to the permanently and totally disabled, and general assistance. tures for assistance payments during the fiscal year 1953. An increase of $130.2 million raised total Federal, State, and local expenditures from $2,392.6 million in 1952 to $2,522.8 million in 1953. Effective October 1952, the amendments raised the maximums on the amounts of individual payments in which the Federal Govern- ment can participate and increased the Federal share within these maximums. Increases in monthly payments of $5 per recipient under old-age assistance, aid to the blind, and aid to the permanently and totally disabled and $3 per recipient under aid to dependent children were possible in States that continued to spend as much per recipient from State and local funds as they had spent in the preceding month. 32 Department of Health, Education, and Welfare, 1953 Since October 1, 1952, for old-age assistance, aid to the blind, and aid to the disabled, Federal funds pay four-fifths of the first $25 (raised from three-fourths of the first $20) of the average monthly assistance payment per recipient, plus half the balance of all expendi- tures up to $55 a month for individual payments (raised from $50). For aid to dependent children, Federal funds pay four-fifths of the first $15 (raised from three-fourths of the first $12) of the average monthly payment per recipent, plus half the balance up to $30 for the needy adult caretaker, $30 for the first child, and $21 for each additional child (raised from $27, $27, and $18, respectively). With the additional Federal funds and the general decline in case- loads, some States with maximums on assistance payments raised them; other States that had been making percentage reductions in payments because of insufficient funds reduced or eliminated these cuts, or determined need under more nearly adequate standards in rela- tion to current living costs. Several States that had adjusted pay- ments before October 1952, however, to reflect increased living costs, made no further adjustments in payments or made only minor adjust- ments in their standards. As a result of the 1952 amendments, the amount of Federal funds used to finance assistance payments in the last 9 months of the fiscal year increased by an estimated $144 million. Between the first and second quarters of the year, the percent of Federal participation rose from 51.5 for both old-age assistance and aid to dependent children to 56.9 and 58.3, respectively; in aid to the blind the change was from 45.6 to 50 percent; and in aid to the permanently and totally disabled from 47.8 to 52.9 percent. In summary, at the end of the year about 5.3 million persons, about 1 in 30 in the population, were receiving public assistance. Total assistance expenditures from Federal, State, and local funds amounted to $2,523 million, or 1 percent of personal income payments in the Nation in the calendar year 1952. The Federal share of this expendi- ture was $1,278 million. The aggregate cost of public assistance appears high, yet many indi- viduals dependent upon public assistance payments are existing on a level of living far below a reasonable standard of decency and health. The large numbers of persons dependent on public assistance, in spite of general prosperity, are mainly those groups unable to take advan- tage of employment opportunities—the aged, the disabled, the blind, and young children. Moreover, the two largest of these groups that are most likely to be dependent—the aged and young children—are increasing more rapidly than the total population. Old-age assistance.—The 2,609,000 aged persons receiving assistance in June 1953 represented a decrease of 2.8 percent from the number in Social Security Administration 33 Chart 6.—PURCHASING POWER OF ASSISTANCE PAYMENTS TO THE AGED AND CHILDREN 2 DOLLARS 60 emmmme DOLLAR AMOUNT PAID 50; PURCHASING POWER REPRESENTED (JUNE 1945 =100)2/ 40 OLD—AGE ASSISTANCE 30 , AID ‘TO SEPENDENT CHILDREN f eebss OPER CHILD) 29 $5 1945 1946 1947 1948 1949 1950 1951 1952 1953 1 Beginning June 1951 includes payments to suppliers of medical care to recipients. 2 Based on Bureau of Labor Statistics consumers’ price index for moderate-income families in large cities. June a year earlier, and were about 201,000 fewer than the number aided in the peak month of September 1950. The caseload in 44 States decreased during the year. For all States combined, the recipient rate—that is the number of recipients in proportion to the total popu- lation aged 65 and over—was 191 per 1,000 in June 1953 as compared with 202 in the preceding June. The average monthly payment was $51.08 as compared with $47.11 in June 1952. Aid to dependent children—The number of families receiving aid to dependent children in June 1953 was 564,000. ‘These families in- cluded about 1.5 million children, or less than 3 percent of the child population. This was the lowest number of children aided since Sep- tember 1949 and 92,000 fewer than in the peak month of October 1950. The recipient rate for all States was 28 per 1,000 children in the popu- lation under 18 years. In 35 States, the number of families also de- creased. The average monthly payment per family in June 1953 was $83.98 (or $23.69 per person) as compared with $77.32 per family (or $22.36 per person) in June 1952. Aid to the permanently and totally disabled.—The still relatively new program for aid to the permanently and totally disabled continued to grow. Georgia was added to the States receiving Federal funds for this program. The total number of recipients in the 39 States now administering programs with Federal financial participation was 34 Department of Health, Education, and Welfare, 1953 179,000 in June 1953, as compared with 148,000 in 38 States in 1952. The average monthly payment was $53.72 as against $50.34 in June 1952. Aid to the blind.—The number of recipients of aid to the blind increased by 1,000 during the year to 99,000 in June 1953. With the addition of Nevada, which first began to receive Federal funds for its program during the year, all jurisdictions are now administering aid to the blind with Federal financial participation. The average monthly payment in June 1953 was $55.53 as compared with $51.26 in June 1952. General assistance.—General assistance, financed entirely from State and/or local funds, was affected by high employment levels to a greater extent than the federally aided assistance programs, since it includes a larger proportion of persons who are actually or potentially employable. The 255,000 cases receiving general assistance in June 1958 was the smallest number since November 1945. From June 1952 to June 1958 the caseload declined 13 percent. The national monthly average payment per case was $47.16 in June 1953 as compared with $45.95 a year earlier. Effect of Old-Age and Survivors Insurance on‘ Public: Assistance Despite the expansion of old-age and survivors insurance since September 1950, many people are still getting old-age assistance be- cause some of the insurance benefits are not sufficient to meet minimum needs for those who have no other resources, or for those with unusual expenses, such as costly types of medical care. In February 1953 about 11 percent of the aged insurance beneficiaries received public assistance to supplement their benefits. ‘They represented 16 percent of the old-age assistance caseload for that month. It is likely that, as the number of beneficiaries continues to increase, the number requir- ing supplementary assistance will also grow. This would be espe- cially likely to happen if the cost of living remains high. Of all paternal orphans under age 18 in the general population, about half— 911,000 in June 1953—received survivor benefits under the insurance program. Nearly 6 percent of the families with children receiving insurance benefits also received supplementary assistance. They rep- resented 5 percent of the families receiving aid to dependent children. The death of the father is the reason for dependency for about one- sixth of the children getting aid to dependent children, and at least one- _ third of these children are receiving survivor benefits based on the wage record of the father. A few additional families may include a person getting insurance benefits—for example, an aged retired father. The other families receiving aid to dependent children—about five- Social Security Administration 35 _ sixths of the total—do not include any person eligible for old-age and survivors insurance. Because the insurance program does not cover all the risks that create dependent families, the expansion of the insurance program does not tend to reduce the aid to dependent children caseload to the same extent that it reduces the old-age assistance caseload. Likewise, Chart 7.—-GROWTH IN SOCIAL INSURANCE PROTECTION FOR THE AGED? RATE PER 1000 AGED POPULATION 350 | : | | 300 | OLD-AGE 250 ASSISTANCE 200 ee a OLD-AGE AND 150 | SURVIVORS INSURANCE, 1940 1945 1950 1953 1 Average monthly number of beneficiaries and recipients, by years, per 1,000 persons aged 65 and over in the population. few recipients of aid to the permanently and totally disabled and aid to the blind are potentially eligible for insurance benefits. A special study of recipients of aid to the permanently and totally disabled made by 30 States in 1951 indicated that there were fewer than 400 insurance beneficiaries among 93,000 assistance cases. A report for September 1950 showed that 1,300 recipients of aid to the blind received both types of payments. 36 Department of Health, Education, and Welfare, 1953 Chart 8.—GROWTH IN SOCIAL INSURANCE PROTECTION FOR ORPHANS Number of orphans receiving benefits or assistance in a given month in each year THOUSANDS 800 -@-@. 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Bh an “OOTXOTAT MONT Se ae en Eo ee AVSIOL MIN TINOSST AL een See Sap oe ema eee Jddyssysst Al 82 Department of Health, Education, and Welfare, 1953 Table 9.—Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding Dec. 31, 1935-52 Number of vied reporting Number of | Amount of | Amount of | Amount of hath credit members assets shares loans unions ! ihe Teal cee Pac: WF ati ee acon 1a pe 762 118, 665 $2, 368, 521 $2, 224, 608 $1, 830, 489 OSG oe pee Wb yee ei Ps ae eke ws oleate iv2o 307, 651 9, 142, 943 8, 496, 526 7, 330, 248 MOST ett Bese eee ee eae 2, 296 482, 441 19, 249, 738 17, 636, 414 15, 683, 676 SLSR YS Meee eke Gates lay Peace ARR Su et 2 AU & 25.163 631, 436 29, 621, 501 26, 869, 367 23, 824, 703 TOROS See Sse ser ee a oe ae Sali? 849, 806 47, 796, 278 43, 314, 433 37, 663, 782 TOAQ Ate Supe uc ee eee YE a 3, 739 1126; 222 72, 500, 5389 65, 780, 063 55, 801, 026 AGAR Fok iis Cera te 2 etie c= Sg Netcy Were to 4,144 1, 396, 696 | 105, 656, 839 96, 816, 948 69, 249, 487 TOAD sees a esc ae Sur See pe ia ay a 4,070 1, 347, 519 | 119, 232,893 | 109, 498, 801 42, 886, 750 OAS ion om Ba Eptole et en ee ye 3, 859 1, 302,363 | 126, 948,085 | 116, 988, 974 35, 228, 153 NOAA sfaly 2 Dae i 0 se he Oo 3, 795 1, 303, 801 144, 266,156 | 133, 586, 147 34, 403, 467 MOA he Sr ae 2 ose a ean a 3, 757 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 GAG Uae Rus ee ey eee ee 3, 761 1, 302,132 | 173,166,459 | 159, 718, 040 56, 800, 937 1 ROY. iy Une SRR Ry TLR, Lar gOS, BE aly a 3, 845 1,445,915 | 210,375, 571 192, 410, 043 91, 372, 197 1O4S Sve 2 Serre NA Beem eek el sae ae 4,058 1, 628,339 | 258, 411,736 | 235, 008, 368 137, 642, 327 MOA OLRM FL cpiee Peet he eee 4, 495 1, 819, 606 | 316, 362,504 | 285, 000, 934 186, 218, 022 1 O50 ees Ree te ee Un ee 4, 984 2,126,823 | 405, 834,976 | 361, 924, 778 263, 735, 838 LO Soars oh ae Tes Wee eae eae 5, 398 2,463,898 | 504, 714,580 | 457, 402, 124 299, 755, 775 AO eines eS eels cece ee eee 5, 925 2, 853, 241 662, 408, 869 | 597,374, 117 415, 062, 315 1 In the period 1945 through 1952, the number of operating and reporting credit unions was the same. In other years, the number of credit unions which reported was less than the number in overation Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1952, and Dec. 31, 1951 Percentage distri- Amount bution Assets and liabilities aig ai Change dur- | Dec.31, | Dec. 31, Dec. 31, 1952 | Dec. 31, 1951 ing year 1959 1951 Number of operating Federal credit ATID OIS Bc os oe a ee ke 2 ae en cA 5, 925 5, 398 527 (285 _ oA aes MGLaleassetSets ost wae aete se eee $662, 408, 869 | $504, 714, 580 | $157, 694, 289 100. 0 100.0 SOARS CONNOM DCTS a saae eel eee eee 415, 062,315 | 299,755,775 | 115, 306, 540 62. 6 59.4 EG) Nie ety a Paeh nae ie BP PE park EEe 2h ~ EO 66, 033, 714 63, 574, O11 2, 459, 703 10.0 12.6 lWOmitedyStates*DONdS2 . 2 eews mae aes 85, 859, 900 77, 678, 164 8, 181, 736 12.9 15.4 Savingsiand wdoan shares-o4- 5 ee 80, 155, 252 53, 776, 524 26, 378, 728 1201 10.6 Loans to other credit unions___-__---___- 10, 297, 188 6, 470, 564 3, 826, 624 1.6 153 Otherassetse oe. 2s Sos ee ees pi 5, 000, 500 3, 459, 542 1, 540, 958 as) elk Totaliabilities: 2p: 2.2 eee 662, 408, 869 | 504, 714,580 | 157, 694, 289 100.0 100. 0 INotestpayables 2s. 22 asec Seen la same. 16, 091, 405 8, 686, 559 7, 404, 846 2.4 1.7 Accounts payable and other liabilities ___ 1, 715, 599 1, 244, 784 470, 815 .3 .3 SAPO SES ed eee ep ea eee ab 597, 374,117 | 457, 402,124 | 139, 971, 993 90. 2 90. 6 Reserve tor -Dadsloamnct sees oe see eee 19, 571, 805 15, 542, 645 4,029, 160 3.0 Beal Special reserve for delinquent loans_-_-_-__- 988, 926 736, 062 252, 864 ol Al WUmdivad eds profits c= seee aa a eee 26, 667, 017 21, 102, 406 5, 564, 611 4.0 4.2 | Public Health Service Health of the Nation The. Nation’s investment in public health and related services has increased since World War II. Nevertheless, expenditures for the promotion of health and the prevention of disease and disability still comprise a small proportion of the Nation’s total expenditures for health and medical care. The American public is spending about $14 billion annually for all types of civilian health and medical services. Expenditures for public health work and medical rehabilitation of the disabled amount to only 6 percent of the total. Public health measures, based upon the findings of scientific research, however, have produced spectacular results. The average length of hfe in this country has increased 6 years since 1940; 9 years since 1930 ; and 21 years since 1900. At the present time, the most widely prevalent diseases and the ma- jor causes of death and disability are the chronic diseases and acci- dents. The protective measures against communicable diseases must be maintained, but they are inadequate against the growing volume of illness and injury requiring costly hospital and medical care. Un- less services are sustained and extended, unless scientific research in the health and medical fields is sustained, hope must be abandoned for any substantial reduction of the burden that hospital and medical care imposes on all people. THE MORTALITY RECORD The familiar yardsticks by which we can measure the health of a people again tell Americans that they are blessed in this respect, but that there is still much room for improvement. In 1952, the Ameri- 1 All vital statistics are given for the calendar year. $3 3&4. Department of Health, Education, and Weljare, 1953 can population had increased to about 160 million. In the same year, an estimated 1,494,000 deaths occurred, an increase of about 8,000 over 1951. The general death rate from all causes, however, still held a few points below 10 per 1,000 population for the fifth consecutive year. For the fourth year also, the maternal and infant mortality rates were low- er than in earlier periods. Maternal deaths occurred at a rate of shght- ly less than 9 per 10,000 live births and infant mortality held at about 290 per 10,000. Within the past five years there has been a striking decrease in the tuberculosis death rate, from 30 per 100,000 population in 1948 to a record low of 16 per 100,000 in 1952. The death rates from other serious infectious diseases also continued to decline. The syphilis — death rate in 1952 was about 4 per 100,000 population, in contrast with 16 per 100,000 in 1938 when the nation-wide control program was inaugurated. Deaths and death rates due to cardiovascular diseases, related dis- eases of the kidneys and circulatory system, and cancer continued to . increase. In 1952, the cancer death rate reached an estimated 144 per 100,000 population, the highest ever recorded. The combined death rate for the major cardiovascular-renal diseases in 1952 was estimated to be 509 per 100,000. Deaths from cancer and the cardiovascular- renal diseases accounted for more than two-thirds of the total deaths in the United States. COMMUNICABLE DISEASES Virus infections continued to be the major problems in communica- ble disease control. Early in 1952, an outbreak of type B influenza swept through most of the States, but as in most such epidemics of recent years, the cases were generally mild. A total of 57,600 cases of poliomyelitis was reported during the year, the largest number to date. The outbreak occurred principally in the North Central, South Central, Western, and Mountain States. A severe outbreak of Western equine encephalitis occurred in the central valley of California in the summer of 1952, following a rainy season which favored the breeding of mosquitoes. Still another virus disease, infectious hepatitis, was reported in many parts of the country. More cases of scarlet fever, streptococcal sore throat, and menin- gococcal infections were reported in 1952 than in 1951. The increases probably reflect the expected cyclic pattern of these infections. Malaria cases also were reported in sizable numbers, chiefly among military personnel and veterans from Korea. Few of these cases were contracted in the United States. Public Health Service 85 Pewee oN The reported incidence of diphtheria, whooping cough, and endemic typhus fever declined sharply in 1952. There were also small de- creases in Rocky Mountain spotted fever and tularemia. Highteen cases of smallpox were reported in 1952, an increase of 7 over 1951. In the first half of 1958, 15 cases were reported, all but 3 in the State of Nebraska. However, not all of these reported cases have been confirmed by laboratory findings. COMMUNICABLE DISEASES IN OTHER COUNTRIES For the fourth consecutive year, England reported an outbreak of smallpox in the spring of 1953. Thirty cases, with 8 deaths, occurred in Yorkshire and Lancashire. Smallpox was epidemic in Colombia at the close of the fiscal year. In Asia, smallpox decreased except in Madras State, India. Jungle yellow fever has gradually progressed northward in Cen- tral America. The first case to occur in that area was reported by Panama in 1950. Costa Rica reported cases in 1951 and 1952, and the first case occurred in Nicaragua late in 1952. Jungle yellow fever also is prevalent in the interior of the States of Sao Paulo and Parana in Brazil. BIRTHS AND BIRTH RATE In 1952, more infants were born in the United States than in any preceding year. More than 3.8 million births were registered and when unregistered births are added the total will probably be 3,890,000. ‘The birth rate for 1952 was 25 per 1,000 population. Since 1947, the birth rate in the United States has been at about the same level as that of the 1920’s. A significant fact in our higher birth rate is that the number of families having a third or fourth child has increased steadily since the close of World War II. The reverse was true in the period follow- ing World War I, when there was a continuous decline in medium- sized families. In 1950, 88 percent of the registered births occurred in hospitals and 95 percent of the deliveries were attended by physicians. Fifteen years earlier, the corresponding percentages were 37 and 87 respec- tively. The sharp rise in the percentage of births in hospitals and attended by physicians is an important factor in the continuing de- cline in maternal and infant mortality rates. MARRIAGE AND DIVORCE Marriages declined slightly from 1,594,113 in 1951 to 1,569,579 in 1952. About 4 in every 5 marriages reported in 1950 were first mar- riages for both bride and groom. More brides married at 18 than at 86 Department of Health, Education, and Welfare, 1953 OE i Ni any other single year of age, and more grooms at 21 years. The median ages at remarriage was 34.3 years for brides and 39.9 for grooms. | On the basis of preliminary estimates, an upward trend has been observed in divorces since 1950. Figures for the first four months of 1953, for example, indicate a rise of 4 percent over the same period of 1952 in 20 States and the District of Columbia. Data from the United States Census of 1950 indicate that 44 percent of the divorces granted that year involved children and that the marriages which ended in divorce or annulment lasted, on the average, 5.6 years. Emergency Activities The Office of Health Emergency Planning continued to perform staff functions of the Public Health Service relating to defense and other emergency activities. Liaison with the Federal Civil Defense Administration, the Office of Defense Mobilization, the Department of Defense, the Atomic Energy Commission, and other Federal and quasi-official agencies has received major emphasis throughout the year. An agreement between the Public Health Service and the American National Red Cross regarding collaboration during natural disasters was officially adopted by the two agencies, April 1, 1953. The Service also participated in the preparation of a memorandum of under- standing, signed June 19, 1953 by the Secretary of the Department of Health, Education, and Welfare and the Federal Civil Defense Administrator, concerning responsibilities of the Department and the FCDA in disasters other than those induced by enemy attack. The Public Health Service, the Armed Services, and the Federal Civil Defense Administration cooperated in the implementation of a program in the Nation’s medical schools designed to prepare medical students for service in national emergencies. The Office of Health Emergency Planning continued to collect in- formation on the effects of disasters and on the means for meeting emergency problems. Disasters in two areas were studied in coopera- tion with other organizations. or EE Se ied gt GG ne cel a ages Oe To SOHsH818 TRITA JO COO [BUOTBN Soy al I I grip eels Ps 8% 08 LE L9 TTT TomquO OD WOLINTTO T 1648 MA JO WOISTATC, ST ace Be: Sais Lb 91 826 68 888 +9 Mis. tek ae oe eos osvosi( [Be10UeA JO UOISIATC ee oh ae all goers eta oh he cae €¢ eg 9 6g wucsbee pest ip Ihe ash eho uc ain de ea Se Ores GU, OTST ACE A eRe aes I Ue Sees S : aman Pears ac 61 r9 £8 Rie ee ares Se er Ga Meee ee es foi ie cet ee gee L L Or ABRs Pans Seow ae ee aoe tag Sige eee SUISINN UITVOH ONAN JO UOIstatqg Me ae see ce eres eee I 61 0% 9 9% DUTT convonpay Ga1eeH olfqnd JO WoIstatq “cee I 4 g Ben 208 a 8g 0€ 88 a aeeH reuoryedno00 JO Worstatd a Oe 4 ee II Toe iy eo v9 991 08% DUTT aa eeRy [BUOlyeusezU] JO WOIStATd EE G T 5 apt eee VL 8I 61 LT 9€ vo eee se onre seer arc ees ses“ seomosey SULICOULIZUY JO BOISTATC 4 Bae gel o> Be ap L I 9 61 9% IT Sh ath IR RECOM RRR Lo) 8 ey, GUsoH ol[qng [8}Ueq JO UOTSTAT g 8 iI 8 9 88 LG 108 9L BGs hee oe heey, ea Sh te *"S[so[Mo10qn T, pues eswost({ OFUOIYO JO WOISTAT, ie aie oak Bee) ee me oe la ee een eae Soe LIP AT ht oe age a ice tah ees SINR Seah ame ote pice a ae So JUSTMOSVUBIT SATIVIISIUIMIPY JO UOISTAIG Be EES ee Or ee Smee ee es a: ' ge Ree ele! og ee LL LI 6 92 Bay ge) ee ey ddee S R OPE Oe JO NORIO a7 el pomriiy 156 Department of Health, Education, and Welfare, 1953 Table 3.—Payments for research grants, fellowships, and training stipends, fiscal year 1953 Training stipends Research grants Research fellowships State Number | Amount | Number| Amount AS DAMA wes ox roe a eee eh ot Al oie ee 14 $143, 076 5 $18, 349 PANG Z OMG ious ee elie Wee ac eas eae 2 12 S300 [eee el | Ns a Gehl AGW AUSTEN aes IE a IO RR Ste, Vy choy ne ae 5 B10 on loinc nt irom PASE ee PUNT IG) isd ks Oe WERCN a at aceas a, ENE Nye LI A 185 1, 998, 611 56 201, 284 COOK ACO He ein es ee Sia ioe ps nae 25 Alte Se Bid Wrasead i eeaaiseel A ey Ss Connecticut 5s sa) eamen ae Sea 46 461, 556 32 94, 332 Districthol Colum) lave eee eee ees 45 395, 484 6 22, 781 Bet Leneg KG Us meeps COR eetiE ng ONE Bas ae es es 22 177, 395 1 3, 248 GC OT Se SROs ae 5 eR eaere ALUN ates 23 224, 776 3 10, 375 Fdahoss 23 eee eee ene ame 3 1G DB G9 eke alt a le TUTE OTS = See eee Cea re ian em re es mr 175 | 1, 602, 380 38 130, 440 Tr hd igs We 0 eee cea ea 18 124, 207 6 12, 664 dG ges oe ce nal Ue ce ee pe AN mal 8 Ce ee 25 169, 282 6 23, 078 NRQTIS AS ies oP Zee Se Tish ae ae 38 311, 741 & 14, 340 REM UIG Key eae ae ates a a Bel coal 9 69, 365 2 7, 040 Teomisiana ee: ke Wot. sep Pe es ee 44 326, 740 1 4, 000 UY Gey hae Weeden epee Sei A: ene AEEN SU 13 188, 213 2 8, 627 Mislead eset. ci eats ne ee omen aoe 71 609, 499 20 76, 382 Massachusettsie. 2 eet eres eee 229 | 2,747,894 82 304, 737 USA BI(e) Utz) 6 ames eee Sao IA ieee ye YR 59 571, 774 6 17, 915 IMEIMTES Oba ees Sate aoe ee eh oe ek 64 661, 559 8 23, 704 IMMSSISSIP DY -2e Sen Jee eee cme te 1 LOR 724 NE Res oe cos IVIISS OUT TY coos BA Na ee epee ee ee OLD 53 497, 196 13 53, 214 IMiontaniage ces 5a ae ieee ee 2 305 OOO Ee se eet eae IN@DrAS Kaine oe Rr eee eee on ee 12 SOs (lO: ees Wie Soa eae eee New Jierseyet Beh eee Roe eee oe 15 110, 611 1 6, 000 ING INEGRICO! So siete oe ne ae 3 22 DSi | L WG ak Sy Se RienS Niece ie eo ae INO Wi KOTKe ass ele co ele eke oe 354 | 3, 992, 749 96 364, 838 NiorthvC sroling ewes: Teeth ears 62 516, 822 16 547, 81 INGrth Dako camer = cers here tela 3 Goa ta te | Les sogh se ere eke eee as QOEO Sra ea cal air tre Dre 100 991, 779 21 71, 423 Okdahomas se wie see ie ves oe 16 133), 27.6) | beset eee ee One cor tes ee eee ee ee te Lae 15 92208) |e See ae ee ee eee Pennsylvania. 2. set ats ees ee ee 157 | 1,507,896 32 107, 887 oder lSlarid sae ease eae epee eres 11 4 SOS (2h Ee NRE oe A Southey @arolin a Meee een eee ee ae 8 58, 834 2 6, 825 South iWakotates sot meses wee eee 5 27, 003 1 2, 550 TM ONMCSSCOiidea cA e JE Bren Meese ev ter ie 38 280, 378 5 12, 916 ROR AS Sie pads the a aN Aes Seiler sted 42 305, 593 2 10, 309 AOE Ua ai ae ar a RO enon es A 27 273, 954 6 20, 388 VERIO Yee ccc e eee Nee me, Le! 6 OO. Adi) Peek So 2 | oe ee VARI ate es Seed oe eee se ee 23 180, 522 5 17, 615 Wiashin sous cece ae ee 39 358, 544 12 40, 398 Wiest Wining =. Abe ea) i aa be 1 AMOOO: |G 2. cate | Sa ne ae EVV ES CORDS Ta epee Aheone Soh Sc a 43 316, 569 16 42, 233 Ee Wied Bee eos ee ee a = ne ra 7. TE 450 22 0 se UCT COUR ICO MGs ee ae er ces 8 4D AZO. | Sak oe Aue || Es ee Research ofnts Research fellowships Country = Number | Amount | Number | Amount cA TEI CA ed 2 Sean aie een eee ee it $35,600) | eta = S28 es eerie ATO OO UID Beis. 5 Sg) Sk ee Cae Eee ala 2 1250003 |beco. Stes Sees ee VASES CAI A es a NE et Oa MS he leans RR Ne mpc TO 1 $4, 762 Boel outa Sa oat aN Soe es, ae Nica HEH = gts Au eel PO ae BAS if 4, 5384 Britishelsles: sees ees, eee ee cee 1 10, 000 16 69, 799 Canadas 2c 4b alOnie Seen e Aue 6 64, 882 5 22, 497 ChinazGhormosa) also an mcemns even. 1 DOS 6) | ee Ot Ne ee a a Demme rey ase actos nee ae eat Ose 4 21,775 7 32, 689 DENT a EH ake Dee ae nh re deen eey ter 2 et 1 3;-GOO's| os te Ces ee HP ATICE Res ee real i en ee Sse ee carat 3 26, 000 4 15, 343 Ciaatemialaai: eke See a ee oe 1 Ae OO E Pee nah S| ee ero ESS fe Ye) ante eR ee Be he bee 1 Tio; OOOH as! oe ree eee Tp@ DATO MAUS SIC eae, Lie ay eae ee 1 ZS OOO ees Ce ears lle ee ae Netherlandse oi 252 se So ae Se | areata va | be Re Men 2 10, 650 OTUs oer St er er apc ola | oc NS 2 Pa} JOK 010, Oi eee pau ae ge Swedenos i eke s re Ae eon el en aI nee ae 5 22, 672 DS WALGZer ari S. 50) 1 i on ee | ER ORE eyo 1, 047 Un 8. Government institutions 2). 5c) aaah te 2 es ees 15 46, 321 RUS fea es ay Ly a a 2,185 |$21, 297, 068 562 | $2, 014, 987 Number | Amount 1 $3, 675 toe i ee i's 75 | 166,403 34 66, 865 28 62, 210 43 95, 517 ae is 8 | 28 830 ee 60 | 133, 240 10 27, 818 7 12, 000 18 44) 875 8 15, 934 24 52, 250 hen 26| 76, 205 108 | 293, 242 29 55, 018 57 | 120,708 "ane 38 | 82, 684 eee! 6). yayas 2 4, 800 ome 139 | 358, 120 34 73, 860 oa 34| 85, 533 1 3, 600 eee, 100 | 228, 322 mand ine 2 |< 92 300 eacoigigie 18| 42,355 10 22, 974 3 6, 567 Spee, 6| 17,600 16 27, 648 Pees a mee Training stipends Number | Amount 950 |$2, 235, 088 —— $$$ eee" Public Health Service 157 Table 4.—Payments to States, fiscal year 1953 {In thousands] & reas oe ene- enta sake ta : State real patare General | health oe Cancer | survey | #0sPital are : disease | contro] | health | activi- "| control} and con; ther Control ties control plan- struction ning “NGI ia To ae 1 $7,166 | $5,300 | 2$13,537 | $8,050 | $1, 348 | $2, 897 $98 |$109, 204 | 3 $1, 113 Pera Daliaeeee se 301 126 400 72 47 13 % 3} O26), | meena AMiZONOEEE ees So 66 57 96 6 2 P39 seeck Fhe SL Goi asleeteh eet INTARGN ONS Gh sa 146 88 252 33 25 50 4 Stolle |e eae ee CitOrMasss tc 151 288 665 181 70 [S25 Seer ec 4,020 458 @olonad Osos e == ee 46 44 128 26 18 S2ai| selon ne ete & 50Gy|Seest 2 Wonnechicwt= =. 35 75 125 34 22 37 8 (OLS: |e eee Fe JOXSEN TRESS ae er 17 20 23 20 12 (Gina POS ae D0 5h eres District of Columbia______ 137 49 48 19 14 4 aoe ee ATs) Stee ee 1QT ONG be a 418 114 266 58 34 59) Nis ees PARP PAM peek es (eOroiqmee eae 505 163 403 77 47 SOnSa renee 3, 591 4119 TOWIO: ae ae 36 Ne 76 20 15 18)" DSi nena Hig icmee ee 285 260 533 147 45 AAR eee Darel 4103 Ca eres ee Sk 103 104 293 64 29 GStieem sens. 4, 922 4181 ONY a 8 os SS I 54 46 208 49 20 iil hin SETS GAO Mi -ee ee IXGHD GEIS). [aoe ae 2 eee 36 56 170 34 25 38 2 13 Oise | Sees aes Kene Veo a=) Gt 194 147 345 66 42 ANS (eae se De O93 | eons aoe WOWMISianaw ees] oo 432 106 297 57 29 Silage eee Bec OTA be aviv J TM E aE 2 oa 15 29 97 18 5 21 4 NO Die oe Sees WViaiydemd esses 129 106 171 44 16 SS yl eee ees i Uo AO al peta ae UP Massachusetts__.-________ 46 172 313 88 35 Qi bites”, eae e DEAQ TE Ess tee MVintielnieometen oes SSA 143 173 447 118 40 103 6 DRO edie uh IviMeSOtaes seo. ek 25 71 247 57 29 Dos haan eee Poi 50 al agen een WHSSISSIPPleut he 396 120 340 55 41 C1 (oe ae eat LEGS Oe | See eee ISRO UNG eee ee a Fs 187 126 317 74 37 Soy eater 18:79 oleae oa Joyal Re Hee Ves es Se a 18 22 68 20 15 sae (th eee 45 Fee INeiraskaseew See Fos 26 31 128 14 iat 26 2 907 eae ee New Geechee te tS 8 21 10 38 10 i (pa (AB es Sale ee New Pe ochre i eee 12 16 50 20 1 ees 1 SAC be ane ING IGS) 79 134 309 90 38 Cont sheer ee sl Wes clo INewalVEexiCOme.- ..-c5-. 28 36 40 97 19 5 Call eo 0437 e ee INGOT NOG <8 See 310 431 825 264 90 2143 |\etee ee 7 Ga WY (tes ae Nonib@aroling 22...) 319 155 473 81 32 OOS): See 5, 057 4129 iNorn Dakotas... 25 37 75 20 15 Reco AAT Nae Se OUI) ae 179 230 550 151 61 149 9 4, 942 56 OIA OMIA. soe ee a 101 82 223 46 29 46 6 699 5] Ope roi ss Pe 26 48 138 28 14 2ialtometor © 836 5] Pennsylvania_.-_-....2.-. 242 270 756 201 78 184 28 Lr Lohse eae ee node Island=—2 Sess 15 29 56 20 |pzeete ee 16 3 SONNE en eae South Carolina______- sed Bs 249 115 274 49 PAL tO ee oe 2,475 4 420 SOmUtnDaAkota sce. 22" 18 23 Th 19 11 il 1 O28 Fa ee Menmesseeie tole = falls! 215 154 354 68 42 DD ulate AS 2880 es Pee ALCON) a Re ean 624 193 692 UY ee 148 8 6, 105 483 (Ui G@ Oe 22 ae eg een LZ 18 86 19 9 16 2 BOS i sera eee NUOTAINOIN en 14 18 45 11 612 | Re ie eee na 7155 fe) aaa aes Oe Wain oS ee 169 - 154 327 70 5 SBE Se ase es 2520 Ota ee Wiasiimetone 22-242 | 30 67 172 44 26 AS ere Weacage 891 53 Wiest) Varginias =.= 2.22. 114 71 203 4] Pail AST ee. Sau ARGO ia tee ae VAS COIMGIN sss 25 67 259 65 28 Bihal eee 2, 088 5g Waviormin ose oS ete 15 12 49 a 5 11 1 338), eae ee AGNES RGN SO ed aa ae 17 67 586 19 ‘ial... ee ene ee Ubi Ror ee ea 1S Nee eae We 49 44 19 14 TO isl Wass SSL ioe ees ee AUICRUOMEVICOR es Nase 316 191 317 42 35 Bil 6 2400 ee See Warciislands. = 2 = =i. 14 8) 6 19 3 ii | ed yd eres | Pe rae 1 Includes $2,528,312 in cash and $1,121,390 in services and supplies for rapid treatment facilities and soe venereal disease projects. Does not include expenditures of federally operated center in Hot Springs, rkansas. 2 Includes payment of $537,000 from special appropriation for Alaska disease and sanitation investiga- tion and control. 3 This amount represents $1,093,193 for construction of community facilities in defense areas and $20,223 for industrial waste studies. Excludes $2,500 paid to Interstate Commission on the Potomac River Basin for industrial waste studies. 4 Payment for construction of community facilities in defense areas. 5 Payment for industrial waste studies. 6 Vermont allotment paid to Vermont Heart Association. 158 Department of Health, Education, and Welfare, 1953 Table 5.—Number of nurses employed for public health work in the United States on January 1 of specified years, by type of employing agency Agency 1938 1943 1948 1953 PT bead b ese es Es Po tea ae eee 19, 502 20, 772 22, 605 25, 990 S TALC AGENCIES! se een A eg ale ee an ie reer ete ae 827 886 1, 003 1, 355 Local official: agencies 5s se ei ea ee 8, 702 10, 731 11, 171 12, 476 Bocaliboards ofeducation 25 0. eae ee eee 3, 887 3, 786 5, 019 2 6, 860 Tocalmonotiiicial-agencies 2-3. Eee ee ee a ee ee 5, 963 5, 156 5, 057 4, 512 Schools-ofnursing=-s-saete st Sr ee ee ee ee | ee ee ene 133 217 Colleges.and universitics (nonnursing)_~ . 2-22-20) tee So |e eee eee 87 National agencies and universities......_---._------------------ 123 213 222 483 1 Excludes nurses employed by industry. 2 Includes District of Columbia school nurses for 1953 only. Office of Education I. Introduction THE YEAR 1953 was in many respects a landmark year for the Office of Education and for American education generally. With the creation on April 11, 1953, of the U. S. Department of Health, Edu- cation, and Welfare, the word “education” has come to appear for the first time in American history as a part of the title of a cabinet- level department of the Federal Government. A new cabinet Depart- ment and a new Secretary have entered the American scene: the Department—and the first Secretary—of Health, Education, and Welfare. The true long-range significance of this development—significance for the American people and for the strengthening and improvement of their schools and colleges—is something which must unfold with the years. It is much too early to attempt any definitive evaluation. At the minimum, however, a voice for education at the cabinet level has been achieved, and the problems—and opportunities—of Ameri- can education are assured of sympathetic consideration in the highest councils of the Executive Branch. The year 1953 was significant also as a period of re-examination and re-evaluation. It was a time for stocktaking, and the charting of new directions—in education as in many other areas of human activity. What are the strengths and weaknesses of America’s schools and colleges? How can they be strengthened and improved to meet the ever-increasing needs of mid-twentieth century America? Are the educational facilities and practices of earlier years adequate to the demands of the new technology of jet propulsion and nuclear fission? Are we training enough scientific, professional, and tech- nical manpower—and womanpower—to meet the challenge of a 159 160 Department of Health, Education, and Welfare, 1953 I a oe og th en Ear AIR ae NO RSA SS divided world? How can the resources of the Federal Government best be applied toward the development of solutions to major national educational problems, while at the same time the values and benefits traditionally associated with State and local control of education are safeguarded? These are the sorts of questions with which the Office of Education and the Department of Health, Education, and Welfare were concerned during the fiscal year 1953—questions which must be of concern to all Americans alike in 1954 and beyond. EDUCATION AND THE BUILDING OF AMERICA If it be true, as has been said, that America is built upon faith, then one important element of that faith is the faith of the American people in education. Among the early English colonists the first com- munity undertaking in each settlement—with the possible exception of the church—was the colonial school. This was no accident. The colonists believed firmly, as succeeding generations of Americans have believed after them, that the political freedom which they sought could be made secure only through widespread popular education. Said Thomas Jefferson, “If a nation expects to be ignorant and free . . . it expects what never was and never will be.” This basic idea—that only the educated man can be truly free, and that self-government is possible only with an educated citizenry—per- vades all early American history and underlay all of the deliberations of the Constitutional Convention. It is not surprising, then, that one of the first acts of the young Republic was the reservation and dedi- cation of the sixteenth section of every township of land in the newly opened Northwest Territory to educational purposes. As a part of the Northwest Ordinance of 1787 the Congress made the clear decla- ration of policy that— . . religion, morality, and knowledge being necessary to good government and the happiness of mankind, schools and the means of education shall forever be encouraged. Implicit in the Northwest Ordinance and subsequent similar legis- lation is the recognition of a valid national interest in the promotion and encouragement of education, a national interest which may at times transcend the more limited interests of the individual States. At the same time it is equally clear that the framers of the Constitu- tion intended to leave strictly to the States and the local communities the control of their own educational institutions, since there is no ref- erence to “education” in the delegation of powers under the Constitu- tion, and the Tenth Amendment provides that the “powers not delegated to the United States . . . are reserved to the States respec- tively, or to the people.” On these two foundation stones—State and local control, with Fed- eral assistance and support where the national interest requires—has Office of Education 161 been built an educational system—or systems—which is unique in the truest sense of the word. Avoiding on the one hand the extreme centralization found in many ministries of education abroad, where education is literally “handed down from above”—and on the other, the evils that would be inherent in a “do-nothing” Federal policy concerning national educational problems—there has evolved a coop- erative local-State-Federal partnership in education, the key to which is found not in competition among jurisdictions, but in collaboration among equals in the larger interest of the Nation as a whole. For the past 86 years, the principal arm of the Federal Govern- ment concerned with the well-being of the American educational sys- tem as a whole has been the United States Office of Education, now an integral part of the new Department of Health, Education, and Wel- fare. As the central educational agency of the Federal Government, the Office was established originally in 1867 for the purpose of . collecting such statistics and facts as shall show the condition and progress of education in the several States and Territories, and of diffusing such information respecting the organization and management of schools and school systems, and methods of teaching, as shall aid the people of the United States in the establishment and maintenance of efficient school systems, and otherwise promote the cause of education throughout the country.* From time to time during the intervening years, the Congress has responded to recognized national needs by authorizing further pro- grams of Federal assistance and support in certain specialized areas of education where the national interest has required. Thus, when it became clear in the latter 1800’s that the national interest required a kind of college or university less bound by the classical academic cur- riculum, the Congress passed the two Morrill Acts (1862 and 1890) through which each State was led to establish at least one college to provide instruction in agriculture and the mechanic arts. Similarly, during the early 1900’s it became clear that the typical high-school program was too exclusively academic and _ college- preparatory in character, and that modification of the program in the direction of better vocational education would be in the best interest of the Nation. In response to this recognized need, Congress passed the Smith-Hughes (1917) and related acts, providing Federal funds on a matching basis to the States in support of improved vocational education. More recently the Congress has acted to provide Federal assistance to local communities in meeting another educational need which would otherwise have been beyond the resources of these communities. This is the program of assistance to school districts in areas where Federal activities have resulted in an increase in school enrollments and a de- 114 Stat. 434. 162 Department of Health, Education, and Welfare, 1953 crease in the local tax base through Federal property acquisition. As- sistance in school construction in such areas has been provided under Public Law 815 and assistance in school operation and maintenance under Public Law 874 (81st Congress, Second Session). Further dis- cussion of this program, as well as others in which Congress has authorized Federal assistance in response to recognized national needs, is found in succeeding sections of this report. LEGISLATION AFFECTING EDUCATION DURING FISCAL °53 Legislative developments affecting education during the period July 1, 1952, to June 30, 1953, may be grouped conveniently into two cate- gories; namely, those associated with the latter portion of the 82d Congress, on the one hand, and those associated with the incoming Eisenhower administration and the first session of the 88d Congress on the other. The principal piece of legislation affecting education which was passed in the latter days of the 82d Congress was the “Veterans’ Read- justment Assistance Act of 1952” (P. L. 550, 82d Congress, Second Session, approved July 16, 1952) which has become better known as the “Korean GI Bill.” Under this Act the Commissioner of Educa- tion was assigned three new statutory responsibilities: (1) the pub- lication of a list of nationally recognized accrediting agencies or as- sociations for the guidance of State-approving agencies in approving or disapproving training courses under the veterans educational pro- gram; (2) advice to the Administrator of Veterans Affairs concerning the system to be used in approving veterans training courses; and (3) service ex officio as a member of the statutory Advisory Committee to the Veterans Administrator on educational and vocational assistance under the Act. The functions being performed in carrying out these responsibilities are described elsewhere in this report. With the inauguration of President Dwight D. Eisenhower on Jan- uary 20, 1953, the new administration began at once to turn its atten- tion to some of the major problems confronting American education. In his State of the Union Message on February 2, President Hisen- hower touched upon some of these problems in the following lan- guage: Our school system demands some prompt, effective help. During each of the last 2 years, more than 1144 million children have swelled the ele- mentary and secondary school population of the country. Generally, the school population is proportionately higher in States with low per capita income. This whole situation calls for careful congressional study and action. I am sure you share my conviction that the firm conditions of Federal aid must be proved need and proved lack of local income. One phase of the school problem demands special attention. The school population of many districts has been greatly increased by the swift growth Office of Education 163 of defense activities. These activities have added little or nothing to the tax resources of the communities affected. Legislation aiding construc- tion of schools in these districts expires on June 30. This law should be renewed; and, likewise, the partial payments for current operating ex- penses for these particular school districts should be made, including the deficiency requirement of the current fiscal year. In addition, President Eisenhower indicated that he expected to send to the Congress shortly a reorganization plan defining new ad- ministrative status for all Federal activities in health, education, and social security, as well as recommendations for establishing a commis- sion to study the proper relationships among Federal, State, and local programs. On March 12, 1953, the President transmitted to the Congress Reor- ganization Plan No. 1 of 1953, proposing the creation of a Depart- ment of Health, Education, and Welfare as one of the executive de- partments of the Federal Government, to which would be transferred the various components of the then Federal Security Agency, includ- ing the Office of Education. The plan reserved to the Office of Educa- tion, or to the Commissioner, the professional and substantive re- sponsibilities vested in them by law, and also specifically provided that the Commissioner of Education (as well as the heads of the other major constituent organizations) should have direct access to the Sec- retary of the new Department. The President also included in his message transmitting the plan to the Congress, although not as a part of the plan itself, a recommen- dation for the establishment, by statute, of a special advisory body to the Secretary on problems of education. Said the President : There should be in the Department an Advisory Committee on Educa- tion, made up of persons chosen by the Secretary from outside the Federal Government, which would advise the Secretary with respect to the educa- tional programs of the Department. I recommend the enactment of legis- lation authorizing the defrayal of the expenses of this Committee. The creation of such a Committee as an advisory body to the Secretary will help insure the maintenance of responsibility for the public educational system in State and local governments while preserving the national inter- est in education through appropriate Federal action. Following approval by both Houses of the Congress, Reorganiza- tion Plan No. 1 was signed by the President as P. L. 18 on April 1, 1958, and the new Department came into being 10 days later, as pro- vided by the law, on April 11, 1953. Plans for the Advisory Com- mittee on Education proposed by the President are being developed currently. Legislation to carry out the President’s State of the Union Mes- sage recommendation for a commission on Federal-State-local govern- 164 Department of Health, Education, and Welfare, 1953 mental relations was introduced by Senator Taft on April 1, 1953, as S. 1514, a bill to establish a commission on governmental functions and fiscal resources. With certain modifications, this bill was enacted as Public Law 109? providing for the establishment of a 25-member Commission on Intergovernmental Relations. This Commission is responsible for studying the proper role of the Federal Government in relation to the States and their political subdivisions in all fields involving intergovernmental relations, including the field of educa- tion, and the Commission is required to submit a report and recom- mendations to the President and the Congress concerning the alloca- tion of governmental functions to their proper jurisdiction and the adjustment of intergovernmental fiscal relations among the various levels of government. The act specifies that the report and recom- mendations of the Commission shall be submitted not later than March 1, 1954. A related measure is the act providing for the establishment of the “new Hoover Commission,” known officially as the Commission on Organization of the Executive Branch of the Government.* This 12- member Commission is charged with the responsibility of studying and investigating the organization and methods of all Government instrumentalities, including those operating in the field of education, for the purpose of proposing to the Congress such changes as may be necessary in the interest of economy, efficiency, and improved service in the transaction of the public business. The Commission is to submit a comprehensive report of its activities and the result of its studies to the Congress on or before December 31, 1954. The principal substantive legislation of the First Session of the 83d Congress specifically relating to the field of education was the extension for 2 years of the program of school assistance in federally affected areas, as recommended by President Eisenhower in his State of the Union Message and elsewhere. Developments pertaining to this program are discussed in section II of this report. Other items of educational interest from the First Session included Public Law 226, which granted the consent of the Congress to certain Western States, Alaska, and Hawaii to enter into a compact relating to higher educa- tion in the Western States and establishing the Western Interstate Commission for Higher Education; and Public Law 141,° which authorized “book rate” postage for the transmittal through the mails of educational films and related educational materials. 2 Approved July 10, 19538. 3 Public Law 108, 83d Congress, approved July 10, 1953. 4See also Third Annual Report. > Approved August 8, 1953. 6 Approved July 20, 1953. Office of Education ee entenes 168 PROGRESS AND PROBLEMS The American people are today doing more than they have ever done before for the education of their children. Individually, and through such organizations as parent-teacher associations and lay citizens groups, they are working ever more actively for better schools and im- proved educational programs. PTA’s throughout the country now have nearly 8 million members—nearly double their membership in 1946. Furthermore, during the fiscal year 1953, American citizens taxed themselves approximately $500 million more to provide for their schools than during fiscal 1952. They spent about $7.8 billion in fiscal 1953 alone to operate public elementary and secondary schools and to put up new buildings. Major credit for these gains rests with the thousands of local com- munities and the millions of interested citizens who, in accordance with the long-established tradition of State and local control of educa- tion, are carrying the principal responsibility for the management of their local schools. The vigor and vitality of this tradition is a source of continuing strength to mid-twentieth century America. Encouraging as this record of progress may be, however, it is clear that the year 1953 is no time for complacency. Many States and local communities are struggling with educational problems which extend far beyond their boundaries or beyond their available resources, but which still require prompt and workable solutions. And experience indicates that educational problems which are unsolved or imperfectly solved in the States and local communities have a way of becoming national problems as the national interest itself becomes imperiled. Among the major educational problems being faced in varying degree across the Nation at the present time, the following are perhaps the most widespread and the most urgently in need of solution. The best collaborative efforts of all our citizens—individually and in groups—and all our organizations—public and private, local, State, and national—will be needed if American education is to meet the challenge, and rise to the opportunities, which these problems present. The need for more and better schools—School construction is not keeping pace with classroom needs. The United States is short right now more than 340,000 public elementary and secondary school class- rooms. Furthermore, increased enrollments (see chart 1), building deterioration and obsolescence will create the need for more than 400,000 classrooms by 1960. Three classrooms out of every five are overcrowded. One out of every five pupils across the country is going to school in a schoolhouse which does not meet minimum fire safety conditions. 166 Department of Health, Education, and Welfare, 1953 Chart 1.—ENROLLMENT IN PUBLIC ELEMENTARY AND SECONDARY DAY SCHOOLS, 1920—60 (DATA FOR 1952 AND LATER ARE ESTIMATES BASED ON NUMBER OF ACTUAL BIRTHS THROUGH MARCH 1953) ENROLLMENT (MILLIONS) 40 [+ ESTIMATE 30 ee eee eoeeeae eee eee e@eose ees eoeceeees ° eeoeeveeee e eoee coee ee eee oe eo ee ae wecerererater GRADES 9-12 RN eee OOOO RCO: C) Wpetrterans scutes tstataher ethene stateless atm eter en CU FB. cee ww owe ae eee ae ee © SO Coe ee oo Beer ecata tate etatatatatata’stetatatetoteratetersrecerececece ores HTH TTT TTT i diliee Soe se Sioletatseteteteta’statatatetscatesststerstonsterstere crotstote srs MMMM THAI EM LELgaiNlee essere celelelelelelelelelelelelelelelelelece SaSMeMllTHHHHHHHHHHHH THe eccezes ; secoleeseseestatenetetaratetetetetetetaretats ee etetptetet star otener sce) dre, tome «on anieara erate Rea’ osaleielo"s suneeecenererersastast en Cee ere Tecere OL Urere ere e amere renee selelelelelelelelelelelelecelecerelsieitctetetetetetetetetetotetatezetetetatetetattetstotetetetstetstetetets delecelepalolelalejeselstsceracelaecelecesneacnstaratatatatetetptars stat atefate taper satatetataeer esting seleleleleceletelelececeleleleleseierelestasstetetetetetatstatetetstetetetets Meee cecelelelececetetetelelelelelelelelelesetatetetetetetstetatatatetetetetetets celeleleleleleleleleleleleleceleleleleisctetctatetetetatatatetetetetetetetsts Phe xesetetececetecececeleleleseleleleleseceselerececsceleatatatasstetctatetatats xecececececetecececearatatatatetatetetitatetetetetetetetetatatetetetetetstets celececeleleledeleleleleleleleletefetelececececececeseatatatetatetetetatatets 90 eee 0 6 0s 0 toe 00 6b 0-6 6 ons (ore here retetarer erator eneipienete welecececececececratacatatscatecatstetatetatetetetetatetetetstetstetetatatatate’ stetetetetetetatecetstetatetetatetstetsetersteshnetstetaaatannenes staslslececececedecedelelelelelesesecestatetetetetetatatetetetetetetetetatatatetstetetetatatatetstetetetetetatetetstetatetetetatateretstatetetate’s wtltleleleletelelelelelelelelelelelesetesecesececceretatetatatatetstetatetatatststetstetatetetetetetststetetetatatetstscstetetetatetstststetetatats @eeeeeeesee tC eeeeeoee se of F&F FF FFF FirInINRK DF ADTEOAL AAIM.°.%°.% °. 2&9 © © © e@ © © eo eo eo wo eo woe ew Oe Oo wtotetetetetetatoteretetetereterecorsters’ KINDERGARTEN ANDsis\srerete’ erste 'ctetatorete-e) gees mene semua ceeeeeeeeeeseeeeeeeee eo © © © © © 6 &@ @ oT RENEE NE ES ENS @eeeeeeeeeeeeereeeeeveee eee eeeese ceeeeeeeeeeoeeeeeeeeeeereeeevreeeee PF AFAAMNMOCC 1.0 * * eee eC eo ow wwe eereeeseeeeeeeeeeeeeee A rea eas otatetets GRADE SLING “stotete tats totetet oto tetcceteretens lane rele sue ee eee en BumeE i ee ee Oe ee ee oe ee ee ee oe ee ee ee ee ee ee Oe 2 2 ee dia ia Oe Oe Oe Oe Oe Oe Oe Oe oe Oe Oe Oe ee ee ee ee ee ee ee ee ee ee ee he er eer ee Piehatstatctatereta* ate’ ore eters etn’ stele tetein, oc aisle Ris she ohare, a inee mc eeu icei acer ce ea ee a athtetatate’ grata int alter el platslangt slate ’ate Weuetoetuanerate erate ate ie ts statics s°e cceen came nn pectacetehe statatdrerstaraarat Chatetste tore’ dig a?bts un ate auger ig ancranc rena tauees ieee se a eaters netetelsiciol statin eterna enpnerneetstntea tet ehaiatatgrd he ates ale yo dnos6 jouoljodns 3.0 solow Aq pup aoupjda2op yo Ayijiqnsip yo sadAy Aq ‘spunjisiqoyas yo yuarseg %9! SOIAN3S TYNOIS %O1 TWNOISS IWISN39 VN S34OUdIN |S 340d rr! TWOSIA LE? LNAWYIVdWI %6! YSHLO TV %el NOILVLINdGWY SSILINGVSIG SdNOUD IVNOILVdNDIO YOFVW GNV S3ILITIGVSIG——"L HPYD 4 246 Department of Health, Education, and Welfare, 1953 ET ae ett GE EER PET EE eC SN rehabilitation. Accounting for 41 percent of the disabilities, amputa- tions and other orthopedic impairments together made up the largest single disability category. About 20 percent of those with orthopedic disabilities became disabled as a result of three major chronic dis- eases—poliomyelitis, arthritis, or osteomyelitis. More than 40 per- cent were disabled in accidents, and the remaining 40 percent had dis- abilities that were congenital or that were the result of other diseases. Chart 1 also shows the distribution of occupations in which the dis- abled men and women rehabilitated in 1953 were placed. It is signifi- cant that 28 percent of them became skilled or semiskilled workers, and that 10 percent of them entered professional, semiprofessional, or managerial occupations. Only 7 percent of them were placed in unskilled work. The average age of those rehabilitated in 1953 was 24 at the time of their disablement, and 34 at the time they were accepted for service. The gradual increase in the average age at the time of acceptance con- tinues as a clearly defined trend. Sixty-four percent of those rehabili- tated were men. Of the disabled persons rehabilitated in 1953, 31.1 percent were referred by physicians, hospitals, or other health agencies; 14.1 per- cent were referred by public welfare agencies; 11 percent applied for help on their own volition; and 8 percent were referred by State Employment Service offices. Those who received physical restoration accounted for 42 percent of the men and women rehabilitated in 1953. ‘Twenty-nine percent were provided with training, and 9 percent received both physical restora- tion and training. All received guidance and counseling. THEY PAY THEIR OWN WAY From the purely economic standpoint, vocational rehabilitation enjoys the unique distinction of being a social program that pays for itself many times over. More than three-fourths of the disabled men and women rehabili- tated during 1953 were not employed at the time that rehabilitation services for them were begun. Twelve percent of the 61,308 persons rehabilitated had never worked in their lives. Those who were em- ployed were generally working in jobs that were unsafe for them, tem- porary, or otherwise unsuitable. The combined earnings of those rehabilitated during the year were increased 553 percent by their vocational rehabilitation. Mention already has been made of the estimated $10 million a year in Federal income taxes which will flow back into the Federal Treasury from this group of disabled men and women. It is worth repeating that, dur- ing their working lives, they will pay in Federal income taxes alone more than $10 for every Federal dollar invested in their rehabilita- Office of Vocational Rehabilitation 247 tion. With their ability to work restored, they pay their own way—many times over. Rehabilitation in the Nations Capital During the past fiscal year the District of Columbia Rehabilitation Service, which is administered directly by the Office of Vocational Rehabilitation, restored 333 disabled men and women to useful work. Twenty-six of these are blind. At the year’s end 908 disabled persons were receiving rehabilitation services, of whom 101 are blind. Estimates of the annual earnings of the men and women rehabili- tated prior to the time they were provided with services and after their placement in paid employment indicate an increase of 1,700 percent— one of the highest on record. Before their rehabilitation, these 333 disabled men and women were earning at an annual rate estimated at slightly more than $40,000. After their rehabilitation, their annual earnings were estimated at a total of more than $750,000. The 26 blind persons who were rehabilitated now earn $57,148 a year. The 60 vending stands operated in the District by blind persons rehabilitated under the program did a total gross business of $1,821,868 during the year. They provided employment for 72 blind men and women, whose combined income from the stands was $300,238. Twenty-one severely disabled patients of the District of Columbia General Hospital (formerly known as Gallinger Hospital) were reha- bilitated during the year, and 120 others were receiving rehabilitation services at the year’s end. Thirty of these who are in process of reha- bilitation are out-patients. Since the cost of a hospitalized patient is $14 a day, the program has effected substantial savings at this hospital. The Rehabilitation Service has one full time counselor located at Saint Elizabeths Hospital, functioning as a member of the profes- sional teams which provide treatment and service to mentally ill patients. The counselor—a clinical psychologist by training—is able to see the patients during the latter stages of their treatment, and help prepare them for restoration to the community. The 30 patients of the hospital rehabilitated under the program during 1953 were costing the taxpayers more than $53,000 a year. Work done by this counselor during the past 2 years supports the con- clusion that the addition of a second counselor and one secretary would make possible the rehabilitation of at least 100 patients a year. This would be the equivalent of the current annual increment of the hospi- tal’s patient population, and would result in savings of more than $178,000 a year. Improvements effected by the Rehabilitation Service during 1953 will result in savings in cost and in better service to the disabled. One of these is the development of a psychometric unit for administering 248 Department of Health, Education, and Welfare, 1953 psychological tests that formerly had to be purchased in the com- munity, or given by counselors. Better service to the blind, through suporcniies for erployiane under sheltered conditions, will result from the expansion of facilities for rehabilitation at the Columbia Polytechnic Institute. Rehabilita- tion of the deaf will be benefited by improved facilities for testing hearing and fitting hearing aids installed by the Washington Hearing Society. The George Washington University Medical School is establishing a pilot study to integrate the concept and skills of complete medical rehabilitation into its curriculum. A rehabilitation counselor has been engaged by the Hospital to provide liaison between the Rehabili- tation Service, the University, and other agencies in the District which can contribute to the rehabilitation of the disabled. Helping Our Friends Abroad The Office of Vocational Rehabilitation continued to play a leading role in developing basic philosophy for the increasing world-wide interest in vocational rehabilitation. In cooperation with the Office of International Relations of the Department of Health, Education, and Welfare; the Department of State; the United Nations; and the United Nations Specialized Agencies; it planned and supervised train- ing for more than 100 visitors from 25 Nations. The effectiveness of this work is borne out by repeated requests from other countries for inclusion of additional trainees in later training plans, and by the remarkable progress in rehabilitation that some countries have made within short periods after their first trainees have returned home. As a member of the Interdepartmental Committee on Interna- tional Social Policy, the Office of Vocational Rehabilitation has responsibility for developing materials on rehabilitation, health, and welfare programs in other countries for use by the Department of State in its work with the United Nations Secretariat, the Economic and Social Council, and the Social Commission. An example of the materials made available to foreign nations is the motion picture, “Comeback,” which was produced for the States by the Office of Vocational Rehabilitation. Prints of this film were made available by the United States Information Agency for distribution in 36 countries. Office of Vocational Rehabilitation 249 Table 1.—Number of referrals and cases, by agency, fiscal year 1953 (Corrected to October 1953] Referrals Cases During fiscal year During fiscal year Agency ! 1 ips pane daar a Re- main- main- Mes aot ing at Closed ing at Total sit? ted | ceptea | end of | Total ——_| end of Mee ites cs year, © (ssatved ee Unem-| Other | Year ° ilitated|ployed 4|reasons 5 United States, total. _|249, 372 | 84,397 | 77,897 | 87,078 \7 221,847 | 61, 308 5, 771 | 21,069 | 133, 173 LO Ss as 6,352 | 2, 266 531} 3, 555,1 6,903 | | 1, 756 235 374 4, 528 hie cai pelea 162 79 6 UT 90 5 0 0 85 Arizona: Groneraees 8 eee 946 261 252 433 555 180 37 18 319 LEUNG ley en 272 42 158 72 84 30 4 2 48 PMERONSAG] aie oo sk 4, 921 1, 691 1, 541 1, 689 4, 207 1, 135 61 553 2, 452 @Walifornias=- =! -_ See A 3 25, 072 4,446 | 16, 412 4, 214 | 12 406 2, 905 1, 005 1, 535 6, 952 Colorado: Generale. 2. ere elk 1, 509 703 383 423 1, 534 451 42 157 813 LEDEC OY oe eal I Se 5 le a 209 58 11 140 147 50 0 7 89 Connecticut: ipeGeral 2 br -.-..-8 2,256 | 1, 298 365 598 | 3,528 922 92 319 2, 180 LBS Shave Le 3 ota a a te 163 76 48 39 185 60 14 10 101 Delaware: Genmerdises. Fo 42 1,017 572 341 104 | 1,298 447 31 102 718 LL 5 28 17 11 68 19 10 2 33 oe of Columbia________ lara §24 824 387 1, 408 333 64 103 903 orida renetale=ssse eel kS 4, 926 1, 893 1, 455 1, 578 5, 993 1, 318 150 765 3, 728 Meee ek 3, 201 323 | 1,885 993 859 237 42 28 546 (Gporgiavtte 2k ae 21,320 | 5,359 |, 4,569 | 11,392 | 13,143 | 3,914 835) 25253 7, 624 Hawaii: ~ : Genera e226 oe Le 1322 250 137 935 766 198 71 14 481 Meg ee 2 | 83 47 14 22 116 28 0 12 76 Idaho: (Chinen: A ree 1, 333> 185 493 655 432 149 2B} 14 242 TS a6 Uk ee 8 12 19 7 48 9 14 5 20 DO SS es 7,035 | 4, 595 951 1,489 | 10,518 | 3,812 170 578 5, 936 Indiana: (ClaSTY eins) | ee er 2, 804 1, 486 669 649 4, 487 1, 049 81 332 3, 010 Lithath J. Sa ae 154 84 14 56 274 70 13 i 177 Iowa: (GiGi aVee eee ee 3,461 | 1,147 OSs Le SS4a le? 7a 760 47 267 1, 697 Mawes eee a ee 178 21 73 84 92 27 12 1 52 Kansas: @enerabs....-S.._-__-s 2, 646 826 857 963 | 1,891 604 45 146 1,091 linea es aa Lk 206 83 75 48 163 48 11 10 93 LGN OATS (le So rr 2, 670 909 641 1.1200 (02 427 660 23 367 1, 372 Louisiana: iremerar..--- Je. ---.--2 3,911 |. 1, 538 801 | 1,572 | 4,846} 1,300 66 289 3, 180 SU ibavOle.\ eee ee eee 693 134 116 443 477 90 5 34 348 Maine: | Generel 2. 2 1, 230 342 310 578 886 218 31 108 526 TESIVOG be 2 ee a 79 23 Bil 25 82 19 9 1 53 2 OS 4,281 | 1,500 | 1,155) 1,586| 4,288) 1,001 109 589 2, 582 Massachusetts: Co o> i ae 3,801 | 1,022 975 | 1,804] 2,470 712 41 137 1, 577 MliMGee re te 321 141 57 123 142 4] 0 5 95 Michigan: enerah 22 ek 7,297 | 2,899 | 1,793 | 2,605 | 10,389 | 3,100 486 307 6, 490 i 396 237 84 487 142 32 56 253 Minnesota: eS CAS. ne 4,377 933 | 1,768 | 1,676 | 3,276 749 67 183 2, 274 ol Se re 343 151 130 62 403 125 0 55 221 Mississippi: et a ee Fe 3) US 586 | 1,218 | 3,148 913 38 136 2, 047 Co ee en 350 197 94 59 499 145 10 13 328 Missouri: feeorele ob 3,280 | 1,632 | 1,186 462 | 4,226 | 1,178 128 883 2, 034 mpm 336 148 74 114 465 121 28 20 291 Montana: ea ae 1, 212 406 357 449 | 1,096 381 9 51 649 eli ellie 137 20 85 32 75 9 8 5 52 Nebraska: ont lh ae 994 609 143 242 | 1,514 571 28 20 892 rae 173 26 65 82 105 31 2 6 66 RR Peis fee Soci 242 67 145 30 188 63 0 27 98 See footnotes at end of table. 293171—54—_—-1T7 250 Department of Health, Education, and Welfare, 1953 in AE EP CE TN NRO REDUCE Table 1.—Number of referrals and cases, by agency, fiscal year 1953—Con. [Corrected to October 1953] cw Neg ME eo a a Na Referrals Cases During fiscal year During fiscal year Re Agency ! in- pe Ac. | Not ane Closed old Total | cepted a q| end of | Total |— ———-| en ok Ors or | C&PtCC | vear 3 | served Reha- | Unem-| other | year $ SerViCES corvices? bilitated| ployed 4/reasons 5 Hampshire: 4 Breen See CU eae oe 529 192 202 135 442 100 15 115 210 Bind ee ee 59 39 10 10 74 17 0 3 a; a Jersey: E Bee eee ala) I eee 2,688 | 1,189] 964] 535] 3,148) 887] 36| 911 1,807 Blinds wobe tok 434 172 174 88 475 111 25 19 315° Mexico: on a Salat Ay HRS way 4 933 240 311 382 661 213 8 24 415 Blinds eee ee ae 104 39 25 40 88 20 1 : ie w York BER Set eb diet 11, 561 | 7,536 | 2,280] 1,736 | 15,840] 4,114] 398] 9 ea7| 9,437 Hine eae 972 370 201 401 842 26 65 6 478 h Carolina: Saks Ske pas lk Mee 6,313 | 3,009] 1,797| 1,507] 7,523 | 2,450 s6| 805 | 4,178 Bind boc ae oe ja a 462 449 260 | 1, 551 299 18 126 1, 102 North Dakota--._...___---- 1, 038 282 295 461 686 207 17 42 414 hio be Generaae sae eee 4, 225 1, 352 1, 274 1, 599 3, 351 1, 154 57 928 1, 905 Bind. Oto eae 510 192 128 190 771 165 41 48 517 Olsiahomack.. ok keke ie 4,018 | 2,275 887 856 | 6,053 | 1, 284 41 598 4, 129 Oregon Generalec: 2a ee eee 4, 816 831 | 1,726 | 2,259) 2,521 562 59 345 1, 550 Blinds Vee ee Pe 153 43 67 43 161 31 6 21 102 Pennsylvania: Gonérahuie se. sense 14,198 | 4,681] 4,799} 4,718 | 10,670 | 3, 493 106 | 1,343 5, 689 Blind vet Bey ea as 2, 431 §21 873 | 1, 037 1, 391 218 46 139 981 Puerto Rico! oA b wee ee 4, 539 1, 188 1, 264 | 2,087 | 2,695 737 56 159 1, 741 Rhode Island: Generalist seu eee 878 347 308 223 1, 057 317 52 66 622 784 ot co Lae ser Or ume eM eo 44 40 2 2 181 21 0 7 149 South Carolina: rs aV si es | ee ee ee 5, 141 1, 801 1, 585 1,755 | 4, 863 1, 580 68 268 2, 935 Blinds 2 a Ae aes 335 128 123 84 276 3 35 142 South Dakota: teneral see hae eee 522 197 38 287 675 135 1 42 493 BB Uh Ea Ts Ox ease ita fe del 97 29 22 46 71 22 0 17 32 Tennessee: Generale 2) see ae 4, 875 1, 997 1, 414 1,464 | 4, 5386 1, 692 95 221 2, 526 Biindew as Lee per ee 705 161 186 358 564 8 14 23 427 Texas GenGralico a ee ee ee 9, 906 2, 928 2, 331 4, 647 9, 554 2, 080 120 663 6, 670 ULM Cites hs wore Sei 1, 497 301 652 544 801 260 25 50 ita eee Oe, Vl Caer eee ee Lz 380 299 491 1, 091 290 14 22 763 Vermont General = eri eure ae 558 165 237 156 492 142 23 73 252 IBNindeee eee ee sa 60 19 19 22 71 20 2 2 45 Virginia Cronerslues --ees 23s 9, 291 3, 019 3, 751 2, 521 6, 320 1, 832 64 929 3, 471 Bind: ase ere 202 71 94 3 135 4 31 9 Washington: Generale 220 ae eae 5, 278 1, 263 1, 126 2,889 3, 600 1, 005 84 196 2, 306 BiG. soe ee Alte 103 45 23 35 217 31 7 2 150 West Virginigy tiers. 2 11, 105 2, 614 3, 179 5, 312 7, 126 1, 655 85 1,171 4, 206 Wisconsin: General? 222 eee 3, 311 1, 505 691 1, 115 4, 982 1, 333 147 72 3, 423 Bain Ss ee ees eee 8 259 8 108 89 62 327 80 15 21 207 Wyong? ce. ee wr ee 928 181 367 380 510 168 12 18 310 1 In States which have 2 agencies, the agency under the State board of vocational education is designated rt ee and the agency under the State commission or other agency for the blind is designated as 6 in 37 2 Services declined, services not needed, individual not eligible, individual needing services other than vocational rehabilitation, referred to other agencies, migratory shifting of the individual, ete. 3 Hligibility for rehabilitation not determined. 4 Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabili- par rehew but never reached the point of employment because of personal factors, illness, aggravated isability, ete. 5 Closed prior to initiation of rehabilitation plan, because of indifference of individual; probable increase © in degree of disability; loss of contact; etc. 6 In process of rehabilitation on June 30, 1953. : Pe cee total cases served include 526 cases transferred to other agencies, justed., / Office of Vocational Rehabilitation 251 Table 2.—Total program expenditures from Federal and State funds for voca- tional rehabilitation by State boards of vocational education, fiscal year 1953 Classification of Federal and State funds expenditures State or Territory purine giles and vocationa Total Federal State guidance and | F urchased placement services services igialens ee ee ce at $31, 126, 311 |$20, 406, 115 |$10, 720, 196 $11, 520, 723 | $19, 605, 588 VS) a STE a I nes 901, 564 579, 855 321, 709 309, 745 591, 819 ou ESSE | eS 2 ee 144, 831 94, 770 50, 061 46, 485 98, 346 Pees ese eet ere sen 545, 489 364, 259 181, 230 183, 029 362, 460 Me ANUIORIIOS ee 8 oe ek 2, 487,377 | 1, 671, 053 816, 324 971, 920 1, 515, 457 MRAP AM OMe bee kere en 187, 842 133, 042 #54, 800 89, 812 98, 030 eemivecricUtee= =) 5 bse ieee 404, 482 276, 952 127, 530 176, 200 228, 282 MMClaW alOd tte fore ene oe Soe belt foal. 194, 193 126, 217 67, 976 79, 406 114, 787 LY oye (GIs 2 SAE 0 eS a he 829, 264 551, 249 278, 015 277, 237 552, 027 A ae ne en 2, 413, 493 | 1, 486, 957 926, 536 720, 971 1, 692, 522 TNO Ss ei 2 ee ee 71, 816 48, 392 23, 424 24, 968 46, 848 Cc ELSES UR ete ge a 1, 965, 656 | 1, 263, 908 701, 748 645, 384 1, 320, 272 aren nee ete Le 498, 801 328, 106 170, 695 167, 997 330, 804 LGA 5 oe Sa a a ae 409, 556 275, 843 133, 713 164, 791 244, 765 aa iinasare pe eee ao ek 270, 785 182, 845 87, 940 94, 904 175, 881 SVT TG en ae ais 5 A ee a 229, 409 146, 393 83, 016 108, 977 120, 4382 Uhh 5) TG Ape DI ees Pace ee 658, 398 426, 471 231, 927 304, 989 353, 409 lea et nee ere eae 118, 138 77, 933 35, 205 42, 727 70, 411 0 ea 509, 467 315, 293 194, 174 241, 781 267, 686 Wradsachtsettse.)-— 2. .22.----2-1-2_--- 376, 643 226, 599 150, 044 177, 973 198, 670 ES 1, 352, 753 932, 245 420, 508 522, 942 829, 811 “ASSP DECOR Le Se re 385, 027 253, 416 131, 611 144, 450 240, 577 SS SE BS eee ee ae 489, 335 299, 530 189, 805 197, 001 292, 334 i RU Ta ae A ee 536, 703 362, 245 174, 458 217, 787 318, 916 TOL UU DIOLS), ain ae A ee 178, 160 124, 361 53, 809 84, 150 94, 010 aI Se OY ee ee ee 248, 008 161, 354 86, 654 81, 608 166, 400 IS ALG 5 Sexe Sa ee 35, 585 25, 975 9, 610 16, 365 19, 220 iaw Hampshire... ....-2-.----------- 62, 134 42, 671 19, 463 23, 208 38, 926 [VSS UCTS Sp SR 498, 977 342, 508 156, 469 221, 891 277, 086 ICOM LOXICO. 2922 ==... 2222 ek 137, 548 88, 969 48, 579 40, 374 97,174 Uitte eS Le 1, 878,879 | 1, 236, 749 642, 130 811, 209 1, 067, 670 iware ©arolina_.-2__....=.---2.-.---.- 890, 547 562, 390 328, 157 252, 197 638, 350 TOUS Gtr d DUET ESCO) FES oA ee 148, 057 92, 738 55, 319 43, 840 104, 217 Cio. A’ es 8 ee ee eee eee eee 528, 009 366, 408 161, 601 204, 807 323, 202 Mian omates oo oes 8 Seca ee 722, 167 486, 585 235, 582 256, 306 465, 861 lS ee 461, 346 272, 978 188, 368 159, 650 301, 696 Se 2, 234, 942 | 1, 416, 739 818, 203 714, 926 1, 520, 016 lige slates 2-2 Ske 128,173 87, 572 40, 601 50, 354 77, 819 SontimO@ aromas cn. (8 eo 681, 633 461, 712 219, 921 248, 275 433, 358 SKOTERN V1 DK 04 6: 96, 230 63, 448 32, 782 30, 667 65, 563 “SYS RGIE a. Lh gt ene ol 777, 578 524, 720 252, 858 283, 754 493, 824 TEES Cy dR i ag a 1, 268, 153 834, 438 428, 715 430, 778 832, 375 VSPID TES ofp ele ae Re 165, 159 122, 135 43, 024 81, 128 84, 031 Sey iieayeh a. a en es ey 121, 406 78, 910 42, 496 36, 414 84, 992 SS ee ee 675, 080 457, 417 217, 663 265, 168 409, 912 se EES eee ee 687, 088 443, 762 248, 326 322, 392 364, 696 iereeery ireinia. 22. ....-.-.-.---.---- 729, 498 504, 613 224, 885 283, 115 446, 383 “OF SU ke 706, 056 465, 600 240, 456 267, 527 438, 529 BViyominpe sc .-225.02/-.-++----------- 118, 962 84, 766 34, 196 50, 571 68, 391 LAT SGT) GOS SS ee ee 56, 168 41, 436 14, 732 26, 705 29, 463 District of Columbia------------------ 258, 374 178, 344 85, 030 124, 098 134, 276 eee ee oe a oes} 195, 041 132, 939 62, 102 70, 837 124, 204 Pee nhORICOn ees) bce oo =+-4---=- 466, 331 285, 315 181, 016 126, 933 339, 398 252 Department of Health, Education, and Welfare, 1953 Table 3.—Total program expenditures from Federal and State funds for voca- tional rehabilitation of the blind by State commissions or agencies for the blind, fiscal year 1953 State or Territory ANZ OMA Oe ie. Sia. 2 ee Yee Colorado. 5-2 ae Be se eee ee 2 Wonnecticut: TAee Bee os ee Michigan. — Vasey Pee os Rie Sipe sé Wiinnesotan ee sae 8 SS eae See Mississippi_._______- sien es TW ee IVISSOUITI A. ec ee Aa de a ee Newaliampshire so 2 20. Sf aes INGWRUOESG ya Ser SF eae eh INGWeMexica Geb 22850 522 See eae ie ae INNe Ww OD Ke 7 tear tat os eae Oregon 225s Pee See Bae RennsylVanidses. No - 23. soe See Bowe Rhodelslang ete ie 2 ae ee South Carolina_____- eee age EN. OP: 5 South Dakovarte Oe. == 5 25 Vie Mennessee. i e-wee ie! shee ie ee War iia aS naar pete 9 E iwet 2B y= Federal and State funds Total 40, 578 48, 822 35, 391 42, 076 247, 996 19, 607 54, 127 26, 502 65, 859 88, 142 26, 204 44, 007 129, 281 84, 136 124, 868 120, 051 21, 511 46, 892 18, 424 133, 267 31, 110 367, 512 358. 793 189, 928 59, 435 321, 546 34, 555 51, 801 22; 490 170, 856 201, 668 21, 267 52, 589 38, 010 80, 762 36, 764 Federal — $3, 456, 827 | $2, 541, 466 28, 478 35, 028 28, 608 31, 270 182, 621 14. 760 43, 909 19, 579 47, 817 73, 145 16, 660 35, 864 93, 221 62, 651 96, 625 95, 273 17, 767 35, 324 11, 239 101, 437 22) 047 249, 267 247, 969 136, 495 40, 703 236, 365 24,792 40, 422 17, 420 128, 106 156, 555 15, 471 34, 371 29, 478 63, 755 26, 974 State $915, 361 12, 100 13, 794 6, 783 10, 806 65, 375 4,847 10, 218 6, 923 18, 042 14, 997 9, 544 8, 143 36, 060 21, 485 28, 243 24, 778 3, 744 11, 568 7, 185 31, 830 9, 063 118, 245 110, 824 53, 433 18, 732 85, 181 9, 763 11, 379 5, 070 42, 750 45, 113 5, 796 18, 218 8, 532 17, 007 9, 790 Classification of expenditures Administration and vocational guidance and P pee placement services $1, 798,822 | $1, 658, 005 16, 377 24, 201 29, 842 18, 980 23, 023 12, 368 20, 464 21, 612 137, 712 110, 284 9, 919 9, 686 34, 206 19, 921 13, 026 13, 476 35, 958 29, 901 61, 043 27, 099 17, 976 8, 228 27, 722 16, 285 84, 459 44, 822 45, 624 38, 512 69, 513 55, 355 70, 495 49, 556 15, 133 6, 378 25, 052 21, 840 11, 957 6, 467 81, 594 51, 673 16, 047 15, 063 131, 022 236, 490 137, 145 221, 648 109, 267 80, 661 21, 971 37, 464 166, 184 155, 362 23, 148 11, 400 31, 779 20, 027 12, 350 10, 142 86, 265 84, 590 114, 156 87, 511 10, 642 10, 622 16, 153 36, 435 26, 969 11, 046 47, 445 33, 311 17, 184 19, 587 Saint Elizabeths Hospital | THE Parrent is the most important person in the hospital; the entire organization of the institution revolves about him. The responsibility for the medical care of each of the patients in the Saint Elizabeths Hos- pital is assigned to the three Clinical Branches and the Medicine and Surgery Branch, the latter of which includes the tuberculosis service. All the other activities, such as the Laboratory, the Dietetic Service, the Construction Department, and so on, are auxiliary to these four branches. A total of 8,795 patients were given hospital care and treatment dur- ing the year as compared with 8,516 the year before, or an increase of 279 patients. Of these, 397 were readmissions, that is, patients who had been cared for previously in this hospital or in similar institutions. Discharges increased also from 814 to 977 or 64.1 percent of admissions. The average stay of the 977 patients discharged showed an increase over the previous year from 520 to 699 days. On June 30, 1953, 7,882 patients remained on the hospital rolls, or an increase of 111 over a year ago. Patients actually in the hospital at the close of the year, 7,113, showed an increase of 74. Division of Medical Services The program of psychiatric and general medical care and treatment of patients carried out in the various branches of this division during the year is outlined below. CLINICAL BRANCHES Fach clinical branch, comprising 2,000 or more patients, is in charge of a Clinical Director. The usual activities of the clinical branches, which deal with the treatment and care of patients, education, and re- 253 254 Department of Health, Education, and Welfare, 1953 search, have been maintained at a reasonably acceptable standard dur- ing the year, although the growing difficulties previously reported on account of overcrowding and shortages of personnel have continued in increased degree. Attention has been given in previous reports to the problems of over- crowding of patients and shortages of professional and ward person- nel. There are opinions in certain circles that the size of the hospital should not increase. The fact remains, however, whether or not this position be taken, that the number of patients is growing steadily, that their average age is increasing, and that the tendency of the older pa- tients is to remain longer. Increasing attention to the possibilities of finding homes for patients outside of the hospital has resulted in an increase this year in the discharges, so that the net gain of patients in the hospital during the year was only 111 or 1.43 percent as against 3.57 percent last year. The proper bed capacity of the hospital at the present time is 6,213. There were actually in the hospital on June 30, 1953, 7,113 patients, an excess of 900 or 14.2 percent over the actual bed space. It is expected that one of the two vacant wards in the Geriatrics Building may be occupied within the coming year, but the situation is still far from ideal. There should be at least 10 percent of vacant beds available at any time in order to have proper mobility of patient load. The pro- portion of ward personnel has not increased with the patient popula- tion; since August 1948 there has been a gain of 135 employees as against 886 patients. At present the ratio is approximately 25 percent below that considered proper by the American Psychiatric Association. In spite of all the difficulties, the staff of the hospital have been most energetic in bringing about releases, with a very satisfactory result overall for the current year. It was reported last year that it was necessary to maintain a wait- ing list of prisoners in Howard Hall, the maximum security section of the hospital, and to accept prisoners as patients only as space per- mits. This was a most unfortunate situation, and all possible steps have been taken to remedy it. At present the number on the wait- ing list has been substantially reduced, and efforts are under way to reduce it still further. The replacement for the present Howard Hall is most urgently needed. The hospital’s request for funds for plan- ning a new maximum security division has been approved by the Bureau of the Budget and is now pending before the Congress. This section of the hospital contains the most destructive, violent, assaultive, and problem male patients of the entire hospital. Understaffing in a division of this type is particularly dangerous. Reference has been made during the past several years to the diffi- culty of filling medical positions in the hospital; this condition per- sists. The number of internships and residencies available exceeds Saint Elizabeths Hospital a ASDA RL Nas’ 4 hoe 255 by a considerable degree the number of candidates. For the coming year, for example, only 3 interns have been secured for the 12 avail- able positions. The number-of residents seeking training has tended to fall as well. The financial returns in the private practice of psy- chiatry are most tempting, with the result that very few of the resi- dents care to stay in the hospital work once their training is completed. Another factor is the competition which exists from another agency of the Government which is permitted by statute to pay a salary premium of 25 percent to diplomates of specialty boards, a privilege which is not extended to Saint Elizabeths Hospital. The problem of the elderly patient continues to become more serious. During the past year there was considerable increase in the propor- tion of women over 60 years of age who were admitted. A year ago about 33 percent were in this age category, whereas during the current year nearly 41 percent were 60 years of age or older. During the year a substantial number of elderly patients who were not in need of active psychiatric care and who were relatively quiet and orderly was sent to the District Home for the Aged and Infirm, although a number had to be returned to the hospital. Every effort is being made to send patients to the District institution as facilities permit. The Geriatrics Building has been functioning very satisfactorily de- spite difficult conditions of staffing. Several clinical studies have been made on patients there, and the building itself has attracted a large number of visitors from this and other countries. The number of voluntary patients admitted to the hospital appears to be steady; 90 were admitted during the current year. The number of Miller Act patients, that is, the so-called “sexual psychopaths,” has shown a distinct drop. This appears to be due to the change in policy on the part of the District Attorney’s Office. Although since the passage of the act in 1948, 61 such inmates have been admitted, the number during the current year was only 5. Of the 61 who have been admitted, 33 have been discharged as having received the maximum benefit. If it appears likely that the Miller Act will be substantially used again, the hospital is prepared to recom- mend certain changes which will make it more flexible and probably on the whole considerably more useful. As in the past, the hospital has attempted to follow an eclectic approach in the line of treatment, holding itself ready to utilize any new methods of treatment which seem to offer help to the patient without incidental harm and without undue devotion to any precon- ceived notions as to psychopathology or treatment. The number of patients receiving individual psychotherapy has been increased during the year, and a very active program of group therapy is being continued. During the year the psychodramatist left for another position, but it is hoped to resume this therapeutic activity again in 256 Department of Health, Education, and Welfare, 1953 the near future. It has been used on a modified scale during the cur- rent year in connection with the rehabilitation program. ) This latter program has been carried out with the aid of the District of Columbia Rehabilitation Service, which has been very helpful in cooperating with the Social Service Branch. The Board of Educa- tion of the District of Columbia has provided a visiting teacher for the benefit of some of the young patients of the hospital, and the recreational and occupational therapy programs are still expanding. Electroshock, subshock insulin therapy, and hydrotherapy have been actively used, especially the latter. The hospital is not imbued with the idea that electroshock is a panacea, but in selected cases it seems very effective. Prefrontal leukotomy (lobotomy) is still looked upon as only an operation of last resort; very few cases are being approved for its use, then only after all other known applicable forms of therapy have been tried without benefit. Only 38 lobotomies were performed during the year. ‘Transorbital lobotomy has not been utilized at all. The number of petitions for habeas corpus has been considerably less this year than last, there being only 27 such writs issued, in addi- tion to 15 orders to show cause. This is a very substantial drop from last year, the total number then being 54 writs and 12 orders. Even this number, however, represents a very considerable investment of the time of the physicians and the ward personnel, particularly when (as 1s sometimes the case) numerous continuances are ordered after the patient has been taken to court. During the year only 3 patients were released by the court as a result of such proceedings. MEDICINE AND SURGERY BRANCH This branch functions through the Medical, Surgical, Neurological, Syphilological and Clinic Services. This hospital is still the only public mental hospital in the United States which is approved by the American Medical Association for rotating internship. The hospital is also approved for a period of residency training in surgery and for internship in dentistry. The services of this branch are available to the patients of the hospital and to those employees who become ill or injured while on duty. During the year, 2,468 patients were admitted to the wards of the branch and a total of 64,184 visits were made to the various clinics. A large staff of visiting physicians and consultants has augmented the services of the branch in various special fields, such as derma- tology, ophthalmology, and so on. During the year it has been arranged to have in residence a fourth year resident in surgery from George Washington University Hospital who is supervised by daily visits of the various members of the surgical teaching staff of that hospital. ‘This has resulted in a very substantial increase in the num- Saint Elizabeths Hospital 257: ber of operations and in the quality of the surgical service which could be rendered to the patients. During the year the head-of the Neurological Service was called to active duty in the Armed Forces and for that reason the Neuro- logical Service has been temporarily given up. The inactive cases of tuberculosis have been concentrated in R Building, which has recently been used as a neurological center. It has been found that although the results with some of the antibiotics have been most gratifying in the treatment of pulmonary tuberculosis there are sometimes sudden flareups which render it highly undesirable to have the so-called in- active cases distributed through the hospital with other non-tubercu- lous patients. The number of patients with active syphilis coming to the attention of the hospital is falling steadily. PSYCHOTHERAPY BRANCH This branch carries on a considerable variety of activities. The psy- chodrama section has been considerably less active during the large part of the year on account of the absence of the director of that par- ticular aspect of the work. Rehabilitation psychodrama activity has been carried on in conjunction with the Social Service Branch for the purpose of orienting convalescing patients to the problems they are likely to face upon their discharge. The group sessions conducted by Alcoholics Anonymous have been continued. Individual psychother- apy has been carried out both by the members of the branch and by the physicians on the ward services. The art sessions offer much pleasure and a therapeutic value to the patients who attend them. The dance therapy program likewise continues to be of value and interest to the patients. Both the art and the dance activities have proven particu- larly useful in the resocialization of patients by giving them the oppor- tunity for self-expression. They are quite unusual in many ways and have attracted a great deal of attention from visitors to the hospital. The psychology section has continued to function actively. A total of 2,708 tests were given during the year, both to patients and to attend- ants and other personnel, and a very considerable number of lectures has been given by members of this section to residents, nurses, and others. The integration of psychology with psychiatry is an old story at Saint Elizabeths Hospital. Not only do the representatives of the section give the tests but they attend the staff meetings and discuss with the physicians the psychological findings and their significance. They have likewise done a certain amount of individual and group therapy, although the number of personnel in the section do not permit any ex- tensive activity along this line as yet. The section is looked upon as an important teaching center and is utilized by students from the George Washington University and Catholic University. 258 Department of Health, Education, and Welfare, 1953 arc ar ee Ue a TF ere Co ney POON AES: CRORES TSION GRIME Se LABORATORY BRANCH This Branch continues to be very thoroughly occupied by the de- mands from the Medical and Surgical and the Clinical Branches. It has not yet been possible to obtain a trained encephalographer. ‘The autopsy rate has continued high; during the year there were 437 deaths and 275 autopsies, or a percentage of 62.9. The work of the year may be summed up as follows: Bacteriology (cultural studies of autopsies and exudates, examination Of SIHCATS, CLC.) oo eee eee re ee ee ie 5, 780 Serology (blood typing and cross matching, ete.) _--.__._---------------- 19, 547 Urineanalyses i ojul bh et ae) ee ee 35, 449 Blood. and feces examinations |-0l 1-8 160-1) 0-10 (0 |:2I OS Se Os) ORI 0 8 | & 0z Lo Fa | T9E 1 ot eee | Ose 7 2 wre 99.1 1 | 8.) ¥ 1:0. 1.0.42 | & |-P6L ETL hee bo 1.040 if IT | 6Z4E | 601 | FT | 08 | 878 | & | FEO‘T| SIFT fees Oe Seo | 29 tO (0) 1 dE Ud} Oo 48ST | 0 1e OC] OM] 6 if O | 98€ | IZ TZ | 06 | 900'T} O | 88 ‘I| #29 ‘I SIT | If | 19 | OL] SE | 86Z] OTT] #2 | F | F | TL «| HBL «| SE | zt] z¢le¢ (lz zZ G8¢| BFE T] FOE | ES] 6L | BLES! ZL | 226 ‘S| 127 ‘2 i TR Seige | Sl si el etal |S ere Slow) wie 2 es) oe ey ee Breielsie leis; elsifle| 2 18le)8)/¢1s8) ¢/6) 2] € | elal ali Siz Plmlsi/3] | 5 Selghar esa aca wif&l| 2! es = ee eae es x |e] 3 a = eo a ‘< 4 ues - + S = S 5 Z 38 Se = fa 2 3 B fon = poise | eee loa” |-¢ Si/EIS (2/2 /8)/els|8| ss) Bs eo a ee |e oe ete ie | 8 Cea al eh Ss ole 2/8\5,/258 Bic) iq 2 | Sey Be eo | Bol a ecole = S/B] mp | & Sy 4 S 3 mlin2| sie + | © oa | 2 1e5n 1 os 5 mis e|3/%) 3 Sag melee & z | 8 5 2 / Ss a al ez, Fe o | 8 S ve) @ ® = 8 2 o Bs n aa) SG oe ae s | syuoryed o[qesinquUITeIm0 NV sjueed afqesinquiley ak oe oe e61 “Og oun ‘[eyIdsoy uy ~-“€¢6T “Og SUNS ‘JUEUTEdOTe 10 YISTA UC oe €S61 ‘OE OUNsL ‘s[[o1 UO peysn[py Ril ie aes ak ile ag cn pa, Seg eS61 Jeok [easy “MOMeoyIssefo Ul sosuvyO RT ie ane mee oe €S61 “Og ouNL ‘sT[O1 UG ~--2------- EG61 194 [eosy ‘suOeIedag ~----------- EGBI ‘OF eunf 04 ‘poyupy ------------- 22 ZS61 “OE ouNL ‘s[[OI UO ES6[ 4004 poosyf Suoiwaiyissyja X4q ‘syuaynd fo yuawmaaowm fo yuawaw}s pawpyosuoj—'¢ a1qRL 18 293171—54 American Printing House for the Blind As tHE official schoolbook printery for the blind in the United States, one of the principal functions of the American Printing House for the Blind, in Louisville, Ky., is the extension of its services:to the schools and classes for the blind through the Federal act ‘“'To Promote the Education of the Blind.” This act, originally passed in 1879, authorizes an annual appropriation to the Printing House to provide free school texts, tangible apparatus, and supplementary materials necessary in the education of the blind. Allocations of books and materials are made to the several schools on the basis of their enroll- ments. Only those pupils may be registered whose vision comes within the accepted definition of blindness as follows: “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20°.” The Printing House maintains large catalogs of Braille books, Talking Books, Braille music publications, large-type texts, and tangible apparatus. The schools for the blind are thereby provided with a rich collection of educational material from the kindergarten through high school. There are approximately 6,587 blind children enrolled in the residential and public school classes for the blind being served by the Printing House. During the 1958 fiscal year, Braille books, educational periodicals, and music made up approximately 60.3 percent of the materials re- quired by the schools; Braille slates, Braille writers, maps, and other mechanical devices about 12.5 percent; Talking Books about 6 percent; and large-type books about 18.9 percent. Approximately 2.3 percent was used for miscellaneous items. 266 nash ee Columbia Institution for the Deaf Tue Cotumepia Institution for the Deaf is devoted to the education of deaf persons whose hearing is so impaired that they are unable to progress satisfactorily in schools and colleges for hearing students. The Institution is located in Washington, D. C., and is composed of four departments: Kendall School, Gallaudet College, the Graduate Department of Education, and the Research Department. Its aim is to promote the welfare and advancement of deaf persons through various educational means and through research. KENDALL SCHOOL This department provides education for the deaf child from pre- school age to college entrance. Its student body incorporates all deaf children from the District of Columbia and many from surrounding States. The oral method of instruction predominates, but when children cannot progress orally other methods may be used which will bring results. This past year the enrollment was 71, of whom 46 were from the District of Columbia. GALLAUDET COLLEGE This department was established in 1864 by act of Congress. A liberal arts and science course is offered students who qualify through entrance examinations. There is also a preparatory year for those who have not completed a full high-school course. This past year, students from 40 States, the District of Columbia, the Territory of Hawaii, and Canada were admitted, with a total of 244 in the student body. The curriculum of the College is similar to that of any other Amer- ican college which offers 4 years of work toward a bachelor’s degree. 267 \ A 268 Department of Health, Education, and Welfare, 1953 soar SOE ncaa a CN REISE SLANE SNIPE After two years of General Education the student may specialize in the work offered by any one of a number of Departments. Many of the graduates take up teaching positions in the various schools for the deaf and have been very successful in this field. GRADUATE DEPARTMENT OF EDUCATION This department trains hearing young men and women, college graduates, to teach the deaf. The course is 9 months. Its purpose is to furnish teachers and administrators in the deaf educational field in the 48 States. At present the demand for this type of personnel cannot be met from available sources. This past year 9 persons were enrolled in this department, 6 of whom were men. RESEARCH DEPARTMENT This department was created to meet the demand of schools for the deaf in the United States for some central point where research can be carried on for the advancement of the education of the deaf in the Nation. Its primary aim is to develop better techniques in the education of the deaf and hard-of-hearing child. During the past year analytical studies were made of psychological aspects of deaf- ness and of the academic program carried by American schools for the deaf. Howard University Howarp Untversiry was chartered by Act of Congress on March 2, 1867. Located in the District of Columbia, the University operates an undergraduate college, a graduate school offering the master’s degree, and eight professional schools, as follows: medicine, dentistry, phar- macy, engineering and architecture, music, social work, law and re- ligion. (Religion receives no support from federal funds. ) ENROLLMENT OF STUDENTS During the school year 1952-53 Howard University served 5,378 students as follows: 3,809 during the regular school year; 973 in the summer school and 596 in the evening school. The net total enrollment excluding all duplicates was 4,913 students, distributed as follows: 596 in the evening school and 4,317 in the ten regular schools and colleges, as follows: liberal arts, 2,249; graduate school, 320; engineering and architecture, 327; school of music, 277; school of social work, 99; col- lege of medicine, 298; college of dentistry, 438; college of pharmacy, 169; school of law, 103; and school of religion, 37. HIGHLY SIGNIFICANT SERVICE TO NEGRO STUDENTS One of the major purposes of the founders of Howard University was the admittance of Negro youth, among others, to all of its educa- tional offerings. The institution has pioneered in the offering of pro- fessional training to Negro youth in medicine, dentistry, pharmacy, engineering, architecture, law, music and social work, as well as in the teaching profession. _ During the entire period of 88 years from 1865 to 1953, Howard University has been the only university of public support in the south- ern states which has offered to a substantial number of Negro youth 269 270 Department of Health, Education, and Welfare, 1953 any approximation of the wide scope of undergraduate, graduate and professional studies characteristic of American state institutions. Since 1948, however, public institutions in 12 southern states, hitherto closed to Negroes, have little by little, opened their doors to Negro youth. The national importance of Howard University as a trainer of Negro professional students is nowhere better illustrated than by ref- erence to medicine and dentistry. If Meharry Medical College of Nashville, Tennessee, alone be excluded, the enrollment of medicine and dental students at Howard University in 1953 exceeded the enroll- ment of Negro students in all the other medical and dental schools in the United States. Howard University and Meharry Medical College have been the responsible pioneers in the development of medical edu- cation among Negroes; and, today, they constitute by far, the major source of Negro physicians, surgeons and dentists in America and in the world. GEOGRAPHICAL DISTRIBUTION OF STUDENTS Of the net total of 4,317 students enrolled in the ten regular schools and colleges there were 4,277 who registered for degrees. Three thou- sand nine hundred sixty-six of these, or 92.7% came from 42 states and the District of Columbia, in continental United States, while 311 or 7.3% were students from countries outside of continental United States, including 27 foreign countries and four United States pos- sessions. The 8,966 students from the continental United States were dis- tributed as follows: New” Eingland: States... 20 2 2" te ee ee 89 Middié Atlantic: Statesiil is: oni sue itt Sa ees ee 632 Bast. North Central States. ij JosJecLe_westl iu. wot. eee 230 West North Central States..s.. 4-240. 2 i 2 91 South Atlantic: States_.--_.2-- 223-222 ee 2, 363 Hast South. Central States... 292 West South. Central States__..2_.-....-_-_ =. ee 244 Mountain’ 'States_20. 259201008 lt ho ee 5 Pacifi¢ States:t o2cedie yep ee bol bee 20 3, 966 The 311 foreign students came from 27 countries and 4 United States possessions as follows: I. from five countries in Africa, 68; II. from six countries in Asia, 10; III. from Australia, 1; IV. from five countries in Europe, 8; V. from Canada, 1; VI. from nine coun- tries in Central and South America and the British West Indies, 146; and VII. from four United States possessions, 33. | Howard University 271 VETERANS There were 578 veterans enrolled in Howard University during the school year 1952-53. Of this total 89 were Korean veterans. The enrollment of Korean veterans increased from 50 in the first semester to 89 in the second semester. During the two semesters of the regular school year the veterans enrollment was distributed among the ten schools and colleges as fol- lows: the graduate school, an average of 22 per semester; the college of liberal arts, an average of 247 per semester; in the school of engi- neering and architecture, an average of 66 per semester; the school of music, an average of 10 per semester; the school of social work, an average of 12 per semester; the college of medicine, an average of 34 per semester ; the college of dentistry, an average of 52 per semester; the college of pharmacy, an average of 36 per semester; the school of law, an average of 28 per semester; and the school of religion, an average of 3 per semester. The relationship of the veterans to the total average enrollment in these colleges ranged from a minimum of four-tenths of one per cent In music to a maximum of 32 per cent in law. During the two regular semesters of the school year they constituted an average of 15.5 per cent of the total average enrollment of the ten regular schools and col- leges, and 12 per cent of the total enrollment of the University for the entire year. | ARMY AND AIR RESERVE OFFICERS’ TRAINING CORPS Army Reserve Officers’ Training Corps.—An average of 233 students were enrolled in the Army Reserve Training Corps, during the school year 1952-53. One hundred thirty of these were enrolled in the first and second year basic army courses and an average of 103 in the first and second year of advanced army courses. Forty-nine students completed the Army R. O. T. C. requirements at Howard University during the year 1952-53. Twenty-nine were commissioned Second Lieutenants of the United States Army Reserve. Nine others were scheduled to receive commissions as Second Lieuten- ants of the United States Army upon the completion of summer camp training. The remaining 11 were scheduled to be commissioned upon completion of their four years of college level academic work. Air Force Reserve Officers’ Training Corps.—An average of 417 stu- dents were enrolled in the Air Force Reserve Officers’ Training Corps during the school year 1952-53. Of these an average of 278 were enrolled in the first and second year basic courses; 121 were enrolled in the first and second year advanced courses; and an average of 18 in the accelerated courses. 272 Department of Health, Education, and Welfare, 1953 Sixty-five students completed the Air Force R. O. T. C. course during the school year 1952-53. Of these 30 were commissioned as Second Lieutenants in the Air Force Reserve Officers’ Corps on the fifth of June 1953. Twenty-three others were scheduled to be com- missioned as Second Lieutenants upon the completion of summer camp. Three were scheduled to be commissioned during the month of August upon completion of courses in summer school. The remain- ing 9 were scheduled to be commissioned upon the completion of their academic requirements for the bachelor’s degree. FACULTY The University was served during the year 1953 by 4388 regular teachers. 262 of these were giving their full time to the University, while 176 were serving in various part-time capacities. All together they made a total full-time equivalent teaching force of 308.74. Of this total 281.82 were in the rank of instructor and above while 27.12 were below the rank of instructor. Forty-eight of the 176 part-time teachers served the University without compensation. COMPOSITION OF THE FACULTY The faculty of Howard University is composed of Negroes and whites, northerners and southerners, Jews and Gentiles, Protestants and Catholics, persons from Europe and Asia, North, Central and South America, and from Africa. From the beginning of its work in 1867 it was a major purpose of the founders of Howard University to employ Negro teachers, among others, on every faculty. Today the Negro members of the professional faculties of Howard University, exclusive of religion, constitute together a group of Negro professional teachers larger by far than all the Negroes so employed in all other American universities combined. The existence of this group of Negro university teachers at Howard University has been a standing inspiration to the Negro people for more than three-quarters of a century, and membership on one of these faculties has been the first employment of many of the most outstanding Negroes in the public life of America. TWO OUTSTANDING EVENTS OF NATIONAL SIGNIFICANCE There were two developments of national significance at Howard University, during the school year 1953. The first was the comple- tion and initial use of the new building for Engineering and Archi- tecture. The second was the admittance of the College of Liberal Arts to membership in Phi Beta Kappa, the Honorary Scholastic Fraternity. Howard University 273 NEW ENGINEERING AND ACHITECTURE BUILDING During the school year 1953 the School of Engineering and Archi- tecture entered a new and modern building, erected by the Govern- ment of the United States at a total cost of $2,161,340. The new School of Engineering and Architecture building is de- signed to accommodate as many as 400 full-time students approxi- mately evenly distributed among the four present degree-granting departments of civil, electrical and mechanical engineering and architecture. The laboratories of each department were designed by members of the departmental staff thereof. They represent careful planning over a period of more than ten years, including studies, surveys, inspection visits to more than forty representative schools of engineering and architecture, and especially selected visits to study special features. Critical review of the final plans was made by representatives of the United States Office of Education and the American Society for En- gineering Education including Lamme Medalist and Professor Emeri- tus Alexander Graham Christie of Johns Hopkins University, Dean S. S. Steinberg of the University of Maryland, Dean Emeritus Fred- erick M. Feiker, George Washington University, and Walter A. Taylor, Director of Education and Research, American Institute of Architects. This was the first modern building ever erected on the soil of the former slave states for an accredited school of engineering and archi- tecture attended heavily by Negro students. The 327 students of engineering and architecture served in this building during 1953 included the largest body of Negro students of engineering and archi- tecture in the United States. Their number exceeded the total en- rollment of Negro engineering and architecture students in all accredited schools of engineering and architecture, public and private, in all the southern states. ENGINEERING AND ARCHITECTURE BUILDING RECEIVES DISTIN- GUISHED ARCHITECTURAL AWARD The new building for engineering and architecture was selected by the Washington Board of Trade to receive one of its distinguished biennial awards in architecture. The Board of Trade commended this building as being “of superior design among the buildings erected in the year 1951-52,” awarded a “Diploma of Merit” to the owner, the builder and the architect, and indicated that it made this award in acknowledgement of the benefit of such superior architecture in the City of Washington. 274. Department of Health, Education, and Welfare, 1953 PHI BETA KAPPA The outstanding event of the year in the college of liberal arts was the installation of Gamma Chapter of the District of Columbia of Phi Beta Kappa, the Honorary Scholastic Fraternity. Howard University was among the nine new colleges admitted to membership in Phi Beta Kappa, the Honorary Scholastic Fraternity, at their recent triennial convention held at the University of Kentucky, Louisville, Kentucky. This action authorized the installation of a chapter of Phi Beta Kappa at Howard University as Gamma chapter of the District of Columbia—the Alpha and Beta chapters being George Washington and the Catholic Universities. This recognition, coming after both national and regional inspection of the institution’s curriculum, faculty standing, scholastic performance, and plant facil- ities, is notable, along with the similar acceptance of Fisk University, as the first such recognition of Negro colleges by Phi Beta Kappa. Noteworthy also was the sponsorship of the George Washington and Catholic Universities chapters, which will now become sister chapters, — and the unanimous endorsement of the South Atlantic Phi Beta Kappa colleges at a regional conference held last fall at Davidson College, North Carolina. Participating in the patter bah of the Gamma Chapter of Phi Beta Kappa at Howard University were representatives of the orig- inal chapter at William and Mary College of Virginia and of other distinguished institutions of learning in the South and North. Together they united in a reverent and glad expression of esteem for the high intellectual and spiritual possibilities of the Negro people and placed their joint approval upon the eleven seniors at Howard and two juniors, to constitute the first student members of the honor fraternity. The founders of Howard University would have rejoiced to see this day. GRADUATES During the school year 1952-53 Howard University graduated 616 students from its 10 schools and colleges. These graduates were dis- tributed among the schools and colleges as follows: liberal arts, 259; engineering and architecture, 46; music, 33; medicine, 67; dentistry, 46; dental hygiene, 7; pharmacy, 25; law, 26; religion, 9; graduate school, 68. The University also awarded three honorary degrees. | From the beginning of its work, until the end of 19538, Howard Uni- versity has graduated a total of 17,621 persons. These graduates are at work in 42 states and 24 foreign countries. In every population center in the United States they constitute a cross section of the leader- _ Howard University 275 ship of the Negro people. Together these graduates constitute the largest and most diversified group of trained Negro public servants related to any single institution in the world. In the eight professions of medicine, dentistry, pharmacy, engineering, architecture, music, law and social work they include a body of Negro professional gradu- ates larger than the output of all other universities of public and pri- vate support combined, in all the southern states. SERVICE TO FOREIGN STUDENTS AND IN FOREIGN COUNTRIES Howard University has developed a far-reaching service to foreign students. Foreign students are now enrolled from 31 foreign coun- tries. It ranks third among American universities in the percentage of foreign students enrolled. Howard University students and teachers have associated daily with teachers and students representative of every race and color, and many of the creeds of the world. They have learned by experience that the common country of the trustable human heart crosses and transcends all these boundaries of external differences, and they are habituated to a friendly interest in human beings everywhere. In recent years many of these teachers and students, as individuals and in groups, have traveled on missions to many countries in Europe, Asia and Africa. Wherever they have gone, they have imparted goodwill and friendship and they have found goodwill and friendship in return. Again and again the responsible leaders in Government and the friends of America have acknowledged their services as being of the highest value to their country and to the cause of democracy in the world. eee Ceres iting hei een eee : * = » sisal od udteabdes opel Sedo Shjeaey aawsse % seg dora wk: ‘hadiwnh $0 cprnot bodizereils be yaoi ay iia ey aaah Asininats ah) sfiSO VIIIRILE a epee hE: TTS eee Eee ant hee SPOR Nyt: a PAU a Seubee thug lnidivnlened rua lo gbed hohe nt pabeal sieve ite oFinkto 3 siapeee iid ya iehas Phin ees Base 8 nag yea tele se see oust is ier eneth i ‘ é = ms ; 5 HARTY COE ifg yi ‘— avs. era Pawn = , ‘t 7 Pa | , i ae 7 7) ey te oe Lage & i ‘Cay f % a* ree rr ads iy Bs 25 BOE EY Ta ASAE eS Fh Des T2333 © SOQGTS Ten Wee ?- ; 4 ™ a : as a ‘o. . 4 # oi H ¥ 4 oe a Sr. Fy Ae yer ‘ % - 4 > 24 ets CUO UCHE Tt oe PEO he FI Pee oY Fe ares SP se Osis : P POs toe ae | were . cha + “s “e3 oh oe Srv ine ey ey LM ah Og LP See g Ek POPES, Dee PS esse Leek aCe e ane hated BS Fo a: ¥ be i ¥ ' ag a ~ wR Ye ee a4 Pitt wey * ‘ St ay cs te y tie 3 7 { 2 pj 1 5 ; + | oe! ae J 4 P Preeti $5 UG L351 - r . ; © ‘ aya 5 I : ty i 2 2 ft me Bs }; ae em i Ae Oe eS Pe DS he eA Eo ee BO 3 rey eine 3 pr it he SPN . ; , a Tee t 4 ; Siete ee aero Sreye G2 ret eevee “te fea yao ye baa one) aes ph sl one My j f c ie oe . y a og eet ; tae { : iF yu sine CLR Litas Sy TLE: mes 2 bes { ¥ wh , . ax ea : . + j : ea tihi 45] BPS, : ye) ia? tJ tend SER 7 eee cy ton . zs. % 1 gi 1G rr, AS a7 ti $ vig? Ce FUPEELE TT TS 3 He . - , ry . : H : 5 | eit SESE RIE sii G. & ; f i F rs oa S ties be we TORS 5 RITES RUSS Me PEE / a r F " i : tases < Sp fe igs Pre as Fy ? Pp? ; FA 1% oh) Sa Ke f ea Gee BD 3 Pi oo , - ry . i H t : - ye 2 +3 © 3 j $eg-5 t Lad ‘ 2.4 4 a - f " ? : 5 is 4 431 : <> fe | yd F { 5 Sy Bae sf i! 7 ‘ ~ ¢ 2 i < ; * ABD ESS SACLE an tise “Teed RE iufe Ee x t 4 ches ie} e , : sh4 a ia PPE ey ce, hee ee oe rg f i ' 7 é 4 / re . ** \ ri ‘ j 4 by \ a x ' nN, 1 : \ i y ™ i ‘ 1 A Ae va 7 ‘ “ ‘ 5 A A re Nd Aah - Pi $ 4 . \ ¢ “ " ont | P ; } = f at | * j { ¥, ; t * 5 \ r. be re 4 e : weal Ar 4 % ‘ a > ' a i ne = _ i sl ri haat = i 1 n 40 me = i | | | ; vv i . ae We ? - 7 : . r | at Appendix Tables Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1953 * States, Territories, and possessions TECES TICE Si = el sy sae MVOMISIAN Gs 222 6 28 2k Wiaryvlands 3 se eS Minnesota- BES eek MhonTaAna, 22... Sk. New Hampshire-___-- New Jersey__-__------ New Mexico__._.____- recone Ws ce oS Pennsylvania_-________ Rhode Island ________- an Cia. os yyes 2S S Washington .-..2.22 2. West Virginia__-_ .___- Wisconsin ___________- VAG ee Total 38, 350, 106 13, 270, 472 33, 049, 650 189, 735, 335 32, 214, 764 13, 499, 206 2, 016, 130 4,732, 197 41, 541, 354 58, 281, 836 6, 848, 256 74, 670, 325 27, 572, 407 26, 196, 934 24, 240, 820 36, 972, 344 80, 750, 738 8, 570, 980 18, 605, 906 55, 790, 308 62, 344, 620 31, 672, 738 25, 833, 903 70, 491, 952 8, 099, 844 11, 489, 690 3, 421, 019 4, 577, 241 19, 239, 576 11, 733. 784 118, 804, 867 36, 318, 061 6, 016, 861 62, 894, 710 60, 061, 475 13, 819, 568 60, 056, 879 7, 474, 771 27, 245, 175 7, 811, 479 41, 209, 474 105, 641, 159 9, 555, 351 3, 824, 588 27, 323, 947 45, 240, 539 26, 939, 541 26, 285, 156 3, 449, 739 4, 198, 113 6, 796, 047 8, 623, 004 372, 404 1 On a checks-issued basis. 2 For detailed figures by programs, see tables 2, 3, and 4. tration 2 28, 171, 034 8, 483, 979 23, 486, 025 151, 474, 193 27, 321, 216 8, 583, 625 1, 321, 714 3, 620, 485 32, 919, 220 40, 095, 280 4, 758, 524 60, 186, 572 18, 114, 010 22, 430, 259 17, 383, 403 27, 049, 108 72, 890, 653 7, 458, 787 9, 732, 109 50, 961, 269 49, 756, 883 25, 488, 431 20, 058, 033 63, 448, 786 6, 190, 036 8, 879, 941 1, 297, 898 3, 789, 167 11, 970, 626 7, 646, 326 105, 509, 566 25, 089, 583 4, 749, 106 49, 417, 164 52, 511, 655 10, 860, 494 46, 770, 487 6, 079, 636 17, 363, 825 6, 177, 371 31, 319, 060 82, 291, 739 6, 740, 661 2, 996, 219 11, 064, 068 31, 775, 728 21, 292, 696 22, 224, 196 2, 587, 499 1, 575, 151 3, 806, 180 3, 968, 963 297, 963 Service 2 4.051, 307 1, 058, 796 3, 788, 695 6, 152, 039 832, 110 1, 113, 861 302, 759 842, 695 3, 279, 897 4, 986, 537 210, 191 7, 651, 730 5, 889, 913 2, 072, 370 1, 668, 492 5, 954, 438 4, 686, 149 380, 573 1, 642, 079 3, 230, 295 3, 880, 212 4, 859, 643 2, 651, 611 2, 703, 091 616, 893 1, 144, 459 179, 737 194, 522 3, 935, 542 745, 658 7, 823, 928 6, 305, 262 631, 698 6, 597, 379 1, 232, 869 1, 112, 999 7, 494, 528 460, 163 3, 653, 540 688, 214 5, 302, 287 8, 110, 335 589, 865 364, 856 3, 049, 608 1, 276, 374 4, 567, 906 2, 598, 188 438, 070 269, 085 533, 133 3, 368, 168 53, 337 Soctal Seeurity Public Health| _ Office of Education ? 5, 522, 786 3, 623, 193 5, 480, 852 30, 513, 234 3, 895, 727 3, 504, 418 230, 975 93, 755 4, 605, 596 11, 920, 485 1, 819, 471 5, 700, 875 3, 177, 197 1, 408, 545 4, 953, 682 3, 817, 363 2, 623, 873 629, 655 6, 978, 258 1, 342, 220 7, 678, 762 1, 005, 704 2, 672, 229 3, 895, 356 1, 153, 859 1, 272, 145 1, 915, 850 541, 588 2, 913, 090 3, 240, 040 4, 009, 041 4, 089, 906 543, 852 6, 415, 396 5, 838, 263 1, 558, 973 4, 240, 503 825, 482 5, 730, 780 870, 811 3, 934, 033 14, 264, 200 2, 104, 752 372, 158 12, 697, 967 11, 650, 140 558, 207 955, 332 339, 162 2, 316, 850 2, 317, 725 1, 018, 142 21, 104 8 Includes grants to Universities and local units, for details, see table 3 Office of Vocational Rehabili- tation $22, 244, 093 598, 358 108, 454 340, 461 1, 585, 690 163, 669 295, 144 160, 682 175, 000 734, 308 1, 274, 634 59, 458 1, 123, 098 387, 816 282, 318 233, 318 147, 789 546, 213 101, 965 249, 989 249, 203 1, 020, 159 314, 789 448, 705 440, 577 138, 444 192, 008 27, 534 51, 964 414, 076 99, 660 1, 447, 487 823, 219 91, 330 455, 817 476, 180 285, 265 1, 608, 790 09, 490 494, 376 74, 062 649, 719 967, 827 119, 111 91, 355 506, 850 535, 672 517, 990 502, 511 85, 008 American Printing House for the Blind ee ee Oe ee ee ee ——_____—.. Department of Health, Education, and Welfare, 1953. 280 962 ‘EL eos ‘SL G06 ‘TS 18¢ ‘ZE 00¢ ‘Iz £02 ‘S9 292 ‘OST OST ‘42% Tee ‘ZT PEL ‘2% OLS ‘16 12 ‘68 ELT ‘OL LEF ‘BLT P8E ‘CE CEP ‘OTT 219 ‘O9T €96 ‘92 26S ‘SLT 08S ‘IZ 922 ‘EST 992 ‘LOT LEP ‘888 ‘9$ Sd AIS eIBs[OM PIITO STS ‘OOT 69F ‘OFT L121 ‘OOT 688 ‘OL S¥0 ‘68 089 ‘8ZT £90 ‘908 FOE 'LLZ GLB ‘SIZ 690 ‘60 ELL ‘60% Z8I ‘26% PL6 ‘06 ELS ‘88Z 0S ‘Elh CT¢ ‘OST EFS ‘29 #S8 ‘TET ZEB ‘BZE GL8 ‘F8 £06 ‘6FF PPE ‘027 OST ‘TST OF8 ‘SF GLI ‘FoF 9LL ‘PIB ‘TI$ ueIp[Tyo peTddy.o JO} SdTAIOg 292 ‘TIT OTZ ‘6L1 CCF ‘6L OF8 ‘$2 SOF ‘$6 FEL ‘EIT SLL ‘FSZ 082 ‘Sze 460 ‘T&z €0S ‘TOF LEZ ‘OIE 898 ‘FLE SOI ‘FOT 850 ‘LE TOL ‘ZOF 008 ‘EI L6L ‘EZI1 1¥9 ‘Z9Z LEL ‘LEE FI9 ‘I6 LOL ‘OF CLZ ‘61z 1S9 ‘ZLT LOT ‘26 PSF ‘CPI T88 ‘20% 602 ‘STS LES ‘LZ FIO ‘9ST L¥E ‘90¢ 616 ‘66 ‘ET$ SOOTAIOS qIeey prryo pue [eula}e 169 ‘ISt G00 ‘TE9 ‘F 988 ‘262 920 ‘S6¢ 660 ‘120 ‘¢ TOUT So. « SST ‘ZE9 ‘T 6IF ‘E8z OTT ‘SLT ‘T 089 ‘SF 9ST ‘Gz ‘% GZI ‘LIE ‘6c$ pe[qestp A[[®102 pue Ajjueuvunied 90} 0} pry 8¥9 ‘SET G8Z ‘STE 0F9 ‘SIT 06¢ ‘2 SPE ‘FOS £80 ‘961 8S ‘E06 208 ‘2€8 £20 ‘ocr 20S ‘ESL 80¢ ‘269 128 ‘9LT OFS ‘SEI OF ‘EhZ 692 ‘ZOL SIE ‘92% Ecc ‘Frg 862 ‘8L¢ 060 ‘F6S ‘T OSF ‘E9 GCS ‘120 ‘T 8F9 ‘6ST ‘T 682 ‘66 689 ‘28 C0 ‘OTT OLT ‘6FT E21 ‘TIS ‘F 892 “G09 GPE ‘6LZ GLZ ‘SOF 218 ‘899 ‘ZE$ purq 2q} 0} pry 626 ‘800 ‘¢ FL8 ‘OF ‘E 168 ‘T69 ‘T 208 ‘OTF ‘T Shs ‘OTS ‘OT 862 ‘8Z0 ‘g ELT ‘OFT ‘S €18 ‘SEZ ‘ST £6 ‘6S ‘8 OFF ‘0L8 ‘€ G10 ‘09 % 88 ‘8E0 ‘FT L8Z ‘292 ‘OT 098 ‘cor ‘Z 6L8 ‘E86 ‘€ 618 '€L8 ‘F 088 ‘990 ‘ZT 096 ‘CLI ‘T 688 ‘618 ‘2 902 ‘c6¢ ‘8 GES ‘GSLs ‘T 0&6 ‘98F O8F ‘81g ‘Z CGP ‘TE6 ‘ES 8F6 ‘E19 ‘ce SLI ‘FFE ‘9 L02L ‘ZL9 ‘% $86 ‘090 ‘2 12% ‘6FS ‘SEEs —$—$—— UeIpTG) 49 -pusdop 0} pry | -IsIsst o88-plo Tes ‘Zg¢ ‘g EI ‘P8E 2 o88 ‘0Z¢ ‘Z 200 ‘E11 ‘T 861 ‘6IZ ‘9 80F ‘LI8 ‘E ISL ‘Z99 ‘OF £68 ‘P10 ‘ST 86F ‘082 ‘61 L8P ‘09 ‘TE BET ‘S40 ‘8¢ 129 ‘469 ‘¢ FIT ‘068 ‘F SEZ ‘GRZ ‘TS CLZ ‘E20 ‘ST 869 ‘SES ‘ET GLI “egg ‘LT C6 ‘68T ‘ZI 682 ‘890 ‘6E 0S9 ‘8g0 ‘¢ 169 ‘086 ‘82 186 ‘9S¢ ‘2 G10 6£0 ‘T 026 “EzS Z6L ‘00S ‘¢ 032 ‘Z0Z ‘TZ 168 ‘626 ‘60 89€ ‘689 ‘ST OTT ‘SFE ‘¢ 8FS “092 ‘LT ZSZ ‘86E ‘668$ d0UB 92E ‘9¥9 ‘2 929 ‘026 ‘TT L9T ‘682 ‘8 868 ‘266 ‘T 1¥6 ‘628 ‘8 9£0 ‘06T ‘9 98z ‘SPF ‘E9 ££0 ‘890 ‘0z TEb ‘88F ‘Ge £88 ‘OSL ‘6F 692 ‘196 ‘OS 60T ‘ZEL ‘6 L8L ‘SSF ‘2 £99 ‘068 ‘ZL 80I ‘640 ‘22 €0F ‘E88 ‘LT 692 ‘O&F ‘ZZ OT0 ‘FIT ‘ST ZLS ‘98T ‘09 PS ‘SSL ‘F 082 ‘S60 ‘OF 022 ‘616 ‘ZE SSP ‘029 ‘E PIL ‘Tee ‘T G29 ‘Ege ‘8 912 ‘Tze ‘2% S61 ‘PLE ‘IST SZO ‘O8F ‘Ez 626 ‘ESF ‘8 FE0 ‘TLT ‘8% 209 ‘oer ‘TOE ‘I$ [8301 Kaeia a eeeniee bian nae TS Lyk od atte s a RE woe rere se ne e--------- BAStIqeN eerste eens ary smerny sak 29 er = CaO Sat ahietde sais nya depen ees SE cae i ae ee “77> """"S9,osNyoesse Jy Ee a ek a erie eo I ees DU UEAIO Lr ee Ae pent a Pigs Beane: suelsmMoy eS RCE Cars og po Mtn Pees OUST ; ae pee ee aes age ee eS ap SCOUT ea Fe ee Poy ct ol Oe Pee ts ROMO SS eee es he Ga ae ae ee ~~ Spo, yy irik res Lemus ~__ 7 BIQUINIOD Jo 4d114SIq ace ees oe eae eee ClO oem ona eeen Bases ctanensehan “""""=-gnoTqoeuU0D See ee soes fe a ee weet = Ope Foe ae ee we een ee ~~" STUIOFTVOD wee eee eee eee Saree 2” ash SESS SCSUB a LY: Sg i at ee a eee euozj1y wre r arse en se --- +e - TOTS 5 CUIBG STV OE OG ONG Se ee ae Fe a acer “"[e810O.L a — suojssessod put ‘saplozypi4ay, ‘soqe3g SS ee ee ee eee 1 €S6[ 400k ywoosf ‘uonpsys1unupp ANANIAG 10190 :saqwIGg 07 SIUDIQ—"Z JIquy \ Appendix Tables 281 "sISBq PeNSs], OUD BUCO 1 a pg ge QLT 12g P99 “S61 229 ‘FE 919 ‘Ge 198 ‘ZE TSZ ‘O8T £92 ‘681 OLL ‘OTT 6ET ‘29T 9ZF ‘GG 962 ‘19 6LG ‘FS 9CL ‘TH 198 ‘92 OLF “601 veo ‘Th 696 ‘11% 669 ‘ec STO ‘OST FEI ‘G6 108 ‘ST. LLY ‘LES LZ ‘ST ZEG ‘BL 298 ‘ele $16 ‘TST SIZ ‘69 SF0 ‘2c FL0 ‘882 GC8 ‘OIZ £08 “6FT €6I ‘CLE 820 ‘OOT 190 ‘ZIT 668 ‘T19 OF8 ‘Ese 190 ‘16 062 ‘8cz 468 ‘PL FI8 ‘0ZE 88S ‘STI C0Z ‘16% 188 ‘STF PEP ‘G8 S6F ‘8ZE 6bS ‘PSE F1 ‘6L 126 ‘OOF 096 ‘2ST T8¢ ‘ZIT 679 ‘60 C88 ‘Z6T 926 (9€% CTO ‘S61 6g ‘z9E GT9 ‘28 €69 ‘OZT 922 ‘609 ASA cog ‘e8 L8L ‘193 G06 ‘96 PL8 ‘9Z9 402 ‘ZT 62S ‘PST GSP ‘Ith Z9S ‘26 626 ‘229 OTE ‘997 686 ‘F 0€6 ‘sce CEL ‘PSE 902 ‘F6T 6L6 ‘SOF 8F9 ‘OSPF ‘T G0 “SFT ‘Z% 192 “180 ‘T LET ‘LL OIZ ‘8z9 006 ‘F2T | 886 ‘699 ‘T 269 ‘Z8T | £88 ‘ZL8 ‘Z LS& ‘S08 T6L ‘OTS ‘T 16z ‘E6I ‘ZS FEL NERS 229 ‘628 'T ILE ‘PES ‘ST 11g ‘¢ 080 ‘6g 982 ‘OF 029 ‘6Z EE ‘86 99¢ ‘“69F £08 ‘F9E CT6 ‘Sze Shs ‘LOF 0L8 ‘FS £62 ‘68 960 ‘080 Z FOF ‘000 ‘T 199 ‘TL 09F “eo 198 ‘OL LSP ‘GEL ‘S PIS ‘LET PPP 166 | 996 ‘0S ‘T 016 ‘FF 620 ‘OTF ‘T Go ‘180 % G8L ‘9¢ 866 ‘966 ‘T G6 68E Z 82E “OLS FOI ‘ZOF PLE ‘FIO ‘S FL8 ‘TSS ‘TI OTS “622 ‘S 662 ‘Shs ‘F 928 “ggg SOF ‘796 ‘T 610 ‘029 °6 786 ‘OLF ‘OT O8€ ‘169 ‘T 69T ‘SL8 ‘Z% 829 ‘OFT Z CPS ‘118 ‘8ST Gz ‘020 ‘% IZ ‘68F ‘IT TT (G96 ‘2 900 ‘960 ‘T F8L ‘T8z ‘8 629 ‘LZF ‘SE 069 ‘T9 20S ‘E28 ‘T TZL ‘TOL 882 ‘TS9 ZL ‘SSL ‘T LIP ‘$19 ‘CT LLL ‘CSP ‘L 608 ‘290 ‘Ez 89L “Ott ‘F Lie ‘290 ‘% OFT ‘192 ‘E OF ‘922 ‘69 00S ‘e669 ‘ST L9G ‘880 'F Gg9 ‘689 ‘TT I1¢ ‘19F ‘e LOE Che 1G $20 ‘ST9 ‘2 OST ‘968 ‘Le Q9T “STS ‘98 £96 ‘Tel ‘¢ 6F2 ‘612 ‘ZT 620 ‘128 ‘SF Me on ae ee eee ee ke SPULIS]T UISITA SO poses twat gs ee ee ee ee es OdTy OJIONG O8T ‘908 ‘ Ripe? ae mablebie gs cree i Sr pea fo “""“TTRMBT TESLe Cisco ia ie oe ee eee ---exSBly Ohi eGsc = erase eet CO a ee Bururos AA OCT ioe CG ot et ne ho es eee ae ae U[SUOOST MA. DOG HOE AG see RO a ee ae SIUIZITA ISOM So Ete ee 2S eee ee ~---"TO4SUTYSe ROW POULLE > = kg a ag. eee ea ee = SIUISITA Cle O66 Ce ee ee ee qUOTHIO A TOO“ OR Le Oe. |S ee ees eee qe30 GCleIBeics oO (Ce ee ae ee ee ee SBXO,L MOO BIG ATG =< ein a eae ae eae ee sessouud,y, PLC tO tinge eS ee en ee ejVOYVBC YINog EZ COG TET sox Vil seme 0 oe pen eae a ae euTjoIeO [INog GEOP OL Og fre ek ee oe eee eee puUvIsT spoyy PRPC OL EOP a en Pee a ee eee ~-BTUBA[ASUUEg TOE O0S Ol 2 ts ee a ee age ee a ee --"1m103019 G69 ‘TTS “Zo a Oriel emma ne ger ae Oe Coat emloyel[yO FOE 20) Oe ot ee ee ee eee ---o1gO GEC Ne ee ee BE SEG See eee e108 WIION CoC Osh bate ao Sr sae tee ee --eUT[OI8O ION BOG GUG SOT ve elt ees op Oe, ae ee ee ~yI0OX MON 293171—54——_19 282 Department of Health, Education, and Welfare, 1953 Table 3.—Grants to States: Public Health Service, fiscal year 1953 * 1 | States, Territories, and possessions Total bet gest aie General health MO ALE Re ssn ao ee nae? ee $147, 158, 086 2 $7, 162, 260 $5, 300, 600 | $12, 999, 970 ATabaniat Secu Ue. yb ah ana ae uae mee 4, 051, 307 301, 508 125, 595 399, 716 BNaoa VA Fe eels ip ps OE gm ee ET aA NON ey 1, 058, 796 65, 719 | 57, 204 95, 491 SA rican Gea Gi ah ee Sic en imei Ne ana 3, 788, 695 146, 322 87, 634 251, 806 Oalifornia eee ca ee ee oe enema 6, 152, 039 150, 838 288, 454 665, 411 COlOTAGCO! Fe TOO ae no aaa Le Oe Je 832, 110 46, 423 44, 487 y GUS eS 1i Conmecticu tase. re ener se ee ee 1, 113, 861 35, 195 74, 781 125, 187 Dela warestdise oi ay Sache y te am 302, 759 17, 191 19, 839 22, 700 DIStElch ot Coltinn bi eee eee 842, 695 136, 909 49, 198 47, 731 WO) (09 ot (6 Fee th en ok ee et area Tt 3, 279, 897 417, 626 113, 666 265, 679 Georeia: he Boe oie os ae Ree res 4, 986, 537 505, 318 163, 097 402, 814 TOA OMS Pk aN, ne Serle Se heer ae 210, 191 36, 459 17, 070 75, 857 LINO 1S SPO a ee a ee ee 7, 651, 730 285, 167 | 259, 683 533, 165 Wo CoNtsN ays Rape a Nees eye Fie cs A A Se) eA Ses 5, 889, 913 102, 542 103, 743 293, 359 - EG Was eee te eee heat ee eg cag 2, 072, 370 53, 966 | 46, 407 | 208, 207 Ig rises en RS la paca rine Race a 1, 668, 492 36, 238 56, 143 | 169, 917 Kentucky ak ee i Se 5, 954, 438 190, 734 146, 790 345, 000 TIOUISIAT AS eee terete et ae i Ne 4, 686, 149 432, 032 106, 502 296, 938 VT tT ee ie eee ee eis 2s cere eda & 380, 573 15, 362 28, 671 97, 157 Weary lan coset Sere ee Ce eee sted 2 ae 1, 642, 079 128, 703 105, 810 170, 538 IMASSACHUSCLIS: ac ue EE eee ee ee 3, 230, 295 46, 259 : 172, 100 312, 984 VEL CHIC alien: ey ee a Rie ec eye een, 3, 880, 212 142, 908 172, 624 446, 773 INEINN ESO ta sue cer et oe eee nee eer 4, 859, 643 25, 464 7C, 514 247, 469 IVEISSISSIP DI 3o ht ren Beedle de 2, 651, 611 396, 052 119, 824 340, 088 IMEISSOUNISE 220). - bo eke eek eee eee 2, 703, 091 187, 058 125, 840 317, 423 IVE OMUAN Aaa Sak oe 2 eee ee ee et es pee 616, 893 17, 709 22, 180 68, 205 Nebraska o.oo ee eee ne ee 1, 144, 459 25, 898 30, 515 - 128, 264 ING VAS re Oe eee re ame peer 179, 737 21, 155 10, 384 37, 971 New. Dampshires ase 22s. es kee 194, 522 12, 025 16, 474 49, 984 ING Wi Sel SCY Renee vel Oe 408 as a ee 3, 935, 542 78, 638 138, 847 309, 276 New: Wiexic0ses st. 3855 = eee eee 745, 658 35, 540 39, 599 96, 653 INOW) Y OfKk $252.8) 2 SO Se eee 7, 823, 928 310, 427 430, 585 824, 707 North C arolins ee 2 eee ee ee 6, 305, 262 318, 580 155, 359 47?, 889 North: Dakota. 2S: = See ae ee 631, 698 25, 284 37, 442 75, 147 (ON a Yoyaae aaah shy Ce fy eee cas ae PN eS 6, 597, 379 178, 656 229, 899 550, 033 Oklahoma ess28 Se 2 oe Seek Se 1, 232, 869 100, 689 81, 866 222, 693 Oregon esses SCE peptone = Seeieies 1, 112, 999 25, 893 48, 444 137, 604 IPOnnsy WANA se. =. 2 fia Coens See 7, 424, 528 242, 420 269, 536 756, 303 Rhode Island---_----_- Sea an eee 460, 163 14, 867 29, 216 55, 867 Souchi@aroling sce. = eee ie eee eee 3, 653, 540 249, 006 114, 565 274, 222 South Dakopas. lee. cca. wees 688, 214 17, 800 22, 517 77, 223 Penmesses set a4) See a) ere 5, 302, 287 214, 846 153, 840 354, 179 siecle Au mealiny MPRCay soe ik SR ai 8, 110, 335 624, 146 193, 296 692, 088 Utama OA A ee ee So 589, 865 16, 640 18, 198 86, 322 WiGTI OT Ges See pe nse ce re oes 364, 856 14, 228 17, 811 45, 282 Wig Ue 0a tre toe ORO DUD tam Rie aw Opes Fea sd 3, 049, 608 168, 519 154, 015 326, 592 Washing toms. cis ocd ol ws be care Mines oc 1, 276, 374 29, 802 67, 074 172, 236 Wiest Virginia. £ 22250 oon 2 see ee 4, 567, 906 112, 903 71, 450 203, 010 WISCONSIMS oes A ak se eran eee 2, 598, 188 24, 910 67, 480 258, 905 SW OMT oe ee Siig gee eed Pa ee 438, 070 15, 253 11, 885 48, 661 (A aska 82. [oA aoe ee eae Case ee eee 269, 085 17, 246 67, 489 48, 631 Biswali.) iy eer eee ees 533, 133 16, 512 48, 709 44, 060 Pier tOyR icons 2 2: se a eee ee oe 3, 368, 168 316, 211 191, 268 317, 320 WircinvislangdSen lo a2 Se ae 53, 337 14, 464 9, 381 5, 856 See footnotes at end of table. _ Appendix Tables 283 Table 3.—Grants to States: Public Health Service, fiscal year 1953 '—Con. wb te Mental : Hospital States, Territories, and heals aceite. Heart disease Cancer Industrial | construction, possessions ities activities activities | wastestudies| survey, and planning 10) Re Se ee $3, 049, 736 | 3 $3, 033, 844 | 34 $5,196,439 | 5 $1,113,416 | $109, 302, 421 J) 2 0 SE se eee ee 71, 634 46, 637 ei BOAR | Stents SEIS oe. 3, 033, 323 LL a 9 a 5, 786 2, 000 1S, LOO tees es one 819, 441 Joo UNI OS eee eee 32, 944 24, 553 BO, QSLIs ee ee ode eS 3, 195, 178 Moniionnia sets 2822258 2b Ske 180, 602 69, 592 3 719, 622 57,000 4, 019, 965 @oOloridors= ase See hese 25, 602 3 49, 452 eso) 4 Ol dt Saath eh 506, 248 Wonnecticuts o8% so82 So te 34, 178 22, 404 i ies oY ad le alt ae STR 769, 779 rete WAR foo. Io ko 2 as Sool. S 19, 911 12, 445 BOAR 72 eter. eee 205, 186 District of Columbia ------------ 19, 286 14, 464 $364, 209) ta ee ee 410, 808 (OG Ae BEES Se eee ae 57, 603 34, 436 BS; 046 ie ces 2, 331, 941 Crcorehy ess Lose 2S os So 2 77, 373 47, 082 79, 977 6 119, 385 3, 591, 491 eo ees ee ee 20, 021 15, 146 17%; GO8A eee ees oe 28, 030 MB M@IS eens ate ees I Le se 147, 280 3 445, 101 147, 140 6 1038, 258 5, 730, 936 BA. oo do's J -s 64, 104 28, 600 3194, 272 6 181, 232 4, 922, 061 Ne Se a ee ok oe 49, 120 20, 043 bs Onde ter cee see 1, 639, 596 a a er 34, 029 24, 682 SOP aIOeLh tear we ee 1, 309, 064 LECCETINUITS (6) Sy as ee 66, 391 41, 591 TA, LOLs eek etee wae 5, 092, 771 eomistang e762) 52 Lp soe 57, 220 8 325, 153 BG; BOT: fete eae ee ee 3, 411, 797 ASS eae ee eee aes 17, 513 5, 000 20,493) |S. s5 ees senna 196, 377 Da EyaAN ween eo. oo seek 43, 620 16, 196 38) 450g | ees eee 1, 138, 759 Peapsacnusebts.:..2-43--.1.4.-5.- 87, 597 35, 068 OA BOG ea aren eee 2, 481, 432 PVINGINI AN oe ee 8 117, 977 40, 262 3153; 004 oe ae es Lees 2, 806, 574 Risin GsOta == se= 2a 2 2s 57, 341 3 247, 748 346050603) 22 ee 3, 751, 047 Use CS) ES ee 55, 040 40, 737 G4 C80 setae meee 1, 635, 190 IMANISSOUT see oo te. a ae 73, 943 37, 248 SO GOS4ss| Soe eee ean cae 1, 878, 945 TC) ENG ES 20, 021 14, 568 17,200 Soe Sasa eee 456, 920 ea Se 14, 474 10, 816 DTN 0a peatagaese ate 908, 922 De eee 5-4 9, 894 6, 536 GF047 eee sees 87, 250 New Hampshire__--------------- 19, 583 11079" 208s ee ee ae 85, 383 NIG? IGG Nee er ee ea 89, 978 37, 735 (Sc40G60 Ere: Sateen 3, 212; 572 ING wa lGXICOs aes eee sect 18, 594 5, 110 ONG85: ane Cate 543, 477 SS 6 es a aera 264, 005 3 582, 749 3 OS0\G06 Tar tee 4, 730, 849 Norio @aroling 2222-22 22 81, 258 32, 078 59, 535 6 129, 000 5, 056, 563 Marti Dakota. te 20, 021 15, 158 17; 920) anc ee een eee 440, 720 (OD) GR De ae 150, 667 60, 721 3 471, 031 7 6, 000 4, 950, 372 Oia MOM A ese ee Sooo S 45, 685 29, 108 46, 402 71,201 705, 225 (OWE (ERO aie see is pele i le a re 28, 156 13, 592 21, 460 71, 500 836, 350 penis yIvania so oS 4 le 201, 103 3 324, 359 81243. S407 (ioe s eee eee 5, 386, 962 Node sand 222) 22" 5222 ee 2OpOUSa esate es See 16ZO14 "| ses eae 324, 186 Sout Carolina. 2222 25---" 2. 49, 411 21, 332 50, 076 6 419, 811 2, 475, 117 BonpaeWakotal a... 52-- 4-2-2 18, 871 11, 348 1S20 7c eee 529, 248 PREDITESSOO sees = Soto Set ae 67, 947 42, 381 2180 00g. |seeateew eee eee 4, 287, 517 io eS a ale Poy lee es Se 3 248, 378 8 82, 952 6, 112, 454 SS A ESAS ee 18, 628 9, 350 15, 70922212 ee eae 424, 928 1S TURE led A 10, 599 12, 315 BL, 66)<|4. Se Se eee 253, 060 Pei os ae eee 69, 761 5, 000 Sis OOD" ace seas 2, 294, 721 TE US a lp lt oa 44, 289 25, 648 43, 407 7 2, 874 891, 044 Ry ese wireinia: 22 228 28 ek 41, 128 27, 331 43; 489 |... = Soke eee 4, 068, 595 Es: SOT TTS 9 aie Sie le ae 65, 311 27, 857 56, 915 78, 648 2, 088, 162 AWS CS COB TN Sa a a 7, 073 4, 724 IN, 468-22 See eee oe 339, 016 PPS dee eee 88 ok os 19, 089 Be Q00U tae ote an ae haa ans Soe 111, 430 a Eee ee 19, 389 14, 146 9, 749) ei oes St Sew 380, 568 1 EAL oi £8 Te a Gil A ga a 42, 416 34, 868 DI Qi4 eles dea eee eas 2, 414, 871 Wareinolslandsess suse. ae 19, 236 3, 101 15:299 42 eee eee ER eer ee 1 On a checks-issued basis. ; 2 Includes $748,679 in cash, supplies and services for rapid treatment facilities and $2,897,194 in cash, sup- plies, and services for venereal disease special projects. ; ’ 3 Includes grants to universities and local units. Does not include funds for federally operated center in Hot Springs, Ark. : 4 Does not include funds paid for special control projects. Lut am & This amount represents $1,093,193 for construction of community facilities in defense areas and $20,223 for industrial waste studies. 6 Payment for construction of community facilities in defense areas. 7 Payment for industrial waste studies. ne as 8 An additional amount of $537,000 was paid to Alaska for disease and sanitation investigation and control activities. 284 Department of Health, Education, and Welfare, 1953 - Table 4.—Grants to States: Office of Education, fiscal year 1953 * States, Territories, and A Total possessions Totals. oP Caos ee $214, 753, 562 ATA DaMa: 6 ees Sass ee 5, 522, 786 IATIZONA eee sree nee > ae See 3, 623, 193 IAT KANSASE Ss lst ae Ree ese ee 5, 480, 852 @alifornid. sess ses eee eS 30, 513, 234 Gotorado. {aes pr bee sees 3, 895, 727 Connecticut 22 ees Sees 3, 504, 418 Wella Ware “cae los eee eases 230, 975 District of Columbia_-_---------- 93, 755 OMG an: belt eee sae eS eee 4, 605, 596 GQeOlviges wee oeeeten soa eee 11, 920, 485 Wdahors. eee eee ee 1, 819, 471 TOISe ni ste ee Se ees 5, 700, 875 MCA Oe) be Per One ee 3, 177, 197 TOWiaiee ested 2 6 oe se lal ee 1, 408, 545 OANGAGe usar eh Ce ee pees 4, 953, 682 KMentuiGkye 4 oat seo ee 3, 817, 363 NOWISIANA ek oe Sere ee ase 2, 623, 873 SST CC aan ea esse ok asks tes Chit 629, 655 Nigry land. ys sia be ate ee 6, 978, 258 IVPASSACMUSeLLS eer se oes eee oS 1, 342, 220 IVICHI Gaile. ns oe oe cee ne 7, 678, 762 IVEINneSOtAL ons ee ee eee 1,005, 704 IMDISSISSID DL 9. eae e ss eee 2, 672, 229 IWEISSOUE Se etaee s Spe ee ee 3, 895, 356 Wiantanaa wee te ee bees 1, 153, 859 INGbraskqessese coe see) ee Nae y paar hy INGVOCRssteA. Oe So eeese eee 1, 915, 850 IN GWeblampsbire.ss- see =e ee 541, 588 INGWrd CPSOyiteose2.. eens oes 2, 913, 090 INGWie VICKICOUM a2 cscs. ee eere ae 3, 240, 040 INGOs WOPK 6 te 2 120s oe ee oboe, 3 4,009, 041 INObO Carolinas... sae t ee 4, 089, 906 Non sDakotae. = ee - Sek eA 548, 852 Gout ins eel es fy ees ee 6, 415, 396 Oflahoma-2e2 Se. Jeep cis Shoe a} 5, 838, 263 ON eee) a ase pies pire aa Ope Ge iy ace 1, 558, 973 IRONS YIVaning <2 oe ee ee eae 4, 240, 503 ROG [SIGN joo ee os ie a 825, 482 Sout Carolinaze =. 2.55 ee 5, 730, 780 SOuUtnM Dakota se eo eee cee ne 870, 811 PPEMMESSCE 2 2 esp sees She oe poe 3, 934, 033 ROMS aha ot Lok. ok ee eee ce emreta 14, 264, 200 DE an a9 US ee ate bby 2, 104, 752 WienImOnt tae e222 oe ee 372, 158 Virginia hoe ee DLS eee 12, 697, 967 WVASHINCTON $5.25) 62. 220228 poe 11, 650, 140 Wiest; Vareiniaa. 28 25> Stee 558, 207 WVASCORSIN S20: 22) yee 955, 332 War Oming. eae 0) oct eek ae 339, 162 ATSC Jo See or eres Seen 2, 316, 850 HELO Wales Chee toys Ae eee 2, 317, 725 PiUETLOcRI COs: kn See eee see 1, 018, 142 Vitginsislands st isa passe 2: 21, 104 Colleges for agriculture and the me- chanic arts $5, 030, 000 100, 111 77, 070 88, 629 175, 094 82, 805 89, 603 72, 770 75, 466 156, 419 108, 805 95, 719 88, 587 98, 945 96, 342 78, 706 92, 948 116, 342 133, 096 99, 321 91, 313 109, 009 75, 490 82, 809 71, 195 74,914 117, 785 76, 388 217, 386 110,078 75, 775 148, 780 91, 856 84, 760 174, 215 77, 491 90, 696 76, 105 102, 403 146, 444 76, 466 73, 364 102, 671 93, 307 89, 586 103, 826 72, 495 Cooperative vocational education $25, 420, 754 670, 987 169, 933 491, 667 720, 644 153, 646 1, 098, 786 655, 676 555, 178 366, 801 678, 348 491, 851 156, 609 311, 936 499, 931 889, 169 B71, 955 614, 337 695, 773 167, 075 287, 991 111, 986 152, 492 500, 499 166, 829 1, 561, 324 958, 134 204, 547 1, 109, 584 438, 879 263, 330 1, 359, 966 100, 529 492, 257 201, 526 715, 420 1, 248, 752 165, 983 155, 887 643, 318 362, 316 414, 354 615, 079 158, 654 158, 654 558, 563 21, 104 Survey and Maintenance school con- struction 2 $118, 308, 139 —_——_ 3, 695, 279 2, 599, 371 3, 905, 429 14, 223, 724 1, 754, 649 2, 326, 538 2, 966, 875 7, 909, 746 1, 346, 574 3, 064, 601 1, 672, 648 548, 171 1, 851, 098 1, 425, 849 1, 847, 348 60, 906 5, 342, 279 57, 646 5, 770, 032 284, 330 1, 451, 422 2, 268, 835 671, 546 247, 179 1, 222, 027 1, 252, 981 2, 430, 909 1, 430, 124 2, 290, 523 73, 975 3, 096, 957 2, 889, 012 805, 587 1, 688, 753 98, 472 4, 189, 151 133, 679 2, 843, 418 7, 690, 084 1, 119, 978 97, 542 7,144, 491 8, 516, 190 5, 581 40, 345 1, 306, 675 636, 811 12, 799 and operation of schools 3 $65, 994, 669 1, 056, 409 776, 819 945, 127 15, 094, 984 1, 638, 494 840, 101 —6 1, 148, 303 3, 186, 169 243, 785 1, 381, 069 740, 068 209, 477 2, 647, 196 1, 614, 221 188, 332 333, 434 1, 231, 095 668, 301 886, 525 50, 098 515, 157 821, 739 239, 748 654, 166 510, 642 314, 182 1, 041, 825 565, 914 800, 207 731, 171 189, 555 2, 060, 065 2, 418, 516 405, 296 — 1,017, 569 548, 980 968, 676 459, 501 272, 792 5, 178, 920 742, 325 45, 365 4, 807, 487 2, 678, 327 48, 686 196, 082 108, 013 939, 293 1, 447, 679 396, 780 - ee ee a a ee ee eee ee 1 On a checks-issued basis. 2 Does not include $9,885,864 paid to Housing and Home Finance. 3 Includes funds paid Army and Navy to be applied to State projects. Detailed Contents Page Peron LAR Y’S REPORT .23 22 28 ee ee 1 SOCIAL SECURITY ADMINISTRATION Bee ory tid ty EN: 1958 le Sole ot eo eel ee bee 9 -ProGram POMENT OTA TION INVLOO5 On ote en ee ee tee 12 Pe AG, AND SURVIVORS. INSURANCE. o.oo Jo ee ce cet 14 eer aNtvICANCH.OF THR, PROGRAM... 22. -2--—L ee eterna cacucue 15 menenciaries and. Benefit Amounts... 22.00 be et 15 DT AUGCh oir tinted S085 ps Pe ota ee be et a 16 Br OMOrare Ol eiie Programs) 2220 22a ee ee 16 Pomteimouans and Disbursements. ooo ou es hive eee De roe ama 080) wl be ee ae 2 eo. ee 18 Menacement Improvement Actions.....-...:-..-...-.-.--...-.--.=-- 19 Administrative Planning for the Disability Waiver-of-Premium Provision. 21 ee TiO TRO CRAM a ee ee on 22 NR a eh Sa orld OU as pe re ee ee aa LL 22 SITE ee Cotes ok i eet 25 MMC IOLTIV ote ttle” a ee ee eas PHP REG tt Cre) oe) oye lh poe elh aceleetes 28 ne ES UES SE NMI GUT ES a pS ee ce Oe 29 ey 5X PENDITURES. 2 Se a oe eee ee 30 EFrect oF OLp-AGE AND SuRVIvoRS INSURANCE ON PUBLIC ASSISTANCE... 34 Lv LOPMENTS.3 80 on on Se ae O e e ee e eeee 36 Institutional Care for the Aged, Blind, and Disabled___________-------- 36 Public Inspection of the Public Assistance Rolls____------------------- 38 Pavce to*Law-Eniorcement Officialsi.o2 ool uee leek lk eleee 39 Aid to the Permanently and Totally Disabled___.._......_..-.---------- 40 Social Welfare Services to Public Assistance Recipients_____.-__-------- 41 SEITEN RRC RO MIVA TEC Neat ae as ye nh ee A hs de 45 eT SPAN tluGieee ie. bee Ie er ee UL a 45 Mernimeal HAcsistance tO otates Orie eye Se ees eee 47 Administrative Review of State and Local Operations____-_-.---------- 47 ere eocram evelopmentsiiuuis tools es So ld ig weit Levees 48 a SS WAN SST FSU VIE IS SSO tne: tea ene PAGE 48 Tue SUREAU CONTINUES1TS PROGRAM: 222 bec ecwerenee loll eee 49 286 Department of Health, Education, and Welfare, 1953 Reésearchie . 2c oc Seis ee oe Or Administration of Grants Under the Social Security Act._._..._._.-_------ Cooperating With Voluntary Organizations__.=-_--2 3.4 _2_<220 2a ee New EMPHASIS IN 1953824 22 2 a a re Juvenile, Delinquents... 2220s fa ee ee Mentally Retarded’ Children=. 202222 23 a ee Children in Migrant Families- 2.041 ii. Ml ay ee eee RESHWARCH 22 OO Soe er Ce ee en! AS aia ee Through Its Advisory and’Consultation Work222) {2 2222 2) See Through Gathering Information on. Programs... 2.2.02 ___. . -. Se a THe Strares ARE Art WoRK FOR CHILDREN. 2248. 2- 2) 2 eee Maternal and Child Health Services... 2.22 0222.22 eee Services for Crippled Childréni 2 020 ee eee Child’ Welfare Sérvices_. oo. ecue let ee ee ee TABLE 1.—Social Security Administration: Funds available and obligations incurred, fiscal years 19538 and 1952...._-._.4.______u_ J TaBLE 2.—Financing social insurance under the Social Security Act: Con- tributions collected and trust fund operations, fiscal years 1951—53____~_ TABLE 3.—Old-age and survivors insurance: Estimated number of families and beneficiaries in receipt of benefits and average monthly benefit in current-payment status, by family group, end of June 1953 and 1952___-_ TaBLE 4,—Old-age and survivors insurance: Selected data on benefits, em- ployers, workers, and taxable earnings, by State, for specified periods, $O61-53 oo oo oy Me eee eR ee eee he fe ee TABLE 5.—Old-age and survivors insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1951—53_- TaBLE 6.— Maternal and child health and welfare services: Grants to States for maternal and child health services, services for crippled children, and child welfare services under the Social Security Act, by program and State, fiscal year 1953.2. 420iveses) lene S fee sel ee i pa ae TABLE 7.—Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average pay- ment, June 1953, and total payments to recipients, by program and State, fiscal year 1953__ 2222-0 222 a ee 78 Detailed Contents 287 Page TABLE 8.—Special types of public assistance under plans approved by the Social Security Administration: Federal grants to States and total expenditures and percent from Federal funds, by program and State, (1 ES WEG OU ae ll lS ls pam see jl etiipeak at ei ei viel nig adalat a 80 TABLE 9.—Federat credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding Dec. 31, 1935—-52_____ 82 TaB.E 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1952, and TE NS Bee oh Seen yD ta Wiens i et a A 82 Cuart 1.—Where aged persons get their cash income__________________ 10 Cuart 2.—Who received old-age and survivors insurance benefits, June enn te re Se ei Se Be A ha a OE Oe A re 15 CuHart 3.—Average monthly family benefits, June 1953________.______- 15 CuHart 4.—The old-age and survivors insurance dollar_________________- Ll Cuart 5.—How assistance payments are financed__________._________- 31 Cuartr 6.—Purchasing power of assistance payments to the aged and I ate ett a oe ee 33 Cuart 7.—Growth in social insurance protection for the aged___________ 35 Cuart 8.—Growth in social insurance protection for orphans. __________ 36 CuHart 9.—More mothers and children are getting health services________ 56 Cuart 10.—More children are getting crippled children’s services________ 59 Cuart 11.—Services for crippled children cover wide range of conditions__ 60 CuHart 12.—Some children do not get adequate child welfare services_ __-__- 63 PUBLIC HEALTH SERVICE eee OW PHN NATION. Ww ooo OR teaslitse ¢ 83 MET EE STUN SEV CCOLC ele fo el eee me oe SL 83 Rumer rea blc Diseases os ON RN ise rs eee 84 Communicable Diseases in Other Countries_..--_.______________-_-_-- 85 RE TPCT CMO ree Ges tet rae ee iy = PG OEP Tat ah wth oc 85 er DOr DIWi rem cee Slee en ue ie Mae SPY eT eS el Ve 85 REIN OWME CO PIN EDL S poke ee eh en ee ee LEO 86 MEI OMT IStribuiiONs 22 ee Le Se LL AL 87 PeAnTe CONDITIONS AND RESOURCES __.U2 008 fi slic est ese 88 MN PRUE ETNICCH ois ile ee Oe UL ee AL 88 Semoussion. on ‘Chronic Iliness... — uc oe es te ee 88 Bere sion OUCATION SG 2 3.2 oe a ee RS or ere tain bho 88 PERM TEETITIO WELT se eho ee ES ee ee er Bt 89 SS DRI Sia Se aL alld co ae cs leo me a 89 ne 1s Tayeastel oy SBS) 9Y 6) a Pig sel natal tig ee a el ee 90 DREN UE CONNED. 2 go. ee eo 8 beer ee ee ME 90 Me Or OVO bp OG ee kk ee ae 91 Pe Go AND MEDICAL CARB... 2 vase eee Sk eee aie bd ee eee 91 MEME WOT OOrViCese ts ok ee ee ee atl eee hk 92 MEE eit nee Se et en te eA 92 RUT RIB TEA oye a oP eS ee ee 94 eT Spitalo ot Ges eo ih 94 HeALTH PROTECTION: AT Ports AND BORDERS. --.-------+-++---+------ 95 MOR ATONITAtONS ee ti ve So Be ol ede ee Be 95 DMR OCS oe he Se ee a eee 96 RENDER COUlAllOUS 0s. os ee ee ee ie 96 f / 288 Department of Health, Education, and Welfare, 1953 Page Hosriran SURVEY AND CoNnsTRUCTION PROGRAM_____.----------------- 96 Tue Nation’s NURSING RESOURCES. _--__-..-.---.----5 40 o eee pe 98 Trends in‘Nursing Personnel_.__-0.4_1----. 2... -- 42) 98 State: Nursing Surveysic vue ce Ol ee 98 | Rural Experience for Student.Nurses_..... 55-2. 055+ 99 Instruction forNursing Aides us). =. 222-24 4. ee JOS 99 Denran ResoURCESS Ses lice oo el a A 99 Supply of ‘Dentists... 2. 2k eed < Se ee 99 Utilizing Dental Manpower and Facilities. ___........-.-.-.---------- 100 Dental Epidemiology ee ee eee ee ee 100 Mmpicat anp Hosprtat RESOURCES. - LL eee 100 MEDICAL SERVICES FOR FepERAL AGENCIES__.....--=.-.--------e sees 101 Office of Vocational Rehabilitation esc ao. 4 be ene 22 3 do eee 101 Training of Personnels.) 252552 sbiiewa doe eke ot ee 101 Facilitiessand-Services.- oc. kn ee 102 Community Cooperation). 2.24 bose cg cde eet il. 2. Se 102 Bureau of Employees’ Compensation, Department of Labor__.____----_- 103 Studies of Occupationel Hazards.._22-..ciliu od .e oe 103 Bureau of Prisons, Department of Justice....i.5.2.22 2. Le ee 104 Bureau of Indian Affairs, Department of the Interior________..._------ 105 Medical. and. Hospital Care2i. - 42.2.4seb we ide oo cae 106 Public Health and Preventive Services. __._.........--.---.------ 106 Nursing Service. Uo. Ce Ite ee ON ee ee 107 Panitation vi250 oe we ee ee nk Se 107 Tuberculosis Controlz....s_-- 222... La ee 107 Oral Healthzone ee ee 107 Maritime Administration, Department of Commerce_________-.-------- 108 United States Coast Guard, Treasury Department_________._-_._------ 108 Foreign Service, ‘Department. of State. .......-..4._-__ 22225 108 ADVANCING FRONT OF SCIENCE... -- WU. sc ee 109 THe CLINICAL CENTER 2. 02. 0 110 RESEARCH GRANTS AND FELLOWSHIPS_.....-....c. ilu ta loo) Bee 111 ARTHRITIS. AND. Metapotic, DISEASES. _.¢ -ce24ic.92. eee 112 Research Accomplishments. 2220 224222.) bul ea Lak ee 112 Research Grants and Some Results... oo. 225. Jesul liv. l) ee 113 CANCER RESEARCH AND CoNTROL.J2U5.000 2 ee eee 114 Laboratory and ‘Clinical Studies/2 J.Lo eee 115 Studies Supported by Research Grants. 2-22 20 eee 115 Applied Research and Development. 2. 22 Soe 2 2 eee 116 Support of Research and Control... ee Se se eee WA 116 DENTAL, RESBARCH. cue eee ee ee A 117 New. Horizons 1n- Heart RESEARCH... 42. 2220 2eLel ee 118 Research Accomplishments: 2 _ una Joes Loe et een eee 118 Research, Grants and: Some. Results... ool 2 Towarp’ MmnTaL Heanta. oo eee a eae 120 Research Accomplishments>_ 2/0 02 eS ee 121 Epidemiology and ‘Statistits-i 2200 22 Te ee ee 121 Grants and Accomplishments sic 00 soca hoe cee eae 122 MICROBIOLOGICAL RESEARCH. 2¢02 ee eee eee ee 122 Detailed Contents 289 Page Research Accomplishments__-_-___- Sep sala 7 Gr. ois Oh ee y 123 feeeearcu (Grants and Some, Results... 2 be Lk Le sl kee 124 NEUROLOGICAL DISEASES AND BLINDNESS____..--._------------------ 124 desearch Grants and Accomplishments._._.22_.2-2..-2- 22. =~. Le 125 PUBLIC HEALTH IN THE’ WORLD. TODAY...-.-----4 2. 2----- 125 DEPT OM THE STATE Sl C. 6 ee eae 126 Peer Ocal Participation: 5.6 20 cue 2. a eee ee 126 Mee aimn OF bIFE AND H@ALTHS. boc oo ol ob lolol eee 127 EINE Mehr 2 oh ee od ae od Seine (Ry Sula etea tar ihe 128 SUE CT EULOT ence a as ee pe eee 128 mmemertrncien, Methods. 22 by ee et Jbl cee eee be eB lee ee 128 mee ea FOUCATION OF THE PUBLIC. ooo) 2k e eek ee ee ek 129 PPMP PenCOTSGAICS Serio ooo Ae Boe ge 129 ME Pa aMGT Ttidicg. 2 ee ce ee A eee a ie 130 Mrmr TOA LTH ON URSING...-0 02 Py oe le et ee ees 130 Annual Census of Public Health Nurses______.._-...-_._-_------------ 130 ENGINEERS AND NEw ENVIRONMENTAL PROBLEMS__------------------ 131 Er MOR inet son Us es 8 Se eee 182 mr tigi g) gee tr a ee A es OS eee 132 Peenmroaninunity PACIitiESs. 0-02-52. Sul ee eee ¥32 inrersTATe PROBLEMS IN SANITATION..____--_.-...----------------- 132 RIT ee ee ee 133 ETS VOCS 6 ne ee ee ew ee eee 133 I I ee be ee ee 134 Bnei NCit Erevention..- <0. Seo. 8 ee ee ee 134 WrerARcH ON ENVIRONMENTAL PROBLEMS___.-..-.-.----+-------«+--+ 134 Dee Omexoiic: Chnemicalséro. 6 cent toyed ood belie heel ae lele 135 GCM GabGny ued eb ni hae Se Gl apd chee ahs’ oe 135 RE etiologies S e Se 136 feerrreand specia) oervices.. fo - -e - e t 136 Pir OLLUTION. CONTROL A. 3.3470. 022 3% oe hic bee ee 136 ETI GEM Cllitiog:: 2 taj 02 22k ek Le ee te 137 Ori eo ee ee UI 137 Peomorine THE H®eALTH OF WORKDRS_22222-.2.-L5---- bebe 138 nmmeeanices in iNiiciry ooo. eee et Pee 138 fe-earcron Occupational Diseases... _<..2--.--------22------------- 139 Pt eaatocis sate eee Yee OL Fife wp Roe 139 Besar rcs ee ews Bo ie od ee he Shee 139 MMU ren On Comen eam. Teeth ek ee 139 New Drrecrions IN VENEREAL DISEASE CONTROL__----------------- 139 eat Os ee eee a i er OEE 140 MEE cence OLAtisliCs. o.oo nt HEU ee 140 memati icease, hesenrch. SL a ee 141 Bee raining Services: 422s Le LL Re ee 142 Bere | URERCULOSIS. CONTROLs0 22-2 222225 5222232222 2222S le SN 142 DRIER ee aUrvoyen 2 oo ee ell eal ea 142 Studies in Tuberculosis Control-_----_-- SSE Shae.” SAAR Riss CEN AN Fae 142 290 Department of Health, Education, and Welfare, 1953 Chronic, Disease Control Projects:..2--. =. -<22__. 2 -eue ae eee Diabetes Projects... 222.25 2.0 -. Sema LS el ele ledac deoet 201 RUE ELIS tees a ee ee te ES 201 Reem ee hoodsClednec dec le tiie) neh es eee de toe 203 Educational and Regulatory Programs___........---------------- 206 Bere rGcicolTOLeCtiON. 2 ts ee OE ee be Nae diy 208 amen ianted Animal Mecd cons. fee ne ee Ik 209 Beno inepection service... 2 ae fe ee Sl VL ek she 209 Products of Spécial Dietary Significance... ...-.-.2-..-i+..-.--------- 209 a ee ee ee ee anodes 211 NED Tk ess 7 RE St Pe I re 214 SEE EMC eC icen Soe Ne ee My ee Pe Tn ee 214 EMRE GIG LOTS ee hs own 216 Me OMe SCT VICES 2 ke kp oe ee eee DM fl Legislation and Regulation-Making Activities__......----------------- 217 2g, ASN ea 6 eg | SM ae El ch Sean oe a le a cg ea 219 292 Department of Health, Education, and Welfare, 1953 Page New: Court Interpretations ic... oi. gel oe 219 ENFORCEMENT oF OTHER ACTS. 2222.50 20/-4sLck Ll el le 221 Screntiric INVESTIGATIONS AND SOME OF THEIR APPLICATIONS____---- 221 ENFORCEMENT STATISTICS <0 4 ge oe ee oe ke 225 TaBLE 1.—Actions on foods during the fiscal year 19538___-__-------_-- 203 TaBLE 2.—Enforcement activities during the fiscal year 1953________--~- 226 TaBLE 3.—Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1958) oe TS re ee ee ae ce 226 TaBLE 4,—Import inspections and detentions during the fiscal year 1953__ 227 OFFICE OF VOCATIONAL REHABILITATION A SUMMARY OF PROGRESS.__.5-..s.--.-24,- --- 36+ -- 5 229 Highlights of 19682-20450. eee 230 Combating Dependency... ... 2222+ o tata 231 FEDERAL-STATH. COOPERATION. 2. 2 SUC0L LUD 42o le) Se MS ae 232. » Objectives and Services of Vocational Rehabilitation___________-------- 232 Organization of the Program... sti tt a a 233 Assisting State Rehabilitation Agencies__._.........---+-------.---254 234 SERVING AmMpRICA’s DISABLED2.-. 1 oi ace atee LE ob ee ee 251 Physical) Restoration... <2..cee nb. 45-65 ceded coe ae 2 237 Rehabilitation,Centers soso. 2 en ee me ee 239 Special Problems in Rehabilitation... -_c.e2.4 i450 - 2 e 240 Mental idlinegs ne sien ict Ske paleo tetas pe ee 241 Heart, disease. . 3.35. eet = oe ne ok ee 242 Epilepsy... cei, sie Set ee 242 Blindness 202 sige boi Rimi eine eee oe atid m= te 242 Expanding Employment Opportunities for the Handicapped -_-_-__-_-_---_- 244 THe, DigaBLep WHO. AR SERVED. =. 222002 - 20-228 ee 244 Characteristics of the Persons Rehabilitated___._._...._......-.-----.--- 244 They Pay Their Own: Way2.ji---ihu.b Lt leo) 246 REHABILITATION IN THB! NATION’S ‘CAPITAL_.2_.2_/_¢_2_ Eat See 247 Heitping Our FrRIpenps ABROAD. J>__.-- Ll. 0 2.2 ls. Lae 248 TaBLE 1.—Number of referrals and cases, by agency, fiscal year 19538__.. 249 TaBLE 2.—Total program expenditures from Federal and State funds for vocational rehabilitation by State boards of vocational education, fiscal year 1953 25.6 UU EL A he A 251 TaBLE 3.—Total program expenditures from Federal and State funds for vocational rehabilitation of the blind by State commissions or agencies for the-blind, fiscal year 1953. .._......i'....-._.2.uleo be ae 252 Cuart 1.—Disabilities and major occupational groups___________-____- 245 SAINT ELIZABETHS HOSPITAL DiEVISION OF MEDICAL SERVICES... ae eae 253 Clinical’ Branches) 2 28 san a See Ee eee 253 Medicine:and Surgery: Braneh {22 e022 oe 256 Psychotherapy Branch: e220 ee eS eee 257 Laboratory Branch S22 Oe 258 Tt ee ee -. Sh ti ba oo Detailed Contents 293 Page ES Gr ee te Deh Sue ce te 258 Meenoual | nerapy: branch. 0 eM DO ee 258 moc service Branch_—_<__. = TOR TERS ek ede Ps ere Ae Ae St: SS ee 259 RE Ce ee RL ae a ee ee eh 259 ae ESL IRs SG ce AO Sc Se Se RS ele Bg 260 Red Cross Activities and Special Services Branch______________________ 261 ME Crider ed ee ea eas 261 MMMM Pee MINISTRATION. 02 goo ee EO 262 Dee OSPT TAL oe ee 263 TABLE 1.—Patients, admissions, and discharges, fiscal years 1935-53___._._ 264 TaBLE 2.—Movements of patient population, fiscal year 19538___________ 264 TaBLE 3.—Consolidated statement of movement of patients, by classifica- Re CR RSet a Ee ne Le eae OS 265 AMERICAN PRINTING HOUSE FOR THE BLIND Services to Schools and Classes for the Blind_________________________- 266 COLUMBIA INSTITUTION FOR THE DEAF IPI tals een ee ME ne A Ole ok tee Oe Le 267 I CD tee sere hs a Lee nk nee eee 267 tren epartment ot Hducation 6.7.2 22 fe See ee ee 268 CEI CUEMEINOUR 2a. ote ate he a ek kee 268 HOWARD UNIVERSITY ETAT SNUUCOIIG tas oe i ke Be ee ee ees 269 Mighiy pignificant Service to Negro Students______-.....------.-----+- 269 meeeenniical Distribution of Students2.2.-.-2--._.---.-.-L.-.-------- 270 IIs one et toe 3 a eee ee 271 Army and Air Reserve Officers’ Training Corps________--_------------- 201 IS eee het ee ea oer s Oh lee ee 272 Meer on OF Cue aAcwlby. 22.20. Meee fe ee en ees a --e 272 Two Outstanding Events of National Significance_________-_------_---- 272 New Pmoeineering and Architecture Building____-__._._._....-.---------- 273 Engineering and Architecture Building Receives Distinguished Architect- IEEE eM Sf rey i et ee ee ee ol eo HL te ek 273 RE oe a ee Pees eee SL So et sl 274 RE eee eh, Oe ee A i Se kk 274. Service to Foreign Students and in Foreign Countries____-------------- 275 APPENDIX TABLES Tas_Le 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1953__._._._._------------ 279 TaBLe 2.—Grants to States: Social Security Administration, fiscal year IIE, ak ee a BUS ties ik ee oi a eb Oe 280 TABLE 3.—Grants to States: Public Health Service, fiscal year 1953___._ 282 TasLeE 4.—Grants to States: Office of Education, fiscal year 1953_____-- 284 U.S. GOVERNMENT PRINTING OFFICE: 1954 Sg A cay i ' Han are eh 7 , i 3