HEALTH, EDUCATION, AND WELFARE 4EQ45 -MIGeL-A — 55 eer ll Pts, Ss : ans U.S. DEPAR® oF £- SS Ke For sale by the Superintendent of Documents, U. S. Government Printing Office Washington 25, D. C. - Price 65 cents cm a U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1955 OvETA CuLP Hopssy, Secretary Vacancy, Under Secretary OFFICE OF THH SECRETARY ROSWELL B. PERKINS........ Assistant Secretary for Program Analysis. BRADSHAW MINTENER....... Assistant Secretary for Federal-State Rela- tions. CHESTER S. KEEFER 5.6. 3. Sees Special Assistant for Health and Medical Affairs. DoNALD M. COUNIHAN ....... Legislative Liaison Officer. TERENCE P. SCANTLEBURY ..... Haecutive Secretary. WILLIAM C. MCCAMANT...... Assistant to the Secretary. PARKS: Mis BANTACS 2 sali ea General Counsel. RUFUS TE: MILES, SRe. aes a ee Comptroller. HORDYCEUULR ART se... ce eee eee Director of Administration. ROBERT @ J: (DECAMP os, sree ce Director of Field Administration. J. eOTE WARE FLUNTER Sehr: cust cit Acting Director of Publications and Reports. FREDERICK H. SCHMIDT...... Director of Security. SOCIAL SECURITY ADMINISTRATION CHARLES I. SCHOTTLAND. ..... Commissioner of Social Security. WILLIAM L. MITCHELL....... Deputy Commissioner of Social Security. VICTOR CHRISTGAU ..... Director, Bureau of Old-Age and Surviwors Insurance. JAY TR RONEY fe ree Director, Bureau of Public Assistance. J. DEANE GANNON...... Director, Bureau of Federal Credit Unions. MARTHA M. ELIOT...... Chief, Children’s Bureau. PUBLIC HEALTH SERVICE LEONARD A. SCHEELE..... .. . Surgeon General. W. PALMER DEARING........ Deputy Surgeon General. JACK BEASUB Ss ie rcee wise ik Chief, Bureau of Medical Services. CHARLES E. BURBRIDGE. . . Superintendent, Freedmen’s Hospital. Otis L. ANDERSON. ..... Chief, Bureau of State Services. WILLIAM H. SEBRELL, JR. . Director, National Institutes of Health. OFFICE OF EDUCATION SAMUEL M. BROWNELL ....... Commissioner of Hducation. J, KENNETH DAPELE: he 3% cle Bee . Deputy Commissioner of Hducation. ii FOOD AND DRUG ADMINISTRATION NauseGue re. IsARRIOK.. . 2 « «0 0 0 Commissioner of Food and Drugs. OR ae TAARVEY 6 00. <8 ee eo 8's Deputy Commissioner of Food and Drugs. OFFICE OF VOCATIONAL REHABILITATION ity tu SWITZER... 6 5 ce ee ee Director of Vocational Rehabilitation. Prony H. WEREBEE ..-. .... 4. Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL WINFRED OVERHOLSER ....... Superintendent. [AMOISONT I. DUVAL .....s-eece Assistant Superintendent. FEDERALLY AIDED CORPORATIONS MONI AVIS . Cb. oe te et Superintendent, American Printing House for the Blind. PPONARD M.-ELSTAD. «3.50 2 ee President, Gallaudet College. MorpEcAI W. JOHNSON....... President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN..... Region I, Boston, Mass. JOSEPH B. O’CONNOR.......-. Region II, New York, N. Y. MIcHAEL J. SHORTLEY ....... Region III, Washington, D. C. PRTGHARD IES IIYLE . . 2. 6s --- Region IV, Atlanta, Ga. BinrvHie H. HOscn....).... + Region V, Chicago, Ill. are. DOABN ..... 6. see Region VI, Kansas City, Mo. Sees. ISOND . . we ee eo 8 - Region VII, Dallas, Tex. ALBERT H. ROSENTHAL..... . . Region VIII, Denver, Coio. Weer WeTAUNTER. «2. 0 0 - +. Region IX, San Francisco, Calif. al ges Ce + Letter of Transmittal DEPARTMENT oF HrAttu, EpucaTion, AND WELFARE. Washington, D. C., December 1, 1956. Dear Mr. Presipent: 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, 1955. Respectfully, Secretary. THE PRESIDENT, THe Wuite Hovss, Washington, D.C. liVMWH VASVIV CNS ninjouoH, SS x © VNVISINOT SONV1SI NIDUIA co "O14 OLYINd ©, ce) i=) SVSNV HUV Ss SadI}4Q pue Salepunog jeuoiay 7 JUVITIM ON ‘NOILVONG “HLIV3H JO LNIWLYVdid Sn Contents Memeecreionys Report: . 6. ee Social Security Administration ......... Reeeeriieaith Service... 2... 1 1 2 eee Me PE CUCOLION © 6.8. ce we ee el Food and Drug Administration. ........ Office of Vocational Rehabilitation. ...... Berehiizabeths Hospital’. 2 wk American Printing House for the Blind Gallaudet College ..... sc pd OR RS NE Mere University Se. ST A detailed listing of the contents of this report, by topic headings, will be found on pages 223-230. atte eee ee ea Sem The Secretary's Report “Government must work to stabilize the buying power of the dollar, else the value of the pension, the insurance policy and the savings bond is eroded away. “Government, through social security and by fostering ap- plicable insurance plans, must help protect the individual against hardship and help free his mind from anxiety. “Government must use its full powers to protect its citizens from depression, unemployment and economic distress. “Government, my friends, must have a heart as well as a head. It must encourage, guide, backstop and supplement—but never dominate or attempt to regiment our people.” Tuis pAssaGE from an address by President Eisenhower admirably sums up the general philosophy under which the Department of Health, Education, and Welfare sought to carry out its responsibilities during the fiscal year 1955—the second full year in the history of the Department. It is the concept, in fact, which led to the submittal to Congress in April 1953 of the plan for the founding of the Department—the first to be submitted by President Eisenhower for reorganization of the executive branch of the Federal Government. Establishment of the Department gave appropriate recognition to the increasing importance which the American people place on better health, improved education, and greater individual security—and to the concern of this administration that these factors receive continuing attention throughout the Nation. Throughout the year, the Department has kept constantly in mind the concept of encouragement, guidance, and supplementation which 1 2 Department of Health, Education, and Welfare, 1955 ea eee the President describes as the proper role of the Federal Government in these fields. The fact that the Department’s programs deal so 1n- timately with the close and varying personal concerns of the individual and his family gives cardinal importance to the avoidance of any act or attitude that might lead to the domination or regimentation of the individual against which the President sounds a warning. The opening pages of this annual report deal principally with those events of the fiscal year 1955 which are departmentwide in scope or are notably significant in the history of the Department. The reports of the five major units which make up the Department—the Public Health Service, the Social Security Administration, the Office of Edu- cation, the Food and Drug Administration, and the Office of Voca- tional Rehabilitation—as well as other related agencies and units will be found in subsequent pages. It is appropriate here, however, to describe the major developments of the year which have special importance to the national welfare. In certain instances, moreover, these illustrate the philosophy of the President, set forth above. In essence, taken together, these represent the highlights of a continuing record of achievement on behalf of the health, education, and general welfare of the people of the United States. Progress in Health The health of the American people continues to be good. Only a few of the health statistics submitted by the States to the Public Health Service of the Department and gathered by the Service itself need be cited here. The general death rate from all causes during 1954, the latest period for which figures were available when this report was prepared, was 9.2 per 1,000 of population, representing a slight decline over the previous year. Maternal deaths of only 5.3 per 10,000 live births and infant mortality of 26.6 per 1,000 live births also showed a decrease in 1954. ‘This is the 18th successive year in which the infant death rate continued to decline, one yardstick of the remarkable progress in curative and preventive medicine. The recent improvements in health are the work of many thousands of individuals and many hundreds of institutions—practicing physi- clans; scientists and their aides; the staff members of hospitals and research institutions, including those of private industry; the great voluntary health organizations which the American people generously support; and public health agencies in the States and communities. Illustrative of some of the challenges that lie ahead for American medicine and science is the fact that cancer and diseases of the heart The Secretary’s Report 3 and circulatory system were responsible for more than two-thirds of all deaths in 1954. The Federal Government plays an increasingly important role, both in the extension, by the authority of the Congress, of its own research and control activities and through its grants-in-aid to States, private hospitals and laboratories, and individuals. There has been some variation, over the years, in the degree and scope of the Federal role, determined, in part, by the relative importance of various health projects and the capacities of both Federal and non-Federal research programs to move forward with maximum productivity. There has been occasional and understandable difference of opinion on these decisions. The total effect, however, of Federal participation in medi- cal research and in the control of illness has been very substantial advancement of the frontiers of medical knowledge and improvement of mankind’s armament for the ceaseless war against disease and disability. Public Health Service—Among notable advances in research con- ducted at the Public Health Service’s National Institutes of Health during the fiscal year were extensive field trials which demonstrate the effectiveness of a cytologic test to detect early cancer of the cervix on a mass basis. New knowledge was obtained regarding the cause and prevention of retrolental fibroplasia, a blinding eye disease which has been affecting 50 percent of the smaller premature infants. Studies of tissue culture which culminated during the year included the discovery of a previously unknown group of viruses which affect the respiratory system. This discovery has importance for future research on infections of the upper respiratory tract, including the common cold. Development of a multivirus vaccine for many of these ailments by scientists of the National Institutes of Health made con- siderable progress during the year. Research activities in air pollution were expanded this year at the Robert A. Taft Sanitary Engineering Center in Cincinnati, Ohio, a focal point for research on the relationship of the environment to human health. An Ad Hoc Interdepartmental Committee on Air Pollution (representing the Departments of Agriculture; Defense; Health, Education, and Welfare; and Interior; the Atomic Energy Commission; and the National Science Foundation) was established at the invitation of the Secretary of Health, Education, and Welfare. It has recommended a Federal program of research and technical services on air-pollution problems. In 1954 Congress broadened the local-State-Federal hospital survey and construction program to include diagnostic and treatment centers, chronic-disease hospitals, rehabilitation centers, and nursing homes. At the close of the 1955 fiscal year, 28 States had applied for 4. Department of Health, Education, and Welfare, 1955 survey and planning funds under this program. Seven States had completed revision of the statewide plans required under the law. Construction project applications, which can be made only after sur- veys have been completed, had been received from two States.* In August 1954, President Eisenhower approved a bill authorizing transfer of Indian health activities from the Department of the In- terior to the Department of Health, Education, and Welfare, effective July 1,1955. During the fiscal year, the Public Health Service worked closely with the Bureau of Indian Affairs in anticipation of the trans- fer of this program, which involved some 3,400 employees and real property valued at $40 million. A new Division of Indian Health was established in the Public Health Service to administer this program. The development by Dr. Jonas Salk of a vaccine effective against paralytic poliomyelitis was among the most dramatic accomplish- ments of American science during the year. This remarkable achieve- ment on behalf of the children of the Nation was signalized by the Congress by a substantial monetary award to Dr. Salk and authoriza- tion of a medal to memorialize his discovery. In April 1955, Dr. Salk and Mr. Basil O’Connor, president of the National Foundation for Infantile Paralysis, which had supported the work of Dr. Salk and his associates, were awarded special citations by the President. Licenses for the manufacture of the new vaccine were granted six pharmaceutical concerns on April 12, 1955. It was apparent, how- ever, that the vaccine would remain in short supply throughout the poliomyelitis season. Acting on the direction of the President, the Secretary began to develop plans for assuring an equitable distribu- tion of the vaccine that was available. The plans were developed in consultation with representatives of the governors of the States, the medical and health professions, the pharmaceutical and drug indus- try, public interest groups, and others concerned with the problem. The Secretary recommended a system of voluntary allocation and distribution of the vaccine while it remained in short supply. This recommendation was based on the conviction that a voluntary plan was the best way to assure an orderly and equitable sharing in the benefits of this medical discovery for the entire Nation. The Secre- tary also recommended the creation of a national advisory committee to advise on matters associated with the distribution of the vaccine, including the establishment of priority groups. These recommenda- tions were accepted by the President. A National Advisory Commit- tee on Poliomyelitis Vaccine was appointed by the Secretary, under the chairmanship of Dr. Chester Scott Keefer, Special Assistant to the Secretary for Health and Medical Affairs. Shortly after the close 1On July 8, 1955, the first project was approved under the new program—a nursing home for Pinal County, Florence, Arizona. The Secretary’s Report 5 of the fiscal year, at the request of the President, the Congress author- ized the expenditure of $30 million for grants to the States for purchase of the vaccine. Additional details on the distribution program, as well as the activi- ties of the Public Health Service with regard to safety and effective- ness of the vaccine, are contained in the report of the Public Health Service. The Food and Drug Adminstration, whose duties are fundamen- tally concerned with health, was subject to thorough study during the latter part of the fiscal year by 14 distinguished members of a Citizens Advisory Committee authorized by the 83d Congress. The two main conclusions and recommendations of the Citizens Advisory Com- mittee, delivered to the Secretary on July 7, 1955, were that: 1. The Food and Drug Administration had insufficient funds, staff, and facilities to carry out its statutory responsibilities to protect the public health. A three to fourfold increase in personnel and facili- ties should be achieved within 5 to 10 years. 2. A more effective job of law enforcement could—and should—be accomplished. An expanded and improved informational and educa- tional program was urged. Midway in the fiscal year, the Food and Drug Administration began expanded research and educational efforts to improve the sanitary handling of grain. The regulatory program with respect to rodent- contaminated and insect-infested grain was resumed, with 12 carloads totaling more than a million pounds being seized during the year. Many times this amount was voluntarily diverted from human consumption. The intensified grain sanitation program was recommended by a 17-member technical committee appointed jointly by the Secretaries of Agriculture and Health, Education, and Welfare. Both Depart- ments, as well as the Fish and Wildlife Service of the Department of the Interior, are cooperating in this effort. Levels of contamination on which seizure decisions are based will be changed progressively as growers, shippers, and grain-elevator operators further improve their handling of this vital raw food. Two amendments to the Federal Food, Drug, and Cosmetic Act were put into effect by the Food and Drug Administration during the year. One amendment facilitates the establishment and amendment of food standards by simplifying ponderous and _ time-consuming procedures. A second amendment enacted during the year provides a simplified procedure for establishing safe tolerances for pesticide chemicals which are necessary and useful in agriculture. Under the new pro- 6 Department of Health, Education, and Welfare, 1955 ee ae cedure, 23 petitions for tolerances or exemptions therefrom were sub- mitted during the year. Final action was taken on 4. Amended definitions and standards of identity were promulgated for several cheeses, cheese foods, cheese spreads, enriched farina, cat- sup, and certain canned vegetables. The Office of Vocational Rehabilitation, a third unit of the Depart- ment concerned with health, was engaged chiefly this year in expand- ing its program under the Vocational Rehabilitation Amendments recommended by the President and unanimously enacted by Congress in 1954. | “This law is especially noteworthy in two respects,’ President Eisenhower said at the signing ceremony. “In the first place, it re- emphasizes to all the world the great value which we in America place upon the dignity and worth of each individual human being. Second, it is a humanitarian investment of great importance, yet it saves sub- stantial sums of money for both Federal and State Governments.” Already, this legislative landmark is bringing to a greater number of handicapped men and women the increased self-respect that comes from earning a living instead of depending upon others. A down- ward trend in the number of disabled workers restored to useful em- ployment was halted and turned upward by the close of the fiscal year. To achieve a substantial expansion of the State-Federal vocational rehabilitation system, Congress appropriated $4 million more for this fiscal year than for the preceding year. Although State fiscal com- mitments were determined prior to enactment of the new law, a num- ber of States moved to match the increased Federal funds with larger State appropriations. Money alone, however, will not rehabilitate handicapped workers. More rehabilitation workers must be trained, more public and private agencies must lend a hand, and rehabilitation techniques must be re- fined and improved. All these are essential if vocational rehabilita- tion is to achieve its goal—prompt and effective help to every disabled person who needs it. To increase the supply of trained rehabilitation workers, 80 teaching grants were made by the Department’s Office of Vocational Rehabilita- tion, 87 short-term workshops or institutes were sponsored, and more than a thousand traineeships were awarded. Physicians, nurses, physi- cal therapists, occupational therapists, psychologists, social workers, rehabilitation counselors, and speech therapists are among those being prepared for the expanded rehabilitation program. To expand further the Nation’s capacity to help disabled workers return to useful work, as well as to improve existing rehabilitation facilities, Federal grants were made to 130 public and private non- profit organizations. Many sheltered workshops or specialized re- The Secretary’s Report 7 LL habilitation centers were thus enabled to provide services to more handicapped people. To help improve rehabilitation methods, a Na- tional Advisory Council on Vocational Rehabilitation, appointed this year, approved 22 applications for support of promising research and demonstration projects. Taken together, these measures will make it possible to rehabilitate more disabled workers. It is important also that each disabled person begin his journey to personal and economic independence promptly— as soon as possible after suffering his disabling illness or accident. In this way, his skills do not lapse from disuse and his savings are not swept away by lengthy unemployment. The 1954 “disability freeze” amendment to the Social Security Act protected the benefit rights of workers insured under old-age and survivors insurance who become permanently and totally disabled. During fiscal 1955, 46 States and Territories had designated their vocational rehabilitation agencies to determine or share in the deter- mination of whether or not an applicant for “disability freeze” pro- tection qualified for such protection. During fiscal year 1955, the first in which the “disability freeze” was in effect, State vocational rehabilitation agencies were notified of 62,800 disabled men and women interested in securing rehabilitation. Saint Hlizabeths Hospital, the public mental hospital in the District of Columbia, observed its centennial during 1955—marking a century of progress in psychiatry and treatment of the mentally ill. Major events included a conference of national and international leaders in psychiatry; the completion of a new Intensive Treatment Building at the hospital; and the production of a pageant, staged and acted by patients, depicting the life of the hospital’s founder, Dorothea Lynde Dix, and subsequent progress in the treatment of the mentally ill. Scenes from the pageant were shown on a nationwide television network as part of the Department’s continuing effort to bring about a a better public understanding of mental illness and psychiatric treatment. Freedmen’s Hospital was also the subject of intensive study during the year, in a long-delayed effort to chart a future course of services to the District of Columbia area and the Nation. Distinguished business and civic leaders and members of the medical and nursing professions composed the Freedmen’s Hospital Study Commission. For the consideration of the Secretary, the Study Com- mission recommended that a new teaching hospital structure be built and that Freedmen’s be affiliated with the Medical School of Howard University. On January 31, 1955, President Eisenhower, in a special message to Congress, had outlined a number of measures for the general im- 8 Department of Health, Education, and Welfare, 1955 provement of the health of the Nation. As has been indicated, a number of these measures were, in one form or another, adopted by Congress. Among the measures recommended in the health message was a proposal for helping Americans meet the rising costs of medical care through establishment of a Federal health reinsurance service to encourage private health insurance organizations to offer broader benefits to insured individuals and to extend coverage to more people. Another proposal was that action be taken to authorize matching grants to the States to help finance the costs of medical care for pub- lic assistance recipients—the aged, the permanently and totally dis- abled, the blind, and children deprived of parental care. No action was taken by Congress on these proposals during the period covered by the report. Progress in Education The serious problems confronting the Nation’s schools and colleges in terms of shortages in teachers and buildings were of great concern to the Department during the year. This concern was expressed in legislation developed by the Department and submitted by President Eisenhower to Congress to mount an attack on the grave classroom shortage in the Nation’s public schools. School enrollment, which has continued to increase, reached a total of more than 38 million during the year. It is expected to climb to more than 46 million by 1960. Factors contributing to the unprece- dented upsurge in school enrollment are an increased birthrate, an increase in the proportion of school-age children attending school, and an increase in the proportion of students finishing high school. Although construction of schools reached a new high with the building of 60,000 classrooms during the year, proper school housing for the new students and to replace obsolescent buildings is not being built fast enough. President Eisenhower’s special message to Con- gress in January 1954 proposed local, State, and Federal action to alleviate this grave—and growing—shortage of classrooms. The Pres- ident’s proposal was for a 3-year program of a fourfold nature: 1. That the Federal Government buy the bonds of school districts which cannot market their bonds at reasonable rates of interest. The President asked for an appropriation of $750 million for this pro- gram, which had the advantage of being able to permit school dis- tricts to move quickly in offering bonds for sale to the public. 2. That the States and the Federal Government, acting together, encourage more general use of a plan already tested in some States. In these States, school districts which are unable to finance new build- ings rent them from State agencies created to build schools. Under the President’s plan, the Federal Government would have helped The Secretary’s Report 9 facilitate the issuance of construction bonds by these agencies by ad- vancing one-half of an initial reserve fund and agreeing to replenish thisshareasneeded. _ 3. That a limited program of direct State and Federal grants be authorized. These grants would have gone, on the basis of proved need, to those school districts which cannot either repay borrowed money or afford the cost of renting a new building and would have been sufficient to permit them to qualify for assistance under one or the other of the foregoing proposals. An appropriation of $200 mil- lion was requested for this part of the program. 4, That programs of statewide action aimed at removing many of the long-standing obstacles to local financing of school construction be encouraged. The Federal Government under the program would have paid one-half the administrative cost of programs of this kind. The 88d Congress authorized 53 State and Territorial Conferences on Education, to be followed by a White House Conference on Edu- cation. The State and White House Conferences on Education were designed to deal with all the major problems of American education in a very fundamental way. The White House Conference was di- rected to “consider and report to the President on significant and pressing problems in the field of education.” By the end of the fiscal year, all States and Territories had appointed conference chairmen and conference planning committees. Seventeen State Conferences on Education were held during the year, with 32 scheduled between July 1 and the fall months. In addition to the state- wide meetings about 3,800 community and county conferences and 200 regional conferences had been held or were scheduled in 27 States. These conferences were designed to form an opportunity for the people themselves to undertake an examination of their school needs and to develop solutions for school problems or, when they are lack- ing, to bring them to the attention of the States or the Federal Government. They had already, at the close of the fiscal year, pro- duced a quickening of interest in the problems of public education on the part of many millions of Americans. In the final analysis, these citizens are the ones who must determine what their schools should accomplish and provide the means by which this can be achieved. Gallaudet College, the world’s only college for the deaf, is a wholly independent educational institution in Washington, D. C. Through the Department, it receives funds appropriated by the Congress in support of its unique educational program. Significant steps were taken during the year to enlarge the program, broaden the curriculum, and generally improve the physical facilities of the college. Plans and specifications were completed for a new library building, funds for which were appropriated by the 83d Congress. Approval was given by Congress to a proposal calling for the construction of a 368636—56——2 10 Department of Health, Education, and Welfare, 1955 new physical activities building and a girls’ dormitory. Congress also indicated approval of a departmental plan for the progressive rehabili- tation of the Gallaudet building and campus. Howard University is another independent educational institution in the District of Columbia which is supported, in part, by Congress, acting through the Department. Work on five new buildings was initiated on the Howard campus during the year, as part of a program to provide larger and more modern quarters for the university. A new dental school building with extensive clinical facilities was also dedicated and placed in use during the year. The American Printing House for the Blind is an independent insti- tution in Louisville, Kentucky, which manufactures Braille textbooks and tangible teaching apparatus for use in schools for the blind. Through the Department, the Printing House receives funds appro- priated by Congress to support its program, which benefits more than 7,000 children enrolled in residential and public school classes for the blind. Progress in Social Security and Public Welfare The growing significance of the social security system in our national life is indicated by the fact that over half the persons who are 65 years of age or older are eligible for old-age and survivors insurance benefits. Nine out of 10 mothers and children in this country can count on monthly benefits in case the family breadwinner dies. Over 714 million Americans were beneficiaries of the old-age and survivors insurance system in June 1955. Of this total, nearly 5.5 million were retired workers and their dependents and over 2 million were surviving dependents of deceased workers. Benefit payments in June 1955 totaled $428 million, an increase of 45 percent since the close of the previous fiscal year. The 1954 Amendments to the Social Security Act, adopted by Con- gress upon President Eisenhower’s recommendation, materially strengthened the old-age and survivors insurance protection which is now available to 9 out of 10 American workers and their families. In the 1955 fiscal year, a principal task of the Social Security Admin- istration was to make effective these improvements in the law. The big job of changing the payment rates of some 6.6 million beneficiaries was completed on schedule. As a result, the checks for September 1954 were mailed on time at the new, higher rates. Over 6 million people receiving benefit payments from old-age and survivors insurance were also advised of the new, liberalized “retirement test.” This provision of the 1954 amendments affords greater opportunities The Secretary’s Report ll to retired individuals to supplement their benefits through earnings from part-time or intermittent work. Coverage by old-age and survivors insurance was extended rapidly to the new groups made eligible by the 1954 amendments. Every rural mail delivery box in the Nation received information about the eligi- bility of farm operators and additional farm workers. Procedures were worked out for the coverage of ministers on a voluntary basis. By the end of the fiscal year, 44 States, 3 Territories, and 13 interstate instrumentalities had arranged for certain of their employees to re- ceive the protection of old-age and survivors insurance. Special efforts were made to put the “disability freeze” provisions of the 1954 amendments into operation as soon as possible. The dis- ability freeze enables workers covered by old-age and survivors insur- ance to preserve whatever eligibility for benefits they have earned up to the time they were permanently and totally disabled. During the fiscal year, about 400,000 potential applicants were identified, and 155,000 applied for the disability freeze of their social security benefit rights. Procedures were also established to carry out provisions of the 1954 amendments calling for withholding of benefit payments from persons living outside the United States and working 7 or more days per month. The State-Federal programs of public assistance reflected the growth and improvement of the old-age and survivors insurance sys- tem during the year, following enactment of these amendments. Four groups among the needy are eligible for public assistance payments—the aged, the blind, dependent children, and persons perm- anently and totally disabled. Of the $2.6 billion spent for all types of public assistance this year, 55.2 percent was from Federal funds, 36.1 percent from the States, and 8.7 percent from local sources. For the most part, the 5.1 million persons receiving public assistance in June 1955 are not eligible for benefits under old-age and survivors insurance. Therefore, as more persons provide for their future security through personal thrift and contributions to the Old-Age and Survi- vors Insurance Trust Fund and other pension systems, there will be fewer people needing public assistance. In February 1951, the number of persons receiving old-age benefits outstripped, for the first time, the number on the old-age assistance rolls. Although the aged population has been increasing yearly by 350,000, the number of old-age assistance recipients has continued to decline—by 34,000 in the past year—to a total of 2,549,000 at the end of the fiscal year. Old-age assistance—the public assistance program that serves al- most as many needy people and costs more to maintain than the three 12 Department of Health, Education, and Welfare, 1955 a a a tie een ere ete ee other public assistance programs combined—should decline appre- ciably in the years ahead. About 18 percent of all people over 65 years of age were receiving public assistance this year. Because of recent improvements in the old-age and survivors insurance program, fewer than 16 percent of the aged are expected to need this aid by 1960. Extension of old-age and survivors insurance coverage to more farm workers and farm operators will be chiefly responsible for this saving to the Nation. A majority of those now receiving old-age assistance live in rural areas or small towns, although a minority of all Ameri- cans 65 years of age or older live on farms or in villages. At present, the proportion of aged persons receiving public assistance in rural places and small towns is two-thirds higher than in metropolitan areas. The 1954 improvements in old-age and survivors insurance will also help many widows and orphans who would otherwise have been de- pendent upon public assistance. About 17 percent of the families who now receive aid to dependent children funds are in need because of the death of a wage earner. By 1960, this should be reduced to 10 percent. The Children’s Bureau of the Social Security Administration has emphasized, in recent years, improving conditions of life for infants and preschool children. Other groups requiring special attention are adolescents in conflict with society, children of migratory workers, mentally retarded children, and children in unprotected adoptions. Help was given these groups of children and others this year through research studies, publications for parents and professional workers, and grants to the States to support programs for maternal and child health, crippled children, and child welfare services. A new Division of Juvenile Delinquency Services was established to aid States and communities working to prevent and treat this serious social malady. The Bureau of Federal Credit Unions of the Social Security Admin- istration was operated at no cost to the taxpayer this year. Fees col- lected by the Bureau covered the direct costs of chartering, super- vising, and periodically examining federally chartered credit unions, which are voluntary associations encouraging thrift and offering credit “for provident and productive purposes.” The number and assets of Federal credit unions continued to increase during the year. For the first time, total assets exceed $1 billion. Progress in Program Development Civil defense responsibilities of considerable importance were dele- gated to the Department at the beginning of the fiscal year by the Federal Civil Defense Administration, with the approval of President The Secretary’s Report 13 Kisenhower. In general, the Department will be responsible, in the event of attack, for control of hazards to health and the provision of clothing and temporary financial assistance to civilians. Substantial progress was made during the year in the assumption of these respon- sibilities. Assistance was provided, through the States, to local communities to help alleviate health hazards, suffering, and hardship caused by hurricanes and other natural disasters during 1955. This tested work- ing relationships with Federal Civil Defense Administration regional offices and with State agencies in the utilization of Federal resources to cope with disaster. Significant research progress was made by the Public Health Serv- ice and the Food and Drug Administration in studying health and sanitation problems related solely to civil defense. A sizable buildup of the Public Health Service Reserve Corps was begun, and arrange- ments were made for specialized civil defense training for its members. For State and local food and drug officials, a civil defense training course was developed which will ultimately reach 50 strategic areas and an estimated 1,000 officials. Stimulation of civil defense interest on the part of State health departments and voluntary medical and health groups resulted from a series of regional conferences and seminars, with all States repre- sented. Representatives of all State welfare departments met in a series of regional conferences to develop plans for emergency financial and clothing assistance to victims of an attack. “Pilot centers” were organized in selected States to prepare civil defense teaching materials for use in the schools. The Department also participated in two governmentwide test exercises involving relocation of staff and the continuity of essential headquarters functions outside of Washington. The first of these, in November 1954, involved only the headquarters relocation plan. The June 1955 exercise, “Operation Alert,” required extensive activities by both headquarters and regional office staff. Surplus Federal property is donated, through the Department, for public and private health and educational uses. During the 1955 fiscal year, surplus personal property with an original acquisition value of $132.2 million was allocated to the States for distribution. Transfer of real property was made to 225 institutions, which thereby acquired 1,521 acres of land and 669 buildings, valued at $16.2 million. Legislation enacted near the close of the fiscal year assures that millions of dollars worth of useful Federal surplus property will continue to benefit health and educational activities in the States. The new statute also improves the operation of this program, especially by enabling the States to assist in its administration, 14 Department of Health, Education, and Welfare, 1955 i AP ee ea othe tr GA Th Ra The Committee on Aging of the Department coordinates activities related to the great increase in the numbers and proportion of older people that has characterized America in recent years. Recognizing that the rapidly growing number of aged persons in the population poses new challenges of great significance to the Nation in social and family responsibility, in health, education, employment, and income maintenance, the Secretary of Health, Education, and Welfare initiated a study of the Department’s Committee on Aging during the fiscal year. In June 1955, a departmental order designated an Assistant Secretary to head a reorganized committee made up of the heads of the Department’s constituent agencies to advise the Sec- retary, develop programs of departmental action, and to serve as a clearinghouse for information and aid the States, local communities, and voluntary organizations in programs for the benefit of the Nation’s senior citizens. During the year, the Committee issued a pamphlet entitled “A ging— A Community Responsibility and Opportunity,” completed a revision of its 500-item “Selected References on Aging,” and commenced a new “Fact-Book on Aging,” an “Inventory of Official State Groups in Aging,” and “An Inventory of Federal Programs and Activities in Aging.” The Committee also maintained its extensive program of public information and consultation with foundations, organizations, and State and local governments. The Department was a cosponsor of the eighth annual Conference on Aging of the University of Michigan. One of the most significant developments was the initiation by the Department of an approach toward closer coordination of the activities of all Federal departments in the field of aging. A plan was presented to the sub-Cabinet by the Department for the organization of an Inter- Departmental Working Group on Aging, and approval was obtained. At the invitation of the Secretary, 10 departments and agencies desig- nated representatives to the Working Group. The first two meetings were held at the Department, on June 10 and July 15. The initiation of the Working Group quickly demonstrated the interrelationship of Federal programs and the need for closer coordination. Plans were commenced for placing the Working Group on a more formalized and permanent basis. International Activities—*In the four quarters of the globe, who reads an American book? Or goes to an American play? Or looks at an American picture or statue?” Such was, in 1820, Sydney Smith’s now-famous criticism of the United States. He continued by inquiring derisively, “What does the world yet owe to American physicians and surgeons? What new substances have their chemists discovered 2” The Secretary’s Report 15 Since Smith asked his questions, the world has come to respect, not only American writing and art but American education, science, and medicine as well. Every year thousands of people from many lands, experts and students alike, journey to the United States to study developments in health, education, and social welfare. This Depart- ment is proud to be one of their principal “ports of call.” This year, for example, the Department supervised the programs of study and training of 174 United Nations Fellows. In all, some 3,464 foreign visitors received training planned or supervised by the Department. In addition, about 400 American technicians in health, education, and social welfare were recruited for foreign assignments with the International Cooperation Administration. Technical assist- ance missions in 88 free nations were aided in this manner. Interdeparimental Activities—Two matters of interdepartmental concern that should be recorded occurred during the year. One was the participation by the Department in a study made by the Depart- ment of Agriculture and the Department of Commerce on the problems of low-income farm families. The report of the Secretary of Agri- culture, which contained summaries of work of the committees of the three participating departments, was published in early June 1955. It pointed out that the joint study provides an excellent base for the development of specific plans for definitive action to deal effectively with the difficulties encountered by low-income farm families. The other was the establishment of the President’s Committee on Migratory Labor. The Committee included the Secretary of Labor, as chairman; the Secretary of Agriculture; the Secretary of the Interior; the Administrator of the Housing and Home Finance Agency; and the Secretary of Health, Education, and Welfare. The formation of this Committee constituted a first step toward considering and dealing with the problem of migrant labor—a prob- lem that for 50 years had been under study and investigation but had failed to command the continuing attention of the Federal Gov- ernment. During this year the Department also participated actively in the work of the Commission on Intergovernmental Relations—the Kestnbaum Commission. The Commission gave special attention to the various grant-in-ald programs, and the Department prepared extensive analyses of its activities for the use of the Commission and reviewed and commented upon the Commission’s proposals and rec- ommendations. It is gratifying to note that after such thorough study the Commission found relatively little wrong with the Depart- ment’s programs. Most of the Commission’s recommendations were 16 Department of Health, Education, and Welfare, 1955 iON CIO Se eke eto lie, Mente Ace Mito ti in accord with views of this Department. The report of the Com- mission should go far toward promoting a better understanding of the Department’s work and its relationship to the several States. Progress in Management Of the important and far-reaching proposals for government re- organization proposed by the Hoover Commission, 18 were applicable to the work of the Department of Health, Education, and Welfare without any further action required by other agencies of government or Congress. At the close of the fiscal year these proposals were under careful study by the Department. Congress appropriated $2.1 billion to the Department during this fiscal year, for all purposes. In addition, receipts of the Old-Age and Survivors Insurance Trust Fund totaled nearly $5.6 billion and dis- bursements totaled nearly $4.5 billion. Of the funds appropriated by Congress, 89 percent was distributed to States, communities, insti- tutions, and individuals, in the form of grants, scholarships, trainee- ships, etc. At the end of the fiscal year, the Department had 39,927 full-time employees working in its offices, hospitals, and laboratories through- out the Nation and overseas. Nine regional offices coordinated activi- ties throughout the Nation. An organization of such size, dealing with complex matters vital to the well-being of every citizen, requires the best possible structure and management. More efficient, effective, and economical operations were constant goals of the Department during the 1955 fiscal year. The first comprehensive and long-range study of the Department’s managerial responsibilities was made this year by the consulting firm of Cresap, McCormick & Paget. The Office of the Comptroller was established to give increased attention on behalf of the Secretary to all budgetary and fiscal matters. The Office of Administration was reorganized to provide more effective guidance to the units of the Department with respect to such problems as organization, work planning, and executive development. In addition to the special surveys and reorganizations described elsewhere in this report, inventories were made of real and personal property for which the Department is responsible and a survey was completed of the procedures for auditing the Department’s grants-in- aid to the States. A Departmental Staff Manual on Physical Security was issued, containing detailed information concerning the Depart- ment’s physical security program, policies, and procedures. The Secretary’s Report 17 Net increases in staff were necessary only at the National Institutes of Health and the Bureau of Old-Age and Survivors Insurance, in both cases because of new legislation involving major expansions of program. During the year, cash awards totaling $14,250 were made to 350 employees who suggested better ways of doing the Department’s job. Estimated savings as a result of employees’ suggestions amounted to $119,998, and most of these savings will recur annually. There were also many improvements not measurable in dollars that were rewarded by cash awards. Illustrative economies made in the course of the Department’s opera- tions this year include: 1. Installation of an electronic data processing system in the Bureau of Old-Age and Survivors Insurance which will cut costs by more than $1 million annually. 2. Freeing 9,775 pieces of office equipment, valued at $651,160, for reuse elsewhere in the Government. 3. Turning in an estimated $41,855 to the Treasury from the sale of useless records as waste paper. 4, A host of reductions in the volume of paperwork. For example, the variety of postcards used by the States to report morbidity data to the Public Health Service was cut from 82 to 5. From the standpoint of the general management of the Department, as distinguished from individual problems associated with specific programs, perhaps the major concern is with the important and con- tinuing task of welding together the many programs of the new Department into an operating whole. The job remained complicated because of the width and the breadth of programs which fall within the Department’s responsibilities. These programs cover a spectrum as broad as the human needs—and, indeed, the human aspirations—of the many millions of Americans who every day, in one way or another, are touched by the work of the Department of Health, Education, and Welfare. Although much, certainly, remained at the end of the year to be accomplished—as will, indeed, always be true in a changing and dynamic society—it can be recorded that substantial progress was made in the endeavor to give coherence and unity to the management of the Department and to enhance the effectiveness of its work on behalf of the American people. 18 Department of Health, Education, and Welfare, 1955 Table 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1955 [On checks-issued basis] States, territories, and possessions IVITCHIG ae ene eee ee WhnnesO basa anes ce ee IVEISSISSIP Dilsee- =e ee ee WiissOUTIaeS Se ee New Hampshire________-_- INeweJersey: S22. -2 2. be S ING WVECXICOS: =e Se Oregon we ee ee Pennsylvania. so-=- Sesesee mhodevlsiand= ss ae a WVMIToinia 8 oe ooe spe ee Washing fone ap aaa IWeSE VIESINIg. oe ee Wisconsin Wyoming Puerto: Ricdssss4oece2 Virgin Islands 3es4. 5 Total 38, 356, 842 13, 246, 513 27, 948, 611 210, 869, 101 33, 010, 492 16, 149, 786 2, 646, 810 5, 345, 213 43, 826, 138 60, 354, 768 7, 283, 258 70, 379, 066 25, 185, 941 24, 765, 357 27, 003, 359 35, 203, 446 70, 374, 839 10, 998, 702 22, 127, 419 59, 835, 200 56, 737, 364 29, 599, 000 29, 889, 972 80, 435, 684 7, 967, 021 12, 142, 029 3, 486, 068 4, 983, 124 20, 214, 949 16, 326, 560 122, 150, 966 38, 955, 322 5, 763, 692 69, 394, 706 60, 819, 349 15, 016, 891 64, 408, 586 9, 146, 890 26, 160, 352 8, 423, 508 43, 036, 435 112, 996, 222 10, 750, 643 4, 184, 213 33, 109, 068 46, 899, 718 24, 429, 637 27, 069, 713 8, 421, 551 5, 407, 596 7, 553, 148 9, 403, 904 429, 258 Social Security Administra- tion $1, 815, 694, 000 |$1, 455, 855, 874 30, 321, 541 9, 572, 158 22, 598, 593 162, 032, 415 27, 242) 618 11, 747, 820 1, 604, 620 4, 521, 103 35, 430, 301 46, 625, 370 5, 325, 806 61, 098, 586 20, 147, 518 21, 756, 514 19, 141, 309 30, 011, 463 65, 212, 221 8, 307, 190 11, 309, 808 54, 860, 594 45, 701, 864 26, 185, 285 25, 090, 656 73, 911, 717 6, 240, 097 9, 216, 839 1, 355, 645 3, 605, 768 14, 283, 426 10, 277, 772 108, 542, 388 32, 539, 509 4, 888, 609 54, 903, 083 50, 607, 348 12, 669, 806 53, 078, 951 6, 912, 220 19, 968, 776 6, 519, 319 36, 234, 880 90, 600, 452 7, 135, 395 3, 654, 470 12, 191, 817 32, 524, 184 21, 724, 769 22, 902, 013 2, 425, 318 1, 814, 678 3, 921, 982 5, 008, 581 355, 709 Public Health Service Office of Office of | American Vocational | Printing Education | Rehabili- tation $95, 048, 735 |$238,974,453 |$25, 599, 938 —_} | | — —— | 2, 923, 962 374, 108 2, 399, 141 4, 409, 545 966, 097 514, 193 504, 421 320, 225 2, 385, 047 4, 222) 608 426, 172 2, 950, 476 1, 644, 409 1, 495, 118 1, 294, 301 2, 582, 215 2, 506, 024 794, 220 1, 306, 211 2, 681, 601 2, 663, 826 1, 270, 068 2, 598, 521 2, 045, 651 306, 966 912, 589 327, 121 623, 840 1, 918, 751 629, 736 4,018, 911 2, 942, 336 200, 825 4, 691, 042 1, 890, 892 523, 747 5, 565, 047 190, 108 2, 815, 726 451, 079 2, 904, 300 6, 036, 172 667, 885 91, 376 2, 305, 932 1, 562, 587 1, 472, 487 2) 148, 715 304, 852 221, 195 568, 194 3, 441, 707 36, 457 4, 417, 953 3, 148, 719 2, 509, 425 42, 573, 053 4, 600, 514 3, 536, 341 369, 509 110, 139 5, 186, 416 7, 953, 966 1, 455, 968 5, 048, 707 7, 277, 073 1, 788, 762 1, 778, 164 3, 865, 391 1, 272, 253 1, 778, 760 1, 777, 956 695, 289 3, 508, 970 5, 287, 021 7, 869, 339 2, 538, 487 564, 726 9, 245, 196 7, 789, 277 1, 470, 870 3, 859, 025 1, 923, 278 2, 909, 521 1, 350, 150 3, 217, 645 15, 179, 437 2, 816, 026 336, 579 18, 027, 649 12, 300, 913 652, 907 1, 445, 491 675, 054 3, 326, 368 2, 895, 897 673, 956 37, 092 687, 890 150, 123 437, 238 1, 840, 255 199, 034 348, 501 167, 924 392, 616 819, 244 1, 547, 175 1, 084, 372 350, 030 418, 692 608, 345 147, 033 232, 528 25, 346 58, 227 496, 840 129, 802 1, 702, 678 924, 364 108, 524 545, 400 529, 175 349, 934 1, 891, 364 121, 284 463, 367 101, 739 674, 999 1, 171, 733 130, 146 101, 788 578, 113 509, 744 576, 451 568, 028 86, 327 House for the Blind $215, 000 Social Security Administration Social Security in 1955 As THE FISCAL YEAR ended, the twentieth anniversary of the Social Security Act was drawing near. Appropriately, this year’s report takes stock of the achievements of the past 12 months against a back- ground of two decades of progress. The last year has been one of the most significant, in many respects, in bringing the old-age and survivors insurance program within sight of its goal. Asa result of the 1954 amendments, signed by President Eisenhower on September 1, about 9 out of 10 of the Nation’s jobs are now within the coverage provisions of the contributory plan to main- tain income after retirement or death. Nine-tenths of the young moth- ers and children in the country have survivorship protection that would assure them of monthly benefits if the breadwinner were to die today. The basic social insurance program has made long strides since it first provided old-age benefits for industrial and commercial workers. The expanded program of broad coverage, protecting against the risk of wage loss resulting from the death as well as from the old age of the worker, is still far from mature. No one has yet been under the program for a full working lifetime nor will the beneficiary rolls reach their full growth until practically everyone who works for a liv- ing has had an opportunity to gain protection. Significantly, how- ever, the 1954 amendments, by achieving almost universal coverage and other desirable modifications of old-age and survivors insurance, provide the assurance of future protection for all segments of the economy. When the Social Security Act was formulated 20 years ago, there was clear recognition of the continuing need for public assistance as well as social insurance. The Committee on Economic Security, in i9 20 Department of Health, Education, and Welfare, 1955 suggesting a dual attack on the insecurity of old age, stated : “An old- age insurance program could be expected in time to carry the major, but never the entire, load. . . . Assistance programs have a definite place, even in the long-time planning for old-age security.” Since February 1951, the social insurance program can be said to be carrying “the major load.” In that month, the number of aged drawing old-age and survivors insurance benefits passed 2.8 million, exceeding slightly for the first time the number on old-age assistance. At the beginning of the 1955 fiscal year, the 5.1 million aged bene- ficiaries receiving insurance benefits was almost double the assistance load. At the close of the fiscal year, 6.1 million aged persons drew — insurance benefits and 2.5 million assistance payments, a ratio approaching 21% to 1. The number of recipients of old-age assistance has declined since the autumn of 1950, ranging between 2.5 million and 2.6 million in the past 2 years. In relation to our growing aged population, the decline has been impressive. And increasingly as the old-age and survivors insurance program has reached more of the aged group, the public assistance program has served as a backstop for individuals whose insurance benefits are inadequate for their needs, either because of low benefits due to low or irregularly covered wages or because of special needs such as medical care. The growth of insurance protection for the aged over the past 20 years and the increasingly supplementary character of public assistance is illustrated in chart 1. In December 1934, only about 5 percent of the aged received payments under the social insurance and related programs then in existence—public employees’ retirement systems and veterans’ pension and compensation programs. Another 5 percent received public assistance including work relief. Just over one-fourth were earners or the wives of earners. Perhaps 1 out of every 2 persons aged 65 and over was mainly or wholly dependent on relatives and friends for support. In contrast, at the end of 1954 all but 15 percent of the aged had income from employment, social insurance and related programs, and/or public assistance. Social insurance has made the major con- tribution in improving the income situation of the aged. Almost half the aged population in December 1954 was actually receiving pay- ments under social insurance and related programs. Old-age and survivors insurance alone was then paying benefits to some 5.3 million while an additional 1.4 million aged workers (of whom from 300,000 to 400,000 had aged wives) were insured and could have received benefits if they had retired. Together these groups aggregated 7 million or one-half of all aged. Public assistance provided the prin- cipal support for more than 2 million aged persons and supplemented old-age and survivors insurance payments for another half million. Social Security Administration 21 Chart 1.—ESTIMATED PERCENT OF AGED PERSONS WITH MONEY INCOME FROM EMPLOY- MENT, SOCIAL INSURANCE, AND PUBLIC ASSISTANCE, DECEMBER OF SELECTED YEARS, 1934-54 PERCENT 30 ALL PERSONS AGED 65 & OVER MILLIONS 15 40 od WIVES OF 1 EARNERS 30 ee 1934 39 44 49°54 ieee ieee SUPPLEMENTARY eB eS ro Ons ieee esas KS renece es es : ma 20 : oo gh | EARNERS SSS. UME th a A ; i By ee 1934 ‘39 44 49 '54 1934’°39 44 49°54 1934 °39 44 "49 '54 EMPLOYMENT_ SOCIAL INSURANCE, PUBLIC ASSISTANCE RELATED PROGRAMS 2/ 1 Includes persons with casual employment whose main support was from other sources. 2 Old-age and survivors insurance, railroad and public employees’ retirement, and veterans’ pension and compensation programs. 3 Excludes persons supported by public institutions. Includes persons on work relief projects in the 1930's. In December 1954, the proportion of persons with some earnings from employment was at about the same level as 20 years earlier, a decline from the significantly higher levels of the war years. The effect of the 1954 amendments in greatly strengthening the gains of the last two decades will be evident even within the next few years. By 1960, the proportion of the aged population who either are receiving insurance benefits or could receive benefits on retire- ment from gainful employment will have risen from one-half to about two-thirds. Provisions to improve the economic security of children have also been greatly strengthened in the past 20 years. Because the original Social Security Act did not include survivors insurance, the full bur- _____ Department of Health, Education, and Welfare, 1955 den of income support for children in need due to the death of the father was placed on the program of aid to dependent children. Assistance payments under the Federal-State program were first made by the States in February 1936. By the end of that year, some 985,000 needy children deprived of support by reason of the parent’s death, absence, or incapacity were receiving these payments and an additional 119,000 were receiving payments under State and local programs. Five years after the adoption of the Social Security Act all but a few States were administering their aid to dependent children programs with Federal financial participation. Of the case load of 854,000 children in August 1940, fewer than 5 percent were receiving payments financed exclusively by State and local funds. Survivor benefits under the old-age and survivors insurance pro- gram were first payable in 1940 and were awarded to some 50,000 child survivors during the first year. Insured status for survivor benefits could be acquired after relatively short periods of covered employment. Hence the insurance program quickly assumed the major role in caring for the Nation’s fatherless children—a diminish- ing group dropping from about 2.8 million at the end of 1934 to about 1.9 million 20 years later. In December 1954, just over one million children were receiving benefits under old-age and survivors insurance because of the death of the father and another 40,000 because of the death of the mother. Some 240,000 needy children received aid to dependent children be- cause of the father’s death. With the drop in the total number of orphans and with social insurance payments reaching an increasing proportion of them, fatherless children have made up a decreasing part of the caseload of the aid to dependent children program. Of the total caseload of 1.6 million children at the end of 1954, about 85 percent had been deprived of normal support, not by death of the father but because of the continued absence from home or the incapac- ity of either parent. Altogether, about 3.3 million children received financial support in December 1954 under a public income-maintenance program—includ- ing programs of the Veterans Administration but not including chil- dren in families receiving unemployment or disability insurance. Many of the children receiving income support under public pro- grams, as well as hundreds of thousands of others, have benefited under the Social Security Act provisions for services for maternal and child health, child welfare, and crippled children. The contributions of these programs over the last 20 years in improving the well-being of children and in saving the lives of infants and their mothers have been immeasurably great. Had the mortality rates of two decades ago not been improved, 24,000 mothers would lose their lives in child birth this year—twelve times as many lost lives as the 2,000 which are expected under present-day rates. Social Security Administration 23 In carrying forward the gains for the Nation’s younger generation, the Children’s Bureau gave special attention in 1955 to the problems of four particular groups of children. A coordinated approach to problems of delinquent children was facilitated by the creation, early _ in the fiscal year, of a Division of Juvenile Delinquency Service. The other groups which received Bureau emphasis were children of migra- tory workers, mentally retarded children, and children in unprotected adoptions. Other programs of the Social Security Administration—not all of which are 20 years old—made further contributions during the year to family security. The Federal-State program of aid to the perma- nently and totally disabled, established under the 1950 amendments, was aiding 236,800 persons in 43 States at the end of the fiscal year. The increase of more than 10 percent over the number of recipients in June 1954 reflected the relatively recent introduction of the program in some of these States. Aid to the blind, included in the original Social Security Act, went to 104,000 persons in June 1955, about 3,000 more than a year earlier. The program of Federal credit unions, too, has a role in increasing family security. Credit unions promote systematic savings and use the funds thus accumulated for consumer loans at reasonable rates of interest. During the fiscal year 1955—marked by the twenty-first birthday of the program of federally chartered credit unions—the con- tinued growth of these credit unions brought their aggregate assets above $1 billion. Program Administration in 1955 Implementation of the 1954 amendments was accomplished smoothly and speedily. Over 614 million old-age and survivors insurance bene- fit checks were recomputed at new rates and released in October, the month following the signing of the amendments. For the Bureau of Old-Age and Survivors Insurance, the first half of the fiscal year saw emphasis on public information activities and on preparation for the new coverage and other provisions which became effective on January 1, 1955. The 1954 amendments to preserve rights to old-age and survivors insurance benefits in the event of disability resulted in a new and major work load. A Medical Advisory Committee was established to advise on the medical policies and standards needed in implementing the new provisions. By the end of the fiscal year, agreements for the admin- istration of the disability freeze had been negotiated in almost all States, and a total of 143,000 freeze applications had been taken. The increase in benefit amounts resulting from the disability freeze pro- visions was about to come into effect as the fiscal year closed, and much work had been done toward completing determinations of disability 24. Department of Health, Education, and Welfare, 1955 for individuals who were aged 65 or over and therefore potentially eligible for immediate increases. Early in the fiscal year, arrangements were completed to implement 1954 legislation transferring to the Bureau of Federal Credit Unions the supervision and examination of credit unions chartered by the District of Columbia. This was the second year in which this Bu- reau’s operations were financed entirely by fees collected from the credit unions. A total of 18,514 employees, the vast majority of whom were in district, area, and regional offices, were on the payroll of the Social Security Administration at the end of June. The staff had been increased by about 4,000 over the previous year’s total to meet the demands of the expanded and growing program. Through participation in international meetings and similar inter- national activities relating to social security, the Social Security Administration added to its own knowledge and insight while con- tributing its experience to other countries. The high point of the year’s international social welfare activity was the Tenth Session of the United Nations Social Commission, held in New York in May, with the Commissioner of Social Security serving as principal adviser to the United States member of the Commission. The Interdepartmental Committee on International Social Welfare Policy, chaired by the Director of the Bureau of Public Assistance, had given major attention to preparation for the session of the Social Commission. Through this Interdepartmental Committee and through the Interdepartmental Labor Policy Committee, staff mem- bers participated in the consideration of important social welfare items coming before the United Nations, its various organs, the International Labor Organization, and the Inter-American organizations, and de- veloped policy statements for the consideration of the Department of State. The Chief of the Children’s Bureau continued to serve as United States Representative to the United Nations International Children’s Fund and attended the World Health Assembly in Mexico City. Other international meetings in which staff members participated included the Tenth Pan American Child Congress in Panama City, the Fifth Inter-American Conference on Social Security in Caracas, and the Fifth International Congress on Mental Health in Toronto. An- other important phase of the Social Security Administration’s inter- national activities was its active cooperation with national agencies, committees, and conferences. There was a slight increase in technical missions for which the Social Security Administration recruits and nominates qualified personnel in social welfare, social insurance, child health, and credit cooperatives under an agreement with the Foreign Operations Administration Social Security Administration 25 (now International Cooperation Administration). During the year, 23 specialists were on duty in 12 countries. Nearly twice as many persons from foreign countries as last year requested training in the establishment of social security systems fol- lowing recent legislation, in management of credit unions, in manage- ment of institutions and welfare agencies, and in staff and personnel development to meet new agency requirements. ‘There was a marked increase in the numbers studying technical aspects of maternal and child health. A total of 714 visitors from some 50 countries came to the Social Security Administration for planning and training in various fields. Of these, 127 were long-term trainees under the auspices of the United Nations, the World Health Organization, or FOA. During the year there was major movement forward on the aspects of civilian defense for which the Social Security Administration would have planning or administrative responsibility. The program administered by the Social Security Administration under normal conditions was analyzed and those functions which would be essential in time of major emergency were identified and reported through the Department to the Office of Defense Mobilization. Participation in the two “Exercises” under the direction of ODM and the Federal Civilian Defense Administration afforded opportunity to evaluate the program activities so identified and to make further progress in the development of plans related to relocation, protection of essential rec- ords, and other administrative aspects of defense planning. During the year the Secretary assigned to the Social Security Administration two of the programs delegated to the Department by FCDA: emergency financial assistance and emergency clothing for civilians. These were assigned by the Commissioner to the Bureau of Public Assistance for administration. Participation in Operations Alert by all Bureaus and the Commis- sioner’s Office tested not only the continuity of essential functions under emergency conditions but also the initial plans developed for the administration of the delegations. The Social Security Adminis- tration has participated in the analysis and planning preliminary to the development of other defense plans of the Department related to the fields of income maintenance and welfare services. Old-Age and Survivors Insurance The 1954 amendments in the old-age and survivors insurance pro- gram, added to those made in 1950 and 1952, have equipped the program to perform its functions well. It now provides protection for almost all American families against the loss of the earnings they 3868636—56——3 26 Department of Health, Education, and Welfare, 1955 alc he TA le Naa NE depend on for their support when that loss is caused by retirement or death of the family earner. And, for several reasons, the protec- tion it provides will be more nearly adequate in the future than it has been up to now. First, the coverage of the program has been made very nearly uni- versal; this means not only that more people are protected under the program but also that those who move from one kind of work to another have all their earnings covered, rather than only a part. Before 1951 major areas of work were outside of the coverage of the program—work in agriculture and domestic service, farm and non- farm self-employment, and employment for Federal, State, and local governments and for nonprofit organizations. The only major areas that still remain excluded are Federal employment already under a retirement system, members of the Armed Forces (whose present temporary coverage expires March 31, 1956), and self-employment in certain professions. Of particular importance is the extension of coverage to both self-employment and wage employment in agricul- ture that was accomplished by the 1950 and 1954 amendments. Second, the “new start” adopted in 1950 will increase the benefit amounts of those coming on the rolls in the future. Under this pro- vision most retired workers will have their benefits based only on earnings after 1950; the relatively low wages of the late thirties and forties therefore will not operate to depress their average monthly wages and benefit amounts. Third, the provision for the “drop-out” adopted in 1954, under which as many as 5 years of low earnings may be disregarded in determining the average monthly wage, will improve benefit amounts. Jt will permit the exclusion of periods of temporary unemployment, apprentice earnings, or “tapering off” toward retirement, so that an individual who by and large has worked throughout his life may receive benefits based on an average at or not far below that of his full- time earnings. Fourth, the provision adopted in 1954 for “freezing” the benefit rights of workers who become totally disabled will mean that such workers, if they have been substantially attached to the work force before incurring their disabilities, will have their insured status preserved and will be able to receive full-rate benefits when they reach retirement age. The effect of all these changes will be that the program will pay higher benefits in the future to individuals who have worked through- out their adult lives and supported themselves and their families but who have had gaps in their earnings records because of noncovered jobs, unemployment, or disability, or who under prior law would have had periods of low earnings counted against them. Social Security Administration 27 An additional reason why protection will be more adequate in the future is that the benefit formula itself has been revised to pay a benefit which is a higher proportion of previous earnings and the amount of earnings that is creditable annually under the program has been increased. Finally, the retirement test of the program has been improved to apply more equitably to beneficiaries regardless of the kind of work they do and to make it possible for beneficiaries to engage in more part-time and seasonal work without forfeiting benefits. The sections that follow describe the contribution that the revised old-age and survivors insurance program is making to the security of the Nation’s families and how that revised program has been put into effect. What the Program Is Doing The following summary of significant statistical indices gives a brief picture of the program in 1955. Neither the figures on bene- ficiaries and benefit amounts nor those on the protection provided by the program reflect the improvements brought about by the dis- ability freeze, since increased benefits resulting from the freeze were not payable until the beginning of the 1956 fiscal year. Preliminary figures on the substantive effect of the freeze are presented in the section describing its administration. BENEFICIARIES AND BENEFIT AMOUNTS In June 1955 about 7.6 million people were receiving monthly bene- fits under the program. Some 6.1 million of these beneficiaries were aged 65 and over—4.2 million of them retired workers and 1.8 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 1.5 million, some 300,000 were mothers and 1.2 million were children. In June 1955, the average insurance benefit paid to a retired worker who had no dependents also receiving benefits was $58.20 a month. When the worker and his wife both received benefits, the average for the family was $102.20. Families consisting of a widowed mother and two children received, on the average, $132.30. The benefit awards for persons now coming on the rolls for the first time are considerably higher than those given above for all bene- ficiaries. The higher amounts reflect the more liberal computation provisions of the 1954 amendments, under which up to 5 years of low earnings may be dropped from the computation of the average monthly wage. Among beneficiaries who had come on the rolls by 28 Department of Health, Education, and Welfare, 1955 June 1955 and whose benefits are based on earnings after 1950 with eligibility to omit years of lowest earnings, the average for a retired worker with no dependents receiving benefits was about $78, for an aged couple about $130, and for a widowed mother and two children approximately $182. THE PROTECTION PROVIDED Of the almost 14 million people aged 65 or over in the United States in December 1954, 51 percent were eligible for benefits under old-age and survivors insurance; 38 percent were actually receiving them. The percentage of aged persons who are eligible is expected to rise to 65 percent by 1960. Of the population under 65 years of age, 65 million were insured at the beginning of the calendar year 1955. Some 24 million of these people were permanently insured—that is, whether or not they con- tinue to work in covered jobs they will be eligible for benefits at age 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 additional period to make their insured status permanent. Nine out of 10 of the mothers and young children in the Nation were assured that they would receive monthly benefits in case of the death of the family earner. THE COVERAGE OF THE PROGRAM About 6714 million people will have contributed toward old-age and survivors insurance during calendar year 1955. An estimated addi- tional 114 million people will have been afforded insurance protection jointly by the railroad retirement and old-age and survivors insurance programs. In June 1955, about 91 percent of all jobs in paid civilian employment were covered by the program or were eligible for cover- age. An additional 3 percent of the Nation’s paid civilian jobs, not covered by old-age and survivors insurance, were covered by Federal, State, or local government retirement systems. The residual group, comprising about 6 percent of the Nation’s paid civilian employment, was not covered under any public retirement program. This group consisted mostly of self-employed persons whose annual net earnings were less than $400, certain self-employed professional people, and domestic and farm workers who did not earn sufficient wages from any one employer to meet the minimum coverage requirements of the law. Members of the Armed Forces, while not covered by old-age and survivors insurance on a contributory basis, are granted wage credits of $160 for each month of active service after September 15, 1940, and before April 1, 1956. Social Security Administration 29 INCOME AND DISBURSEMENTS Program expenditures during the fiscal year totaled $4,436 million, of which $4,333 million was for benefit payments and $103 million for administrative expenses. Total receipts were $5,534 million, in- cluding $5,087 million in net contributions, $438 million in interest on investments, and $10 million in transfers from the railroad retirement account. Receipts exceeded disbursements by $1,098 million, the amount of the increase in the trust fund during the year. At the end of June 1955, the fund totaled $21.1 billion. On June 20, all assets of the fund, except $560 million held in cash, were invested in United States Government securities as required by law ; $2.3 billion were invested in public issues (identical with similar bonds owned by private investors), and $18.2 billion were invested in special certificates of indebtedness bearing interest at the average rate paid on the total interest-bearing Federal debt at the time they were issued. The average interest rate on all investments of the trust fund at the end of the fiscal year was about 2.3 percent. Administering the Program EFFECTUATING THE 1954 AMENDMENTS Immediately after enactment of the amendments, recruitment objec- tives were established for each part of the Bureau; these objectives were related to anticipated loads, the ability to recruit qualified per- sonnel, and the rate at which new staff could be successfully trained and absorbed. The net personnel increase required by the 1954 amend- ments was approximately 3,400. This brought Bureau staff at the end of the fiscal year to just over 17,600 employees—the staff needed for operations at the new and continuing workload level at which the Bureau will operate. Training on the amendment provisions and on new policies and _ procedures was essential for both experienced and new personnel. One device followed was to train groups of key supervisory and technical people, who then carried the new knowledge back through the super- visory line and to all parts of the country to people already on the Bureau’s staff. Central office training classes were established in Baltimore for new employees. More than 1,200 new field employees received intensive instruction in these courses during the fiscal year. One of the first tasks required by the amendments was the conver- sion of the monthly benefit checks of over 6.5 million beneficiaries to the new higher amounts. This operation was completed in time to permit release of the September checks when they were due. This was accomplished through timely procedural planning and testing, 30 Department of Health, Education, and Welfare, 1955 the maximum use of mechanical methods for the actual conversion, and close synchronization of operations with those in the ‘Treasury Department’s disbursing offices. The burden of administration stemming from the amendments was greatest during the period from January 1, 1955, to the end of the fiscal year. In the first 3 months of 1955, over 100,000 more claims applications were received than in the first 8 months of 1954. Because this influx of claims was concentrated in such a short period of time, pending loads in the district offices rose to unprecedented levels. By June 30, 1955, substantial inroads had been made in this backlog, but the district office pending load was still high. ADMINISTERING THE DISABILITY “FREEZE”’’ Under the new disability “freeze” provision, persons having both substantial and recent covered work prior to disablement are eligible to have their insurance rights frozen during the period in which long- continuing total disability prevents them from performing any sub- stantial gainful work. Adoption of the disability freeze provision not only created an entirely new area of program administration for the Bureau, but also, for the first time, provided for Federal-State administration of a phase of the old-age and survivors insurance pro- gram. The law directs the Secretary of Health, Education, and Wel- fare to enter into agreements with vocational rehabilitation agencies or other appropriate State agencies to make determinations of disa- bility for freeze purposes. A new division in the Bureau of Old-Age and Survivors Insurance— the Division of Disability Operations—was assigned primary respon- sibility for making determinations in cases not covered by State agree- ments and for reviewing certain disability determinations made by State agencies. The Division received substantial help in the develop- ment of policies and procedures from a committee appointed by the State Vocational Rehabilitation Council, from constituents in the De- partment—particularly from the Office of Vocational Rehabilitation— and from other departments and agencies. ‘To assist in the develop- ment of medical standards and policies, a Medical Advisory Commit- tee to the Social Security Administration was appointed. This Com- mittee, composed of members of the medical and related professions having a common interest in the problems of the disabled, provided consultation on medical policies involved in making disability deter- minations and technical advice on the formulation of medical guides and standards. The Medical Advisory Committee is expected to con- tinue beyond this initial year of operations to evaluate the medical aspects of the administration of the freeze and will assist the Bureau in preparing medical policies and procedures and in solving problems that have medical content. Social Security Administration 31 A major phase in preparing to administer the freeze was the nego- tiation of agreements with individual States to make determinations of disability. The Governors of all States were asked to designate an appropriate agency or agencies for this purpose. At the end of the fiscal year, designations had been received from all but two juris- dictions. In 42 States the vocational rehabilitation agency was des- ignated; in four the vocational rehabilitation agency and either the public welfare agency or a special agency for the rehabilitation of the blind; and in five the public welfare agency. Agreements with 38 States and advances of funds were approved by the Commissioner by the end of the year. Under the law, the State agencies may elect to exclude certain cases from the agreement. In general, cases where disability began many years in the past and cases where the disabled individual is an old-age insurance beneficiary and therefore may be eligible for an immediate increase in benefits were currently excluded from the agreements. In addition to speeding work on negotiations of agreements and providing State agencies with funds with which to start operations, the Bureau made intensive efforts during the second half of the fiscal year to identify potential applicants and to process freeze applica- tions. District offices identified several hundred thousand potential applicants and accepted 143,000 freeze applications before the end of the fiscal year. Because an old-age insurance beneficiary who had been disabled before he attained age 65 could, through the freeze, re- ceive an increase in his benefit amount beginning with the month of July, priority was given to the securing and processing of applications from these older people. The 1954 amendments included a statement of policy to the effect that disabled individuals applying for a determination of disability under the freeze should be promptly referred to State vocational re- habilitation agencies for rehabilitation services, to the end that the maximum number of disabled individuals may be restored to produc- tive activity. To carry out this policy, the Bureau, early in the fiscal year, began describing the services available under State vocational rehabilitation programs to each disabled person inquiring about the freeze. Concurrently, contacts were made with State rehabilitation agencies to work out arrangements for making prompt and effective referrals. As these arrangements were completed State agencies be- gan receiving information on many thousands of disabled individuals, including many who were not freeze applicants. Although it is too early to assess accurately the substantial values that will result from this process, experience thus far has shown that a large proportion of the disabled persons referred were not previously known to voca- tional rehabilitation agencies. 32 Department of Health, Education, and Welfare, 1955 The Division of Disability Operations began making tentative de- terminations on cases in March. About 62,000 applications were re- ceived in the Division before the close of the fiscal year. Although only a scattering of determinations had been completed by State agencies, the volume will grow rapidly as the agencies become staffed and trained. In July 1955 the benefit checks of more than 18,000 old-age insur- ance beneficiaries were raised as the result of the freeze; additional cases were in process. The average July rise was $10.48 (in some cases a portion of the increase was attributable to the drop-out provi- sion in the 1954 amendments). Dependents of old-age insurance beneficiaries entitled to the freeze received proportionate increases in their benefits. OTHER ADMINISTRATIVE DEVELOPMENTS Several years of detailed research have gone into the study of the possible application of large-scale electronic data-processing equip- ment to the Bureau’s earnings record operation. Studies culminated this year in the selection of data-processing equipment which will be installed in the latter part of fiscal year 1956 for maintaining earn- ings records and for properly crediting earnings items reported in- correctly by employers. This equipment, using magnetic tape to record earnings information, will eliminate the setting up of a second sum- mary punchcard file for approximately 80 million accounts on July 1, 1956, which would otherwise have been necessary in order to include the additional data required by the 1954 amendments in making benefit computations. In addition, its use in the operation to properly credit incorrectly reported earnings items will reduce the number of items that cannot be credited and will cut the cost of the operation sub- stantially. Within a year after initial installation, the use of the equipment will be extended to the Bureau’s statistical operations, where increased efficiency will result. Another major subject of study over the past several years has been the plan to combine social security reporting with reporting for income-tax withholding purposes. Under that plan the quarterly wage reports now filed for social security purposes would be elim- inated for those employers whose employees were also subject to in- come-tax withholding. The withholding-tax statements (Forms W-— 2) filed by the employer once a year for each employee would be used to maintain the wage records necessary in the old-age and survivors insurance program. Under agreement with the Treasury Depart- ment, the copies of the Forms W-2 filed by employees with their income-tax returns would also be sent to the Bureau of Old-Age and Survivors Insurance for withholding-tax verification purposes. Social Security Administration 33 The plan is expected to reduce the reporting burden of employers (about 200 million wage items would be eliminated), to provide an automatic method whereby employees may verify annually the accu- racy of reports of their earnings under old-age and survivors insur- ance, to effect improvements in efficiency in the Government’s process- ing operations, and to strengthen social security tax and withholding tax administration. Adoption of legislation to carry out the proposal has been recom- mended by the President and a bill (H. R. 7770) embodying the plan has been introduced in the House of Representatives. In September 1952, the House Appropriations Committee initiated studies of the possibility of check writing by benefit payment agencies to replace the current practice of certification by agencies and dis- bursement by the Treasury Department. Subsequent to experiments by the Railroad Retirement Board, the Bureau of Old-Age and Sur- vivors Insurance with the Treasury Department and the General Accounting Office studied possible applications of this procedure to the old-age and survivors insurance area offices. As a result of these studies the Bureau’s Birmingham Area Office in July 1955 assumed the responsibility, on an experimental basis, for writing benefit checks. In the 1956 appropriations bill the Congress authorized expenditure of $3,870,000, in addition to amounts previously authorized, for a building to house all of the Baltimore operations of the Bureau, and also authorized the use for construction of funds previously author- ized to be used in preparing for construction and not required for that purpose. The limit of cost as established by this congressional action is $25,370,000. During the year the Government acquired title to the site for the building, on the outskirts of Baltimore. Financing the Program In setting the schedule of contribution rates in the 1954 amend- ments Congress again made clear its intent that the old-age and sur- vivors insurance program is to be self-supporting from contributions of covered workers and employers. The rates in the schedule were arrived at after careful review of long-range actuarial cost estimates. According to these estimates, the level-premium cost of the program after 1952 on an intermediate basis, assuming interest at 2.4 percent and earnings at the levels that prevailed during 1951 and 1952 (the latest then available), was 7.50 percent of payroll. The level contri- bution rate equivalent to the graduated rates in the law was estimated at 7.12 percent of payroll, so that there was an estimated deficit of 0.38 percent. 34 Department of Health, Education, and Welfare, 1955 Revisions in these estimates have recently been prepared that take into account the rise in earnings levels since 1951-1952 and the most recent coverage and benefit experience. According to these new estimates the level premium cost of the program after 1955, on an intermediate basis and assuming 2.4 percent interest, is 7.51 percent. The level contribution rate equivalent to the graduated contribution rates in the law is estimated at 7.29 percent, with a resulting deficit of 0.22 percent. Thus the new estimates show that the deficit has been significantly reduced. Taking into account the practice of using contribution rates rounded to convenient fractions, the system is as nearly in balance as is practical. The difficulties involved in making exact predictions of the actuarial status of a program that reaches into the distant future are widely recognized. If different assumptions as to, say, interest, mortality, or earnings had been used, different results would have been obtained. Accordingly, no one set of estimates should be looked upon as final. As economic and other conditions change, the Department will con- tinue to prepare new cost estimates reflecting the latest information available. A Study of the Minimum Benefit Public Law 761, the Social Security Act Amendments of 1954, contained the following section calling for a study of the minimum benefit under the old-age and survivors insurance program: Sec. 404. (a) The Secretary of Health, Education, and Welfare shall conduct a full and complete study with a view to determining the feasibility of increasing the minimum old-age insurance benefit under title II of the Social Security Act to (1) $55 per month, (2) $60 per month, and (8) $75 per month. (b) Such study shall include (1) a detailed analysis of the estimated increase in cost, if any, involved in increasing such minimum benefit to each of the above referred to amounts, (2) estimates of the financial impact such increase would have upon the Old-Age and Survivors Insurance Trust Fund, and (8) an estimate of the amount, if any, by which Federal grants to the States for public assistance would be reduced by reason of such increase in minimum old-age insurance benefits. (c) The Secretary shall report to the Congress at the earliest practicable date the results of the study provided for by this section. In accordance with this directive a study of the feasibility of in- creasing the minimum benefit to the specified amounts was conducted during the fiscal year 1955. The study included, in addition to the required analysis of costs and of the impact on Federal grants for public assistance, an analysis of the relationship of the proposed in- creases to employment patterns, earnings, and benefit levels of workers and of beneficiaries with a view to determining who would benefit Social Security Administration — AS dsrpiiitsones) 35 from, and who would be disadvantaged by the proposed increases in benefits and cost. In connection with the study, estimates were prepared of the bene- fits that are expected to be awarded under the program in the next S5years. Itis anticipated that about 80 percent of the benefits awarded to retired men workers during that period will be based on earnings after 1950 and will reflect the changes in the program, described earlier, that are expected to improve benefit adequacy. Among these retired male beneficiaries whose benefits are based on earnings after 1950 only 6 percent are expected to qualify for less than $60 a month; over 80 percent are expected to receive benefits between $75 and $108.50. The study was completed and a report on the study was submitted to the Congress shortly after the end of the fiscal year. ‘The conclu- sions reached in the study, as summarized in the report, are as follows: . . . the proposed increases in the minimum would result in appreciable in- creases in the cost of the old-age and survivors insurance program. The increase in cost on a level-premium basis for the $55 minimum would be 0.6 percent of payroll; for the $60 minimum, 0.9 percent ; for the $75 minimum, 1.8 percent. With a $55 minimum the savings in Federal grants to States for old-age as- sistance would amount to about 4 percent at present and about 8 percent in 1960. The comparable figures for a $75 minimum would be 10 percent now and some- what under 19 percent in 1960. The additional expenditures for old-age and survivors insurance in 1955 would amount to from 5 to 7 times the reduction in the Federal share of assistance costs ; for 1960 from 8 to 11 times. Those who would benefit from the proposed increases in the minimum, aside from those people now on the rolls, would be widows whose husbands died before the recent improvements in old-age and survivors insurance, families where the wife had barely enough covered work to be insured, and people who had spent most of their lives outside of covered work such as doctors, lawyers, Federal em- ployees, and investors. In addition there would be some regular lifetime work- ers in low-wage areas, such as Puerto Rico and the Virgin Islands, or in farming, with its low cash wage and considerable remuneration in kind. The chief group that would be hurt by reason of paying additional contributions without any benefit increases would be the regular, full-time, lifetime workers who supported themselves and their families throughout their lives by work in covered jobs. It would seem very difficult to justify to the long-term contributors to the sys- tem, who even under present law receive less in proportion to their contributions than do the short-term contributors that they must pay still higher contributions to help finance benefit increases for others while not getting additional benefits themselves. Especially would this be true when it is considered that among those who would receive the increased amounts would be self-employed doctors and lawyers, Federal workers, investors and others whose major source of sup- port—income from noncovered work or investments—is not subject to the taxes that support the program. Thus the provision of high minimum benefits not only would increase the cost of the program but it might also jeopardize the financing of the program by de- creasing the willingness of the long-term regular worker to support the system. In the opinion of the Department of Health, Education, and Welfare there are values inherent in the contributory, variable-benefit system that make it most important that no step be taken, however expedient it may seem in the short - run, that would weaken the financial basis of the system, 36 Department of Health, Education, and Welfare, 1955 Legislative Developments in 1955 A bill (H. R. 7770) to consolidate reporting of wages for income- tax withholding and social security purposes was introduced in the House of Representatives shortly before the first session of the Eighty- fourth Congress adjourned. Since quarterly reports of earnings would not be made under the plan for workers covered by the income-tax withholding procedures, the bill provides for changing the insured status requirements under the program from the present quarterly basis to an annual basis. H. R. 7770 also includes a provision under which the Federal old-age and survivors insurance trust fund would earn a higher rate of interest on its investments. The law now requires that special obligations issued to the trust fund bear interest at a rate equal to the average rate of interest borne by all interest-bearing obligations of the United States forming a part of the public debt. (When the average rate is not a multiple of 1% of 1 percent, the rate of interest is the multiple of 14 of 1 percent next lower than the average rate.) In determining the interest rate under this rule all obligations, in- cluding very short-terms ones, are included. Yet the financial com- mitments of the system are basically of a long-term nature and it is appropriate to take that fact into account in arriving at a rate of interest that is equitable. Under H. R. 7770 the interest rate on special obligations issued to the fund would be the average rate of all marketable United States Government obligations having matur- ity dates more than 5 years after issuance; thus short-term obligations would not be considered. ‘The bill also provides that the average rate would be rounded to the nearest (rather than the next lower) multiple of 14 of 1 percent. Late in the first session, the House of Representatives passed H. R. 7225, a bill that would lower the retirement age to 50 for insured individuals who are permanently and totally disabled, reduce the benefit eligibility age for wives, widows, female parents, and women workers to 62, continue monthly benefits for disabled children after age 18, extend old-age and survivors insurance coverage to self-em- ployed professional people not yet covered (except doctors) and a few smaller groups, increase the contribution rates, and establish an Ad- visory Council on Social Security Financing. Time did not permit full consideration of the measure by the Senate. The Department en- dorsed the extension of coverage provided by the bill but stated that the other provisions required study and evaluation more extensive than could be provided during the closing days of the 1955 session of Congress. Social Security Administration 37 After a number of months of intensive study and public hearings, the Select Committee on Survivor Benefits of the House of Represen- tatives (the Hardy Committee) reported out a bill, H. R. 7089, that was passed by the House on July 13, 1955. The Senate Committee on Finance is expected to consider the bill at the next session of the Congress. This bill would make major improvements in the sur- vivor benefit programs for servicemen, including extension of con- tributory old-age and survivors insurance coverage to members of the Armed Forces and coordination of the survivor benefits payable by the Veterans Administration with those that would be provided by old-age and survivors insurance. The bill would substantially carry out the recommendations of the President and of this Department that coverage be extended to members of the uniformed services on a contributory, wage-related basis. H. R. 7089 includes provision for reimbursement of the Federal old-age and survivors insurance trust fund for past and future expen- ditures resulting from the gratuitous $160 monthly wage credits which are provided under existing law for military service performed since September 15, 1940. When it became evident that Senate consideration of H. R. 7089 could not be completed in 1955, the Eighty-fourth Congress enacted Public Law 325 asa stop-gap measure. This law extended the expira- tion date of the gratuitous $160 monthly wage-credit provision from July 1, 1955, to April 1, 1956. If H. R. 7089 is enacted to provide contributory coverage of the Armed Forces effective January 1, 1956, the social security law will need to be amended so that the $160 gratu- itous credits will not be granted for military service after 1955. In addition to the significant developments that occurred during the year in respect to improved retirement and survivors protection for members of the Armed Forces, the President took steps to im- prove veterans’ legislation by establishing the President’s Commis- sion on Veterans’ Pensions, with General Omar N. Bradley as Chair- man. At the President’s direction, this Commission began a comprehensive study of the Federal laws providing nonmedical benefits to veterans and their dependents, including the relationship of these benefits to benefits provided under the social security and other general programs, as a basis for recommendations to be sub- mitted to the Congress. The Department was asked to furnish information about the present and potential effects of the old-age and survivors insurance program and others administered by the Department on veterans. Amendments to the Railroad Retirement Act were approved Au- gust 12,1955. These amendments made no basic changes in the coor- dination of the railroad retirement and old-age and survivors 38 Department of Health, Education, and Welfare, 1955 a eT TPIS eR Ok GANA Ss AS insurance programs; however, they did remove the former require- ment in the railroad law that survivor annuities be reduced by the amount of any old-age and survivors insurance benefit (based on a different wage record) payable to the annuitant. Some progress was made during the year toward carrying out the recommendation of the Committee on Retirement Policy for Federal Personnel that old-age and survivors insurance coverage be extended to employees covered by the Federal civil service retirement system and that the latter system be revised to be supplementary to old-age and survivors insurance. The Department of Health, Education, and Welfare believes that the recommendation, if carried out, would substantially improve the protection afforded to Federal employees. Public Assistance The twentieth year of administering public assistance under the Social Security Act was an occasion for taking stock—appraising gains and evaluating needs in planning the future direction of the program. Gains in Public Assistance Benefits of the public assistance titles of the act are now extended to the needy aged and blind and to dependent children in all the ap- proximately 3,100 counties in the United States, and in Alaska, Ha- waii, the District of Columbia, Puerto Rico, and the Virgin Islands. Nevada, since 1945 the only jurisdiction without a federally aided program of aid to dependent children, passed legislation authorizing the initiation of its program in July 1955. The federally aided pro- gram initiated in Maine during the year brought to 43 the States administering aid to the permanently and totally disabled for which Federal grants were provided under a 1950 amendment to the act. In addition, States provide general assistance, using only State and/or local funds. During the past 20 years the State public assistance programs have undergone great development in their ability to help people meet their needs in ways that are consistent with the dignity of the individual and with respect for his rights and responsibilities. Much of the gain is attributable to implementation of concepts embodied in the public assistance titles of the act reenforced by the knowledge and experience of related fields of economics, law, social work, medicine, and public administration. For example, placement of responsibility with a single State agency for statewide operation of the program has contributed to the develop- Social Security Administration 39 ment or strengthening of State departments of public welfare through- out the country and provided for equitable administration of as- sistance to needy people within a State. Although traditional respon- sibility of the States and localities for administering public assistance was retained, certain provisions in the Social Security Act reflect the national interest, such as those relating to proper and efficient admin- istration and consideration of income and resources in determining need for assistance. 7 The act also provides for a fair hearing when a needy person has been denied aid or is dissatisfied with the amount of his assistance payment, or when his application has not been acted upon with reason- able promptness. This has protected needy persons against arbitrary or erroneous decisions of an individual staff member and strengthened State responsibility by providing for State review of a local decision. Most States define a needy person as one whose income and resources are too small to provide what the State has set as the minimum re- quired for basic maintenance needs, and today aid is usually given to supplement any income and resources the applicant possesses up to this standard. However, standards in many States are still far below what many consider necessary to secure the essentials of well-being. Much of the increase in public assistance payments during the past two decades reflects increased living costs. For example, although there was an increase in the average monthly old-age assistance pay- ment from $15.04 to $51.89 from 1936 to 1955, the actual purchasing power of today’s payment is $26.58 in terms of the 1936 dollar. The 1950 amendment to the Social Security Act requiring the desig- nation by each State of an authority to establish and maintain stand- ards in institutions where assistance recipients reside has provided an impetus for a nationwide movement to raise standards of institu- tional care. There has also been increasing emphasis in administering assistance in such a way as to help the needy person make the maximum use of his capacities for self-help and to deal constructively with problems which have contributed to his need for assistance. Public assistance has helped to strengthen family life in many ways. By aiding the needy aged, blind, or disabled individual within his family setting, he has been enabled to remain at home without inter- ruption of family life because of need alone. Through aid to de- pendent children the needy parent and child have been enabled to remain together, and children have been provided the opportunity of growing up in the setting of their own family relationships. Efforts toward rehabilitation of the needy disabled have helped some gain greater self-sufficiency and others to resume responsibility for the care and support of their families. Public assistance, in supplementing the old-age and survivors insurance program, has added to the basic 40 Department of Health, Education, and Welfare, 1955 economic underpinning which has enabled the needy family to pre- serve, in the face of adversity, the continuity of cherished relationships and other strengths of family living. Trends in Caseload and Expenditures? Nearly 6 million persons (5.8 million) received some form of public assistance in June 1955—3.5 percent of the total population, or ap- proximately 1 in 28. This represented an increase of 200,000 from the preceding June, with the highest increase between November and December. The year’s peak of 6.1 million was reached in March. All programs showed increases except old-age assistance. Expenditures for assistance payments from Federal, State, and local funds during fiscal 1955 amounted to $2,712 million, representing about 1 percent of personal income payments in the Nation. The Federal share of this expenditure was $1,351 million. The 5.8-percent increase in total expenditures reflected increases in average payments in each of the assistance programs, owing in part to increasing expendi- tures for medical care through vendor payments and higher standards of assistance in some States. OLD-AGE ASSISTANCE In June 1955, 2,549,000 persons received old-age assistance, a de- crease of about 33,800 persons, or 1.3 percent, from the previous June. The greatest monthly reduction, 8,700, occurred in October 1954 when a substantial number of cases were closed following receipt of higher old-age and survivor insurance benefits provided by the 1954 amend- ments to the act. Only 14 States had higher caseloads at the end of the year than at the beginning. The national average monthly pay- ment for old-age assistance was $52.30 in June 1955 as compared with $51.45 a year earlier. AID TO DEPENDENT CHILDREN About 620,000 families received aid to dependent children in June 1955, an increase of about 38,500 families, or 6.6 percent, from the preceding June. Increases in caseloads were general throughout the country with reductions in only 7 States. The average payment per family in June 1955 was $86.78 ($24.04 per person) as compared with $85.08 per family ($23.81 per person) in June 1954. 1 Caseloads, averages, and total expenditures in all programs except general assistance are based on data including vendor payments for medical care and cases receiving only medical care. Social Security Administration 41 AID TO THE BLIND Nearly 104,000 persons received aid to the blind in June 1955, an increase of about 3,000 during the year. Only 16 States had fewer recipients, and 11 States had lower average assistance payments at the end of the year than at the beginning. The national average monthly payment in June 1955 was $57.41, as compared with $55.80 in the previous June. AID TO THE PERMANENTLY AND TOTALLY DISABLED About 236,800 persons in 48 States received aid to the permanently and totally disabled in June 1955, an increase of 25,100 from June 1954, owing largely to the relative newness of the program. The average monthly payment was $54.93 in June 1955, as compared with $53.51 in June 1954. GENERAL ASSISTANCE Some 310,000 cases received State and/or locally financed general assistance in June 1955, an increase of 11,000 or 3.8 percent from the preceding June. ‘This was a decrease of 71,000 cases from the year’s high of 381,000 reached in March. That peak represented the largest number receiving general assistance since April 1951 but was 271,000 under the postwar peak of 652,000 in March 1950. The average pay- ment per case for June 1955 was $53.78, as compared with $51.62 a year earlier. Effect on Public Assistance of the Expanding OASI Program A 1954 amendment extended old-age and survivors insurance cover- age to about 10 million more people in the course of a year (over half of them farm operators and farm workers). ‘This is expected to have a significant long-range effect in reducing the number of aged depend- ent on assistance, since many come from agricultural groups to which insurance coverage was extended. It is estimated that by about 1980 a very high proportion of the aged will receive old-age and survivors insurance benefits; those who do will need old-age assistance only if their insurance benefits are low or if they have special needs. Some of those not receiving insurance benefits may also need old-age assistance. However, the immediate effect in reducing the number dependent on public assistance is more limited. Many of those currently re- ceiving old-age assistance never had and are not likely to obtain cover- 368636—56——4 42 Department of Health, Education, and Welfare, 1955 age under the insurance program because during their working years the coverage was limited. Others are eligible for only minimum insur- ance benefits insufficient to meet their basic needs or have unusual expenses, such as costly medical and/or nursing care. As a result, although the proportion of aged population receiving assistance dropped from 22.5 percent in September 1950 to 17.9 percent in June 1955, the rate of reduction was only slightly higher during 1955, the year following the amendments, than in the preceding year (1.8 per- cent as compared with 1.0 percent). The liberalized benefits, however, resulted in an average increase of $5 a month in the insurance benefit payment of aged persons re- ceiving supplementary old-age assistance. A somewhat smaller in- crease was received by most wives of retired workers and most widows receiving monthly benefits in excess of $25. Widows’ benefits at the previous minimum of $18.80 were raised to $30 a month. Asa result, although about 86 percent of the aged receiving both assistance and benefits in September 1954 continued to receive assistance, the amount of assistance was reduced; 2 percent of the cases were closed. Aid to dependent children families also receiving benefits had an average increase of over $8 a month per family. About 73 percent had their assistance payments reduced, and 3 percent of the cases were closed. Payments for the other old-age assistance and aid to dependent chil- dren cases were not reduced. The increase in benefits resulted in a reduction of almost $2.1 mil- lion a month in payments to those receiving both old-age assistance and insurance benefits and $197,000 for aid to dependent children families also receiving benefits, in September 1954. In many cases, the increase in benefits released some State and/or local funds to meet current unmet need of recipients. AGED PERSONS RECEIVING BOTH INSURANCE AND ASSISTANCE In February 1955, about 489,000 insurance beneficiaries received old-age assistance to supplement minimum or near minimum insurance benefits insufficient for their basic needs or to meet special needs. They represented nearly a fifth (19.2 percent) of all old-age assistance recipients. ‘The number receiving both assistance and benefits in- creased 77 percent since September 1950 and 5.6 percent since February 1954. As a result of benefit increases provided by the 1954 amendments, the average old-age assistance payment for recipients receiving both insurance and assistance was reduced from $48.00 in February 1954 to $40.92 in February 1955. Aged beneficiary-recipients get, on the average, a lower benefit and a lower assistance payment than those receiving only insurance benefits or only assistance payments. For Social Security Administration 43 recipients who were not drawing insurance benefits, the average old- age assistance payment was $54.20. FAMILIES WITH CHILDREN RECEIVING BOTH INSURANCE AND ASSIST- ANCE More than 32,000 families received both insurance benefits and assistance in February 1955—5.2 percent of the families receiving aid to dependent children in February 1955 in comparison with 5.9 per- cent a year earlier. Since only 1 family in 6 receives assistance because of the death of a parent—the risk covered by the insurance program—the aid to dependent children program is affected to a more limited extent by expansion of insurance coverage and liberali- zation of benefits. The average assistance payment in February to families receiving both types of benefits was $66.71; to families not receiving insurance benefits the average assistance payment was $87.17. Program Developments _ The need for welfare services, in addition to financial assistance, has been increasingly recognized as illness and disability became major factors contributing to dependency, and the relatively large number of families receiving aid because the father has deserted gave evidence of social problems on which further help is needed. In- creased emphasis was given to the broad purpose of public assistance— helping needy persons through the provision of income and services to achieve as much economic and personal independence as possible. To increase the effectiveness of administration in carrying out broad program objectives, work undertaken during the year was based on (1) an evaluation of changing program needs in planning to provide assistance and services effectively; and (2) an analysis of operations in planning for the most appropriate and efficient administration at Federal, State, and local levels. Full utilization was made of the ex- perience, knowledge, and skill of all those directly concerned with the administration of the program—State and local public assistance staff, regional and central office staff of the Bureau, and those in other agen- cies and organizations both within and outside the Department. This was evidenced, for example, by requesting and utilizing State consid- eration of policy material in early developmental stages; joint partici- pation of Federal, State, and local staff in projects in specific subject areas; wide regional and central office participation in work planning ; and utilization of technical and lay advisory groups in evaluating program needs and legislative proposals, detailed below. 44 Department of Health, Education, and Welfare, 1955 a ce nk a tag te Five major areas were identified on which Bureau work was focused during the year: (1) improvement in services to needy individuals; (2) increased understanding of the public assistance program through citizen participation; (3) improvement in public assistance adminis- tration; (4) improvement in methods of carrying out Federal respon- sibilities in working with States; and (5) development of the defense welfare services program. IMPROVEMENT IN SERVICES TO NEEDY INDIVIDUALS Improvement in services available to needy persons, including both clarification of policy on services and obtaining skilled staff to provide them, was considered the most important problem on which further work was needed. Chart 2.—MAJOR CAUSES OF DEPENDENCY OF PUBLIC ASSISTANCE RECIPIENTS,’ 1955 5.1 MILLION DEATH OF fs PARENT [,,2 == AGED (OAA) 0.4 M AVERAGE AGE 75 YEARS OLD AGE 2.5 M 20% BEDRIDDEN OR NEED CONSIDERABLE PERSONAL CARE ABSENCE OF PARENT 14M 1 Excludes general assistance recipients under State and local programs. Need for welfare services.—Dependency of one and a third million persons receiving federally aided assistance today is attributed pri- marily to disability, chronic illness, or severe infirmities of old age. In addition, absence of a parent accounts for need in more than half of the 620,000 families continuing to receive aid to dependent children. As shown in chart 2? nearly a fifth of the aged receiving assistance— *These data were obtained through studies, undertaken by the Bureau with participa- tion of State public assistance agencies, of the characteristics of recipients of old-age assistance, aid to the disabled, and aid to dependent children; and more recently through participation in the study of the homebound made by the Office of Vocational Rehabili- tation at the request of Congress. Social Security Administration 45 some 460,000 persons—are bedridden or require a substantial amount of care from others because of physical or mental impairment; 235,000 persons receive aid to the permanently and totally disabled; more than 100,000 persons receive aid to the blind; and 450,000 persons in 125,000 families receive aid to dependent children because of need due to the incapacity of a parent. In addition, a high proportion of the other 2 million aged caring for their own daily needs have health and other problems relating to aging; their average age is 75 years. The aging, the largest group receiving public assistance, have need for many types of services. In addition to a high incidence of chronic illness, the aging suffer from the loss of family ties and friends, from lack of recreational outlets, and from frequent lack of employment opportunities irrespective of skill or physical vigor. Many need help in getting medical care, in devising arrangements to maintain their own homes as long as their health permits, and in obtaining suitable institutional care if and when needed. Others can benefit from skilled help with personal family problems. Estranged husbands and wives might be reunited and the deserting parent helped to resume the re- sponsibilities and satisfactions of family living, with benefit to the children. Undoubtedly, more old people can be enabled to make greater use of their individual capacities and thus participate in and contribute more effectively to family and community life. Some recipients of public assistance who now require considerable care from others because of age or disability could be helped to learn how to care for themselves, thus providing the individual with a greater degree of independence and releasing the time of others in the family for more productive pursuits. The use of homemaker service would enable some older people to maintain their own homes for a longer period than would otherwise be possible. Vocational rehabili- tation and other services might help others among the younger groups who receive public assistance to engage, as many would like to, in some gainful work. Emphasis on welfare services.—Federal and State interest was in- tensified during the year in coordinating welfare, medical, vocational, and other services with financial assistance to help needy persons be- come self-sufficient to the full extent of their capacities. The Bureau of Public Assistance worked with other Bureaus in the Department and with national voluntary social agencies in planning for the devel- opment and utilization of other needed community resources in order to make available to public assistance recipients services that will con- tribute to the improvement of their capacity for self-help or self-care. Interest in welfare services was stimulated by the release of the draft report on services in the aid to dependent children program developed by the working group composed of staff from both the 46 Department of Health, Education, and Welfare, 1955 hE nL AE hf eh SME AS ER EE Children’s Bureau and the Bureau of Public Assistance. The report was sent to all State public assistance and child welfare agencies and provided a basis for joint study of the need for services in general and the specific needs in the aid to dependent children program. On the basis of joint planning by regional staff of both Bureaus, seven - regional conferences including 38 States were held during the year. These were attended by administrators, program supervisors of aid to dependent children and child welfare services, and in some instances by other State and local staff. The report was discussed individually with the other States and Territories. Similar group discussion has been held in the Bureau’s central office and regional offices, with full staff participation. The regional staff of both agencies is continuing to encourage, among State and local staff, wider group discussion of concepts in the report and the further exploration, testing, and devel- opment of the quality of the job now being done. The Bureau is attempting to give encouragement to the work already being undertaken in the expansion of needed services over the country by State and local governments, private organizations, and others interested in the welfare of people. It has especially continued its participation in the activities of many groups in stimulating the devel- opment of needed services for the aged. The Bureau is represented on the Department of Health, Education, and Welfare’s Committee on Aging, which is concerned with broad needs of the aging population and how the programs of the constituent units of the Department may cooperate in meeting them. The Bu- reau continued its collaboration with the National Social Welfare Assembly’s National Committee on Aging. A Bureau staff member led one of the workshops at the Assembly’s Annual Meeting and is also chairing a committee to advise on the development of a pamphlet on agency examples of casework services for the aging. Participa- tion has also continued on the American Public Welfare Association’s Committee on Aging. A cooperative project during the year was a joint meeting between the Bureau and the Office of Vocational Rehabilitation, attended by several State administrators of public assistance and vocational rehabilitation programs and a selected regional representative from each constituent. This conference provided opportunity for com- ment and suggestions on ways to make more helpful to State agencies the document on “Working Together To Rehabilitate the Needy Disabled,” developed and planned for joint release by the two Bureaus. The Bureau also participated with other groups concerned with improved coordination between voluntary and public agencies in pro- viding casework services, including the Family Service Association of America and the National Social Welfare Assembly’s Conference Social Security Administration 47 on Individualized Services. Similarly, work with the National Legal Aid Society was initiated in identifying needs of public assistance recipients and encouraging State and local agencies to participate in the development of legal aid services. There also has been increased activity on the part of State agencies in developing services and in making maximum use of other com- munity resources and a corresponding increase in requests to the Bureau for assistance in this area. During the year, work was initi- ated within the Bureau on statements of the broad areas of social welfare services appropriately included in public assistance admin- istration and the role of public assistance agencies in providing and securing them. Background materials are being collected which reflect recent experience of public assistance agencies in the develop- ment of constructive services. Work is also continuing on a state- ment on the use of homemaker services and experiences of several States in this area. Need for more skilled staff—The skill and helpfulness with which the services of the agency are made available to the needy individual will in large measure determine whether he will be encouraged to make maximum use of his own capacities. Adequate service, however, depends largely on the technical skill of staff. Public agencies gen- erally have been unable to establish qualifications and salaries for staff at a level that will assure the professional skill needed. Through staff development programs, State public assistance agencies in many instances have enabled untrained workers to improve the quality of service provided. Professional training, however, is needed to assure that skilled services are provided to needy persons in order to achieve the full objectives of the public assistance programs. As indicated in chart 3 less than 2 percent of public assistance staff in casework jobs had full social work training—2 years of study in a graduate school of social work. Yet public assistance staff was respon- sible in 1955 for dealing with nearly 6 million persons dependent on public assistance, many of whom had serious individual and family problems. Although an additional 15 percent of the caseworkers had some social work training, more than two-thirds of these had less than 1 year of training. The largest number, 49 percent, had only under- graduate college training, or graduate training in other fields, and about 9 percent had only high school training or less. The low salary of these caseworkers, averaging $2,569 in 1950, even though increased since, has contributed to both the inability to secure professionally trained workers and the high rate of turnover of public assistance personnel. In 1954, for example, more than a fourth of all persons leaving public assistance casework positions had been in their jobs less than 1 year; the educational qualifications of those leaving SSS 438 Department of Health, Education, and Welfare, 1955 Chart 3.—EDUCATION AND SALARY OF PUBLIC ASSISTANCE CASEWORKERS PUBLIC ASSISTANCE CASEWORKERS EDUCATION SALARY 734,000 OR MORE 0.2% —— ] Jr: | > SOCIAL WORK DEGREE UNDER $2,000 SOME GRADUATE SOCIAL WORK eeeesevccces oe eeeee ee eens eeeee e@eeoee “ — — wees eeeoee eeeeeee jocnecce eeeceee Pete eeececerrees ees eee oeeeesosoeeevese ereseerosceese’ OO, = ° OTHER GRADUATE STUDY OR BACH. DEGREE SOME COLLEGE STUDY V 78% 777 YY; HIGH SCHOOL OR LESS Source: Public Social Welfare Personnel (1950), Bureau of Public Assistance and Children’s Bu- reau, 1953. were slightly higher than those of the new workers recruited. With only 15 percent of the jobs paying over $3,000 in 1950, public assistance cannot compete for the limited supply of trained social work staff available in the country or induce young people to seek such training. In the consultation provided individually to 22 States and to groups of States in 6 regions during the year, emphasis was placed on evaluat- ing current staff development programs and on long-range planning to provide for continuing progress in ways and means of improving the quality of agency services. A subcommittee of the Committee on Personnel and Training advisory to both the Bureau of Public As- sistance and the Children’s Bureau will participate in the formulation of criteria for States to use in their long-range staff development planning. Case records and recruitment materials were distributed to the States to facilitate their work. Recordings and films, including two new Arizona films—‘Rehabilitation of the Blind” and “The Rehabili- tation Team in Action”—and “Family Affair,” produced by the Fam- ily Service Association of America, were also made available on loan. The Bureau has also worked with the American Public Welfare Asso- ciation’s Committee on Social Work Education and Personnel which has been active in a variety of areas concerning the education and standards for personnel in public welfare agencies. Social Security Administration 49 The Bureau has also continued cooperative work with the Council on Social Work Education, primarily on development of recruitment and teaching materials on administration and supervision and on cur- riculum content. In an effort to improve the quality of public welfare services, the Council has recently obtained a grant from a private foundation for a 3-year study, beginning August 1, 1955, on educa- tional preparation needed for public social services. Emphasis was also placed on following up recommendations made by the Committee on Personnel and Training meeting in June 1954. The committee meeting in June 1955 recommended that continued effort be placed on developing more adequate plans for financing the education of public assistance staff and expansion of teaching facilities in schools of social work. INCREASED UNDERSTANDING OF THE PUBLIC ASSISTANCE PROGRAM THROUGH CITIZEN PARTICIPATION Effort was made during the year to extend understanding of the public assistance programs through planning for increased use of citizen participation in its administration. Exploratory work ini- tiated last year in planning for the use of volunteers to supplement agency services for recipients and to increase understanding of the public assistance programs was continued during the year, with the help of an experienced volunteer. Review was made of selected volun- teer programs currently in operation; interpretive material was pro- vided on the value of volunteer service in a public welfare agency; and criteria were developed concerning the provision of supplementary services by volunteers. The role of Federal, State, and local governments in furthering citizen participation in providing supplementary services was con- sidered by an ad hoc advisory committee, including representatives from North Carolina, New York, the District of Columbia, Ohio, and Kansas, and staff of the American Public Welfare Association and constituent units in the Department. A report of this meeting was distributed to participants of the committee and will be sent to State agencies. Consideration was also given to other aspects of citizen participa- tion in public assistance administration, especially through member- ship on local administrative and advisory boards. Material was pre- pared for State use on the functions of boards in public assistance administration. This included detailed information about boards currently functioning in public assistance programs throughout the country and recommendations for consideration of proposed changes in State public assistance legislation concerning types of boards, their functions, size, method of appointment, and qualifications and terms of office of members. 50 Department of Health, Education, and Welfare, 1955 ee a IMPROVEMENT IN PUBLIC ASSISTANCE ADMINISTRATION To improve the quality of administration and service of the public assistance program, study has been made of many phases of Federal, State, and local operations. Reshifting of workload necessitated by reduced appropriations and changing program objectives resulted in reappraisal and further streamlining of Bureau functions to enable it both to assure that provisions of the Social Security Act are carried out in practice and to develop materials and provide consultation in the welfare services area. Regional and central office staff participated in this reappraisal, which resulted in recommendations for a series of improvements subsequently used as the basis of further work plan- ning. A time study of regional office activities was also initiated early in the year. Some progress has also been made in simplifying and achieving increased integration in work planning and related report- ing of the regional offices. Analysis was made of variations among States in the cost of admin- istering the public assistance programs and the factors causing the variations. Policies and operations which appear to have resulted in differences in the average caseload per visitor were analyzed, since this factor accounted for about three-fourths of the interstate variation in costs. State agencies furnished much of the basic information for this study and a committee, representing States with high, medium, and low administrative costs, participated in exploring the various factors affecting cost variations. Study was also initiated on facets of administration of large urban welfare agencies which present special management problems because of their size and volume of assistance and services provided. Repre- sentatives of State agencies responsible for the administration of public assistance programs in the six largest cities in the country met with Bureau staff to consider problems of administrative management and State supervision resulting from local agency size and urban setting. Discussion focused on methods for carrying out the State supervisory function, staffing patterns, workloads, and other factors affecting the costs of administration. Reviews of State and local administration were conducted by Bureau staff in 25 States with focus on consideration of eligibility determination and correctness of amount of payment in 20 States. In the others, one or more of the following subject areas were exam- ined : State supervision of local operations, hearings, relatives’ respon- sibility, operation of the State review team, and promptness in appli- cations. Findings were discussed with the responsible State officials, and summaries of review findings were prepared for adminisrative use in the Bureau. = Se = ——= Social Security Administration 51 Consultation and other help was provided to State agencies on many management subjects, including surveys of administrative and fiscal procedures, planning for operational changes, development of management guides for local staff, appraisal of the work of special investigating units, distribution of illustrative State materials on manuals and other types of written instructions, and methods for State determination of workloads and staff for local agencies. Devel- opmental work by Bureau staff continued on fiscal provisions of State operations; principles governing Federal financial participation in the costs of office space, medical care, welfare services, defense activ- ities, and administrative costs for several States; fiscal accountability by State agencies; case recording; and measurement of the quantity and quality of the visitor’s job. Bureau staff participated in sections on management problems in State conferences, American Public Welfare Association regional conferences, and other meetings on this subject. Legislative proposals.—Although no Federal legislation pertaining to public assistance was passed in fiscal 1955, study of program needs led to legislative recommendations included in H. R. 3293 intro- duced on January 31, 1955. Bureau staff participated in the prelim- inary work done on these legislative proposals by a task force including representatives of interested constituent units within the Depart- ment. ‘The task force appraised the need for legislation, defined possible areas for action, and made estimates of their cost. The legis- lative proposals were reviewed by the executive committee of the American Public Welfare Association, including State public welfare directors, and leaders of voluntary groups invited by the Secretary to advise Department officials on matters requiring legislative action. IMPROVEMENT IN METHODS OF CARRYING OUT FEDERAL RESPONSI- BILITIES IN WORKING WITH STATES Attention was also directed toward improvement in methods of working with States. Effort was made to clarify Federal and State responsibilities, identify principles in working relationships with States, determine the best way to present Federal requirements to States, and distinguish between these requirements and the objectives toward which States may work in bringing about improvement in program administration. Sections of the Bureau Handbook of Public Assistance Adminis- tration dealing with Federal and State responsibility, sent to State agencies in draft form, provided a vehicle for joint consideration of Federal requirements in general, and specific aspects of Federal and State working relationships. Reports of regional staff discussions 52 Department of Health, Education, and Welfare, 1955 im ne ei ach cc a ae seane re with State agencies were compiled and used in the reappraisal made of Bureau functions. Other sections of the Handbook were prepared dealing more specifically with the responsibilities of a single State agency and the statewide operation of the public assistance programs, based on requirements in the act. Review was also initiated of Federal requirements affecting State administration of public assistance programs. Effort was made to identify principles and criteria pertinent to such a review, and to identify Federal requirements around which problems have arisen or otherwise are in need of further consideration or revision. DEFENSE WELFARE SERVICES Responsibility for planning national emergency financial assistance and clothing programs was included in the delegation by the Federal Civil Defense Administration to the Department. This delegation was made so that these civil defense activities, as well as others, would be built into and become part of the normal functions of govern- ment. Following assignment of these programs to the Social Security Administration, responsibility was given to the Bureau of Public Assistance in December 1954, since the network of public welfare agencies throughout the country, with facility for extending assist- ance and services to people in need of them in every community, pro- vided both the framework for integrating the newly developing program and the basic principles and methods to be used in dealing with people in time of stress. In carrying out its defined responsibility for developing technical guidance for States and directing Federal activities concerned with financial assistance and clothing for the temporary relief or aid of civilians injured or in want as a result of attack, the Bureau has been working through State public welfare agencies and is utilizing the advice and counsel of State agency staff, as it does in other programs for which it is responsible. A series of meetings were held with regional and State public welfare agency staff in eight regions to discuss proposed plans, policies, and procedures for the two programs. This series of meet- ings followed consultation with a committee of State administrators. Other activities included the establishment of a Defense Welfare Services staff within the Bureau; organization and training of this staff; preparation of a memorandum of understanding between the Department of Health, Education, and Welfare and the Federal Civil Defense Administration; conferences with clothing industry repre- sentatives and other clothing specialists; and analysis of State civil defense plans. Social Security Administration 53 Children’s Bureau The Children’s Bureau was created in 1912 by an act of Congress to investigate and report upon all matters pertaining to the welfare of children and child life among all classes of our people. In 1935 the Children’s Bureau was given the additional responsibility of administering the grants to the States provided under the Social Security Act, Title V, to enable them to extend and improve the serv- ices for promoting the health and welfare of children, especially in rural areas and in areas of special need. In recent years the Children’s Bureau has directed special attention toward the conditions of life for the infant and preschool child. Its efforts in this direction were continued during 1955 through its research studies and the interdependent child health and welfare programs, implemented in part by grants to the States for maternal and child health, crippled children, and child welfare services. The Children’s Bureau placed special emphasis, during 1955, on bulwarking opportunities for development for the older child. “The Adolescent in Your Family,” a bulletin for parents, was published and widely distributed. ‘Technical assistance was strengthened for the State and local coordinating committees for children and youth in which the young people themselves are active. A Division of Juvenile Delinquency Service was established within the Bureau to provide technical consultation to States and communities on the prevention and treatment of juvenile delinquency. Some Facts and Figures About Child Life The number of live births in 1954 exceeded 4 million, reaching a new all-time high. The estimated birth rate, 25.3 per 1,000 total popu- lation, is close to the highest in the past 30 years. The U.S. child population under 18 years increased from 47 million in 1950 to about 54 million in 1954, a 15-percent rise. Between 1954 and 1965, the number of children under 18 years is expected to rise by almost 25 percent to a total of 67 million in 1965. In this period the 10-to-17-year-olds will increase by about 50 percent as the large number of children born in the late 1940’s and early 1950’s enter this age group. In 1952, 42 percent of the children in the United States were living in rural areas. The infant mortality rate for the first 11 months of 1954 was esti- mated at 26.6 per 1,000 live births, the lowest so far recorded. Many of the States continue to show marked deviations from the national average. 54 Department of Health, Education, and Welfare, 1955 About 310,000 infants were prematurely born in 1954. Fifty-eight percent of neonatal deaths and 41 percent of infant deaths were re- ported as associated with prematurity. In 1952, 4 percent of reported pregnancies which reached 20 weeks or more of gestation resulted in a stillborn infant or death in the neonatal period. The maternal mortality rate in 1954 was the lowest ever recorded (estimated at 5.8 maternal deaths per 10,000 live births). Maternal mortality has declined without interruption since 1929 when the rate was 69.5 per 10,000. In 1952, over 155,000 births occurred among mothers who were delivered without a physician in attendance. Twenty-three percent of births to mothers in the nonwhite group and S percent of births to mothers resident outside of metropolitan counties had no medical attendant at delivery. In 1952 accidents took the lives of 17,121 children, 1-19 years of age and accounted for 36.3 percent of the mortality of this age group. Mortality due to accidents was highest in the 15-19 age group; the rate was 387.2 per 100,000 children. Cancer has become the leading cause of death due to disease among children 5-19 years of age. Next in importance among all fatal diseases are these: diseases of the heart and acute rheumatic fever among children 15-19 years, acute poliomy- elitis in children 5-14 years, and congenital malformations in the preschool group. The estimated 1,476,000 marriages in 1954 were 4 percent fewer than in 1953. The marriage rate of 9.2 marriages per 1,000 population in 1954 was the lowest since 1933. However, the proportion of mar- ried persons in the population, thanks to higher rates in earlier years, is relatively high. In 1954 close to 69 percent of the adult population were married; in 1940 the percentage was 60. Forty-five percent of the 390,000 divorces in 1953 involved families with children under 18 years of age. About one-third of a million children had their families broken by divorce in this one year. In 1953, about 2.9 million children under 18 years, or 1 in 20 of the Nation’s children, had lost one or both parents by death. This repre- sents a sharp drop from the number of orphans in the country in 1920 when there were 6.4 million orphaned children, or 1 in 6 children, in the population. The decline in the number of full orphans has been particularly striking—from 750,000 in 1920 to about 66,000 in 1953. An estimated 150,300 children were born out of wedlock during 1952 (54,100 white; 96,200 nonwhite). ‘This number was about 3 per- cent more than the estimated 146,500 children born out of wedlock during 1951. There were 58,700 unmarried mothers 15-19 years of age, or 89 percent of those who bore illegitimate children in 1952. Of every 1,000 unmarried women between 15 and 44 years, 15.2 gave birth to a child out of wedlock in 1952, eee Pe eS Pe | eS te Social Security Administration 55 An analysis of children living in institutions, based primarily on data from the 1950 U.S. Census of Population, shows that more than a quarter million children under 21 years of age (260,429) were living in institutions of all types in the United States in April 1950. Almost 28,000 of these children were under 6 years of age. A sizable number were in institutions primarily designed for adults, such as prisons and reformatories, jails or workhouses, and homes for the aged and dependent. Of the 260,429 children under 21 years of age living in institutions of all types, about one-third (95,260) were living in institutions for dependent and neglected children. This represents a decrease of about 34 percent since 1933. For the country as a whole, 81 percent of the 95,260 children were in institutions for dependent and neglected children operated under private auspices. The U. S. Senate Subcommittee to Investigate Juvenile Delin- quency estimated that there are 200,000 to 300,000 boys and girls who run away from home annually in the United States. Police arrest data reported by the F. B. I. in its Uniform Crime Reports for 1,005 cities show that the arrests of juveniles (under 18) increased 2.3 percent in 1954 over 1953. In 1954, juveniles represented 57.6 percent of all persons arrested for auto theft, 49 percent for burglaries, 44 percent for larcenies. Statistical data available to the Bureau for 1954 showed the sixth consecutive annual increase in the number of delinquency cases re- ported by the juvenile courts. An estimated 475,000 children came to the attention of juvenile courts in 1954 because of delinquent be- haviour. ‘This number exceeded the previous high experienced during World War II. Children With Special Needs The problems of certain groups of children call for special atten- tion. Some of the more serious are: the adolescent in conflict with society, the children of agricultural migratory workers, mentally re- tarded children, and children in unprotected adoptions. The Nation as a whole is concerned about juvenile delinquency be- cause of its tragic consequences for the individual young person, its contagion among youth, and its social and economic costs for the community. For the past several years the Children’s Bureau has given particular attention to the problems of delinquent children. This emphasis is continuing through the coordinated program of the new Division of Juvenile Delinquency Service (see page 68). For the country as a whole, it has been estimated that there are many hundred thousand children of migrant agricultural workers. It is difficult for any single State to take responsibility for the health, 56 Department of Health, Education, and Welfare, 1955 OO ee welfare, and education of the children in those families since they are on the move so much of the year. Because these children are not residents they frequently do not receive the services that are available to other children in the communities through which they travel. The Children’s Bureau, working with the Office of Education, the Public Health Service, and the Bureau of Public Assistance, is stimu- lating a pilot project along the East Coast. The purpose of this proj- ect is to encourage the 10 States involved in the East Coast migrant stream to do interstate planning for services to migrants so that each State can more easily perform its share of the total job. The exact number of mentally retarded children is not known, but it is estimated that about 1 person per 100 is mentally defective and that about 750,000 children of school age are of low intelligence. As the birth rate goes up the number of such children increases. At the same time the growing complexity of our society makes their so- cial and vocational adjustment ever more difficult. Parents, doctors, nurses, educators, and social workers are increasingly concerned about the health and welfare of these children. The number of parent groups pressing for action for this special group of children is grow- ing rapidly. Unprotected adoptions in which children are placed without the benefit of social agency skills is a subject of much study and contro- versy. Because of the seriousness of the black market in adoptions the Bureau is seeking advice from legal, medical, social work, and other professional groups and from adoptive parents and law enforcement agencies. Conferences with the professional groups were begun in 1955, and the work will be more fully developed in 1956. Federal Interdepartmental Committee on Children and Youth The Congress places responsibility upon a number of the agencies of the United States Government for programs which contribute in varying degrees to the social well-being of children and youth. In 1948 the President requested these agencies to form an Interdepart- mental Committee on Children and Youth to assist each other in keep- ing informed about program developments, to work together for greater effectiveness in program planning, and to strengthen working relationships between the Federal Government and the States. This triple assignment has been carried out during the fiscal year 1955 by the regular monthly meetings of the full Committee, the work of its subcommittees, and an informational exchange with the State committees. Twenty-eight Federal agencies are represented on the Committee. | : | : : Social Security Administration 57 Much of the work of the Interdepartmental Committee goes for- ward through the activities of subcommittees appointed to deal with special problems which are timely and involve a number of Federal agencies. At present there are seven subcommittees. ‘These are con- cerned with Children of Agricultural Migrants, Transition from School to Work, Children in the Territories and Islands of the United States, Juvenile Delinquency, Mental Retardation, Care of American- Related Children Outside the United States, and the Business of Being a Parent in This Decade. The Committee exchanges information with the 53 State and Ter- ritorial Committees on Children and Youth. It publishes, irregu- larly, a newsletter, “What’s Happening for Children and Youth,” and sends pertinent Federal publications to the State and Territorial Committees. The Children’s Bureau furnishes secretarial assistance to the Interdepartmental Committee on Children and Youth. Programs of the Bureau RESEARCH IN CHILD LIFE The Bureau’s small research staff, working under the guidelines of a newly developed plan, is helping to carry out the legislative mandate “to investigate and report upon all matters pertaining to the welfare of children.” Research on programs for disadvantaged children has been emphasized this year. In addition to its own studies and those conducted jointly with others, the Bureau has sought to stimulate research in child life by other agencies by formulating the questions requiring study and developing research methods and has assisted agencies engaged in such research. In its technical research, studies of the costs and effectiveness of various programs have received major emphasis. Study subjects in- cluded the unit costs of child placement and institutional care of children, methods of evaluative research as illustrated in studies of psychotherapy, and a review of studies on the evaluation of school health services. Improvement in methods of reporting for maternal and infant mortality studies has been stressed as a guide for the pre- ventive programs of the medical profession. Work continued on assembling information about programs and services for mentally retarded children. Throughout the country juvenile delinquency is being studied from both the psychological aspect of the inner motiva- tions of the child and the sociological factors in the environment. In an attempt to bridge the gap between these two approaches, the Bureau conducted a conference of experts from both fields. A report of this conference for use by research workers is in preparation. 368636—56——_5 58 Department of Health, Education, and Welfare, 1955 be NS ts finches Micha ee Ete Statistical reporting of State expenditures and services under the grant-in-aid programs was improved. A new report on maternal and child health services was developed. Special report forms have been developed which will provide an unduplicated count of the num- ber of children served by public child welfare agencies annually, data on persons granted educational leave from public child welfare pro- grams, and information on the professional training of child welfare workers in the State programs. A reporting system to provide more accurate data on juvenile court cases has been initiated. As part of its research interpretation activities, the Bureau pub- lished Zhe Adolescent in Your Family and a revised edition of Infant Care and proceeded with a revision of Your Child From One to Sia. Two supplements of Research Relating to Children were issued to help investigators in the field of child life keep informed about studies being conducted in their areas of special interest. More than 1,000 individual letters were written in reply to personal inquiries concerning a variety of problems relating to children. The research staff provided technical consultation requested by State health departments on studies in areas such as evaluation of child health conferences, health records for children of agricultural migrants, maternal and infant mortality, pregnancy, hospital care of premature infants, use of vital records, and fetal and neonatal wastage. State welfare departments and voluntary organizations were as- sisted in studies on such problems as unit costs in child placement, in- dependent adoptions of children, delinquency prevention, training school staff development, drug addiction among juveniles, and com- munity services for children. MATERNAL AND CHILD HEALTH SERVICES All the States, the District of Columbia, Alaska, Hawaii, Puerto Rico, and the Virgin Islands receive Federal funds to extend and improve services for promoting the health of mothers and children. The State maternal and child health agencies report that increases occurred from 1953 to 1954 in most maternal and child health services provided. The number of expectant mothers receiving services at prenatal clinics increased from about 178,000 in 1958 to 192,000 in 1954. Mothers receiving postpartum medical examinations also increased. Well-child clinics provided services for about 1 million infants and preschool children in 1954. One-and-a-half times that number re- ceived nursing service through State maternal and child health pro- grams. About 21% million examinations by physicians and slightly over 3 million dental inspections were provided to school children, who also received over 2 million home and office nursing visits. More than 2 million children were given diphtheria immunizations and Social Security Administration 59 about the same number received smallpox immunizations in 1954. Various other services were also provided to mothers and children. During 1955 the Bureau analyzed the total expenditures of com- bined Federal, State, and local funds for the maternal and child health programs in fiscal 1954. This was of particular interest be- cause, for the first time, the States reported the estimated total cost of the program. In previous years, reporting had been limited to ex- penditures of Federal and of legally required matching funds. Total maternal and child health expenditures for 1954 amounted to over $538 million, or more than 214 times the Federal and required matching funds reported in 1953. To better prepare health personnel for their maternal and child health programs many States carried out institutes and other special training projects. In fiscal 1954, the State agencies spent almost $250,000 for training programs to improve the skills of professional personnel in the maternal and child health field. In addition, special projects having training as the major objective were maintained by a quarter of the States, with the help of Federal funds. For example: the California State Department of Public Health with the School of Social Welfare of the University of California established scholar- ships and an internship program for medical social workers interested in public health and medical care programs; the Massachusetts De- partment of Public Health and the Harvard School of Public Health held a 2-week institute on child growth and development for medical social work teachers; and the special project at the Homer Phillips Hospital in St. Louis for improving training in pediatrics for Negro physicians became a reality. | Increased regional interest in care of the premature infant has developed since Colorado initiated a one-day postgraduate institute program on care of premature and newborn infants for physicians, public health nurses, hospital nurses, and hospital administrators. The team has presented six such programs this year in Colorado and Wyoming. Requests for next fiscal year have been received from other areas in Colorado, Wyoming, Idaho, New Mexico, and Nebraska. The premature institute program conducted by the Cornell-New York Medical Center continues to prove a popular training oppor- tunity for both physicians and nurses. A total of 109 teams coming from 24 States and Hawaii has attended the institutes between 1949 and 1954. The following publications relating to maternal and child health were prepared and/or published during the year: Medical Social Service for Hospitalized Children; Children’s Shoes and Footwear; Nutrition and Health Growth; Your Premature Baby; and The Child With Rheumatic Fever. 60 Department of Health, Education, and Welfare, 1955 Or The Bureau sponsored two conferences on Health Services and Juvenile Delinquency which brought together workers concerned with the various facets of the problem of juvenile delinquency. CRIPPLED CHILDREN’S SERVICES All the 53 States and Territories, with the exception of Arizona, are participating in the crippled children’s program. The expendi- tures of Federal, State, and local funds for this program for the fiscal year 1954, totaled more than $36 million, of which $11.1 million represented Federal funds. The objective of these programs is to locate children in need of care and provide the means of restoration through diagnosis, medical and surgical treatment, and alleviation of unfavorable social and psychological influences which contribute toward the degree and duration of the disability. In 1954 an estimated 271,000 children—more children than in any previous year—received physicians’ services from State crippled children’s agencies. The 1954 total for children served represents an 8-percent increase over 1953 and an increase of 26 percent since 1950. Substantial gains were reported in the number of children receiving clinic service (an increase of 9 percent) and in the number receiving physicians’ services through home or office visits (an increase of almost 18 percent). Children served in clinics numbered 221,000 and constituted more than four-fifths of all children under the program; about 48,000 children received physicians’ services through home or office visits. Hospital inpatient care was provided to over 48,000 children. State crippled children’s agencies are broadening their programs to include more kinds of handicapping conditions and are experiment- ing with new types of services. A notable example of this is new approaches to the preschool blind child. The Michigan Legislature has approved a special project of the State department of health to provide more extensive services for preschool blind children and their parents. Indiana is holding an institute for parents of preschool blind children. There is increasing interest by the State crippled children’s agencies in the care of children with amputations. A team for care of these patients has been trained at Duke University and another qualified team is at work at the new rehabilitation center at the University of Louisville. Plans have been made for facilities for amputee children in West Virginia. At Grand Rapids, Michigan, a midwestern amputee training center is opening to serve handicapped children from nearby States. Plans have been worked out cooperatively with the Army Prosthetic Research Laboratory for the production of the improved ARRL hand in children’s sizes. Hands, mechanisms, and gloves will be produced and paid for in Michigan and will be available to child Social Security Administration ’ 61 amputees in other States. A service for children requiring upper extremity prosthesis has been established in Los Angeles which will serve children from other States as well as California’s own. CHILD WELFARE SERVICES Over 280,000 children were receiving child welfare services from State and local public welfare agencies according to a cross-section count on the day of March 31, 1955, as reported to the Bureau. In the 50 States and Territories reporting, 40 percent of the children receiving services were living with their own parents or relatives, 42 percent were in foster family homes, and 18 percent were living in institutions or elsewhere. In its child welfare services the Bureau consults with State public and voluntary agencies in planning and operating their child welfare program. It also administers the grant-in-aid funds for child welfare services and develops guides, recommendations for practice, and infor- mational materials in relation to the child welfare program as a whole and for specialized services, such as social services to children in their own homes, homemaker services, services to unmarried mothers, and foster family and group care programs. The marked increase in child population gives all aspects of devel- opments within the child welfare program added importance. The past year has seen some basic changes in administration in several States. Connecticut, which has had a State-operated program for children under 6, enacted legislation to bring responsibility for the care of “neglected and uncared for” children over 6 years of age into the same program. Kentucky, Maryland, and Pennsylvania have con- solidated the various statewide public services for children in one program within the public welfare department. ‘Tennessee has given permanent status to the State Commission on Youth Guidance whose early work resulted, this year, in a completely new juvenile court law. Many State legislatures are showing a greater awareness and con- cern over the need for increased child welfare funds and are making an effort to find more adequate revenue. Connecticut, New York, Penn- sylvania, and Vermont are greatly expanding services and are recruit- ing additional qualified staff. Michigan has succeeded in legislative efforts to provide grant-in-aid State funds for foster home care to counties on an equalization basis, and both Alabama and Florida are increasing their State funds for child welfare. Nationwide shortages in personnel, affecting all professions, are reflected in social work. Lack of staff and turnover continue to be out- standing problems for State agencies and all groups interested in child welfare. The Council of Social Work Education, the schools of social work, State and local departments of welfare, and Federal agencies are working together to enrich staff development programs 62 Department of Health, Education, and Welfare, 1955 decd eS ceca a acca NE I as a means of developing the competence of existing workers. The States are focusing on increasing supervisory and consultant skills. The Bureau has been helping States strengthen the work of their staffs in casework practice, supervision, policies, procedures, and attitudes through institutes and consultation. Educational leave, made possible through the use of Federal child welfare funds, continues to be a mainstay for the States in developing staff competence. | Among new State projects financed by child welfare services funds are: strengthening of the adoption program under public auspices in Vermont; a forestry camp for older delinquent boys in Maryland; four additional child welfare workers in Cook County, Illinois, to strengthen the public social services with respect to independent place- ment of children. Cooperative work with other agencies within the Social Security Administration has included Bureau participation on several inter- bureau committees. These include: the Ad Hoc Working Group on Guardianship with the Bureau of Public Assistance and the Bureau of Old-Age and Survivors Insurance and the interbureau Committee on Common Social Welfare Matters which includes representatives of the Office of the Commissioner in addition to the Bureaus named above. The Children’s Bureau continued its joint planning with the Bu- reau of Public Assistance on services to children in aid to dependent children families. The document prepared in draft last year was discussed with State agency staff members in conferences under the cooperative leadership of regional child welfare and public assistance representatives. There have been other evidences of progress in the provision of services to children in their own homes. Massachusetts has passed basic legislation for the protection of dependent and neglected chil- dren, with a declaration of policy toward the strengthening and en- couragement of family life. The southeastern States are proud of their high percentage of children receiving public casework services in their own homes rather than in institutions or foster homes. Many States are voicing a realization that, if social services for children were adequate, more children could remain in their own homes and delin- quent behavior might be greatly reduced. Social agencies are giving increased attention to those children whom neighbors, the police, and others report for serious abuse or neglect and children whose families may, at first, be reluctant to take advantage of community aids in times of trouble. In addition, special projects to identify and plan for the hard core problem families in the community have been initiated in San Mateo County, California; St. Paul, Minnesota; Washington County, Maryland; and St. Louis and Kansas City, Missouri. MES en! eee a ee a ee Oe ee eg ee Tek ee ae IE — = = Social Security Administration 63 Homemaker service is provided by 104 agencies in 74 cities in 29 States and Puerto Rico. Of these, 83 are voluntary and 21 public. A great many are for services to the aged but a number are devoted to children and their families. Unmarried mothers present a dual challenge for the Bureau and the State and voluntary child welfare agencies. In the first instance, over one-third of these mothers are themselves adolescents and in need of protection and guidance. Secondly, the babies need to be pro- tected from the special hazards which confront them. The Bureau is taking leadership in exploring the extent of the problem and the contributions which the several professions of law, medicine, and social work can make in safeguarding the mother and child. Bas- ically, the need is for adequate medical, social, and legal services available to the mother under conditions she can accept. The spotlight has been on adoptions with their tremendous increase from around 16,000 in 1934 to around 95,000 in 1954, approximately half of these being with nonrelatives. 'The National Conference on Adoptions, held in Chicago on January 26-29, 1955, under the auspices of the Child Welfare League of America and the exploration by the Children’s Bureau of the “black market” in babies have con- tributed to nationwide thinking. In June 1955 the Children’s Bu- reau called a conference of 31 national agencies and organizations directly concerned with the three parties to adoption—the child, his natural parents, and the adoptive applicants. The Bureau has also been working cooperatively with Federal agencies having statutory responsibility for intercountry adoptions and for bringing foreign children into the United States for adoption and care. Foster care of children, both in foster family homes and institutions, is a heavy responsibility of State public welfare agencies both in terms of numbers of children and expenditure of public funds. The num- ber of children receiving foster family care under public agency auspices increased from 49,000 in 1933 to 114,000 in 1952, or 138 per- cent; during this same period, the Nation’s child population increased 14 percent. The majority of the children receiving foster care are cared for in foster family homes. About 56,000 additional children are estimated to be in foster family care under the auspices of volun- tary child welfare casework agencies. An important trend in group care is the development of small group homes in the community for adolescents who cannot take root in foster family homes and children who need temporary shelter. Specialized group facilities are also being developed for emotionally disturbed children. JUVENILE DELINQUENCY SERVICE PROGRAM For the sixth consecutive year there has been an increase in the num- 64 Depariment of Health, Education, and Welfare, 1955 oe cn ee ber of delinquency cases reported by juvenile courts. Public interest in the problem of juvenile delinquency remains at a high level. News- papers continue to devote considerable space to the problem, and addi- tional funds were provided by Congress to permit the Senate sub- committee to continue its investigations of juvenile delinquency. Evidence of this general interest is also reflected by activities taking place in the States. In at least a third of the States some action at the State level relating to delinquency has been taken. This has taken the form of new legislation, either relating to the juvenile court statute or the statutes relating to the administrative structure of State agencies providing service to delinquent children, or both, or in the form of studies or surveys of State services for delinquent children. For the fiscal year 1955 the Congress made a supplemental appro- priation of $75,000 to enable the Bureau to expand its services in the field of juvenile delinquency. On October 6, 1954, the Secretary of the Department authorized the creation of a Division of Juvenile Delinquency Service in the Children’s Bureau. The primary responsibility of the new Division is to provide tech- nical consultation to States and communities relating to the following types of service or care: police work with juveniles; courts and proba- tion services; institutional care for delinquent children including training schools, forestry camps, and detention care; legal aspects of delinquency including legislation, community coordination, and plan- ning for the prevention, control, and treatment of delinquency; group work activities with potentially delinquent gangs; and training pro- grams for personnel, professional and nonprofessional, working with delinquent youth. Working relations have been established by this Division with many national organizations concerned with juvenile delinquency, as well as with the several Federal agencies carrying some responsibility for its prevention, control, and treatment. In response to State and local requests, consultation has been provided in the areas of training schools, juvenile police services, statewide surveys, State legislation, juvenile courts, and the training of institutional, probation, and police personnel. The major attention given by the Bureau over the past year in the field of juvenile delinquency is reflected in 9 publications on the sub- ject. Six new bulletins issued were: Training Personnel for Work With Juvenile Delinquency; Parents and Delinquency ; The E'ffective- ness of Delinquency Prevention Programs; Tentative Standards for Training Schools; a directory of Public Training Schools for De- linquent Children; and a report on the Secretary’s National Con- ference on Juvenile Delinquency held in June 1954. Three more bulletins in preparation were: a revision of Some Facts About Jwvenile Delinquency; a bibliography on Juvenile Delinquency: Practice and Social Security Administration 65 Research; and a report on the Bureau’s conference on Health Services and Dissocial Behavior. The Special Juvenile Delinquency Project, which was supported by voluntary organizations and foundations and closely coordinated with the Bureau, was dissolved in July 1955. INTERNATIONAL COOPERATION The international program has moved along this year with no radical internal changes in policy or administration. The trend toward increase in the training load in the health field has continued— the Foreign Operations Administration group coming from the less developed countries and the World Health Organization group from both highly developed and less developed countries. In the FOA program in both maternal and child health and social welfare, the grants generally have been for 12 months with 8 or 9 months for academic training in a school of public health or social work, or for graduate work in a school of medicine. The WHO fellows, in general, have been highly qualified persons who have come for a few months of observation of new developments in their fields. During the year, training programs have been planned for 69 long- term trainees and observers and 133 short-term visitors. Of the 69 long-term trainees and observers, 36 were in the health field as follows: maternal and child health 17, pediatrics 6, obstetrics 3, gynecology and obstetrics 2, nursing 2, other 6; 25 were in child and youth welfare as follows: group work 5, child welfare 5, juvenile delinquency 8, other 7; 8 were in medical social work. The child health and welfare specialists recruited and back-stopped by the Bureau are contributing to the programs in six countries. The Maternal and Child Health Demonstration in Samawa, Iraq, continues to increase. The Government in Iraq has constructed 3 new buildings on the grounds to handle the increasing number of patients and trainees. In Egypt the major responsibility of the American maternal and child health physician has been the development of a rural health demonstration with special emphasis on maternal and child health at the village of Shubra Mant, near the Pyramids. Health visitors are being trained for work at the new center. The medical social consultants, working in El Salvador and Pan- ama, have turned over to local medical social workers the hospital social service units which they had initiated. They are now function- ing on a truly consultant basis to the medical social workers in the several hospitals, to hospital administrators, and to health centers. They are active also in the field of social work education and have had teaching responsibilities in connection with the schools of social work in each country. 66 Department of Health, Education, and Welfare, 1955 OO eee In Mexico the American consultant nurse-midwife has been work- ing with other nurses on nursing curricula at schools in various parts of the country and has given assistance in the organization of a new division of nursing in the Mexican Ministry of Health and Welfare. She and an American physician were loaned to Uruguay for 2 months when that country had the most severe polio epidemic in its history. In February the Director of the Division of International Coopera- tion attended the tenth Pan American Child Congress in Panama as a member of the United States delegation. She also attended the technical conference of Public Health Chiefs of U. S. Operations Missions for the Near East, South Asia and Africa, and the Far East, which was held in New Delhi, India, from February 22 through March 7. She visited the All India School of Hygiene and Public Health in Calcutta. From there she went to Iran, Pakistan, Iraq, Lebanon, Egypt, and Libya, as a consultant on maternal and child health activities of the Foreign Operations Administration program in these countries. The Chief of the Bureau serves under Presidential appointment as United States representative on the Executive Board of the United Nations International Children’s Fund (UNICEF). In May 1955, she was a member of the United States delegation to the World Health Organization Congress in Mexico City. Federal Credit Unions During the fiscal year ended June 30, 1955, the aggregate assets of all Federal credit unions exceeded $1 billion for the first time. The program was 21 years old on June 26. On June 30th, there were 7,562 units in operation. ‘Their 3.8 million members owned assets totaling $1.1 billion, of which $767.7 million consisted of loans outstanding to members. Federal credit unions were operating in Alaska, Hawaii, the District of Columbia, the Canal Zone, Puerto Rico, the Virgin Islands, and in each of the 48 States. About 83 percent were serving employee groups in commerce, industry, and government—local, State, and Federal; 15 percent were serving associational groups such as labor unions, churches, and fraternal organizations; and 2 percent were serving residents of small rural communities or residents of well- defined neighborhood groups in urban areas. About two-thirds (67 percent) of those operating on June 380 had assets of less than $100,000, and more than half (58 percent) were chartered after January 1, 1947. Between July 1, 1954, and June 30, 1955, the number of operating Federal credit unions inereeee 572 or 8. 2 percent; membership in- creased 358,378 or 11.2 percent; total assets increased $203 million or 22 percent; and amount of loans outstanding increased $145 million Social Security Administration 67 or 23 percent. Outstanding loans to members accounted for 68.4 per- cent of total assets at the end of fiscal year 1955 as compared with 67.8 percent at the end of fiscal year 1954. Each Federal credit union is a separate corporation. Each is man- aged and operated by officials elected by and from the group it was organized to serve. The field of membership of each unit is specifi- cally defined in its charter, and the Federal Credit Union Act specifies that it may provide cooperative thrift and small-loan services only for its members. The Federal Credit Union Act specifies the maxi- mum size of a loan that may be made to a member ($200 or 10 percent of the credit union’s paid-in and unimpaired capital and surplus, whichever is larger) ; the maximum loan maturity (36 months) ; and the maximum rate of interest (1 percent per month on the unpaid balances, inclusive of all charges incidental to making the loan). The treasurer of a Federal credit union is the only elected official who may be paid for his services to the credit union. His compensation, if any, must be authorized by the members. Although each unit is authorized to borrow from any source up to 50 percent of its paid-in and unim- paired capital and surplus, borrowing has not been an important source of capital for most Federal credit unions. Funds used to make loans to members are the accumulated savings of members in their credit union. Such savings are called “shares” and are risk capital in the corporate sense of the term. Program Operations The Bureau of Federal Credit Unions grants charters to groups that voluntarily apply and are determined to be eligible and qualified under the terms of the Federal Credit Union Act. The Bureau does no pro- motional work; information and assistance is furnished only upon re- ceipt of a bona fide request. Interest in the organization of Federal credit unions is stimulated by the Credit Union National Association, a nationwide voluntary organization, through advertising and through the efforts of its staff of field men. State credit union leagues, which are voluntary associations of credit unions on the State level, also actively promote and assist in the organization of new credit unions. In an increasing number of localities volunteers, usually officials of operating credit unions, are generating interest in the establishment of Federal credit unions. Many assist groups to apply for charters and later follow through with the instruction of the newly elected officials. In addition, new credit unions are established through the efforts of persons who learned about these self-help organizations at their pre- vious places of employment. During the year, the Bureau granted 794 charters to groups that were found after investigation to be eligible and qualified. 68 Department of Health, Education, and Welfare, 1955 88 Ee a A complete set of manuals is furnished to each newly chartered Federal credit union, and, when necessary, instructions and assistance in conducting the organization meeting are given by one of the Bu- reaw’s field examiners. In a number of States, Credit Union League personnel and volunteers are providing personal instructions for the officials of new credit unions. In fiscal year 1955, less than 1 percent of the official time of Bureau examiners was devoted to organiza- tion work and to the initial instructions of officers, directors, and committeemen. In fiscal year 1955, 6,716 examinations of Federal credit unions were completed by the Bureau’s staff. This was an increase of 425 over the number completed during fiscal year 1954. A total of 24,812 man-days was devoted to the making of these examinations for an average of 3.694 days per examination. The average time for the 6,291 examinations completed in fiscal year 1954 was 3.560 days. The average assets of those Federal credit unions whose examinations were completed in 1955 were $131,314 as compared with $119,692 for those completed in 1954. Of the examinations completed in 1955, 66 (or about 1 percent) were in cases of actual or suspected defalcations. These 66 examinations accounted for 5.4 percent of the total field ex- aminer’s time devoted to examinations during the year. The corre- sponding ratios for fiscal year 1954 were 1.2 percent and 4.6 percent, respectively. At the end of fiscal year 1955, the Bureau had a budgeted staff of 238—24 departmental and 214 field. At the end of the previous year there were 23 departmental positions and 195 field positions provided in the budget. Recruiting for field examiner positions during the year proved to be more difficult than in prior years owing to the relative shortage in the available supply of trained accountants to meet the demand for such trained persons by Government agencies, private industry, and public accounting firms. Toward the end of the fiscal year the Chief of Field Operations worked out, with the assistance of the Bureau’s Regional Representative in Chicago and in New York City, a procedure for direct recruiting of graduating seniors of colleges and universities. The experience gained and con- tacts made are expected to be even more helpful in the future than they were this year. Fiscal year 1955 was the second year that the Bureau’s operations were financed entirely by fees collected from Federal credit unions. The Federal Credit Union Act specifies four kinds of fees and provides that the revenue from these fees shall be used to defray the costs of administering the law. A charter fee of $5 and an investiga- tion fee of $20 are paid by each group when it makes application for acharter. For each calendar year after the year in which its charter is granted each Federal credit union pays a supervision fee the SATUS: oe ee ee en ee ee Social Security Administration 69 amount of which is determined by the amount of its assets as of Decem- ber 81 in accordance with section 5 of the act. The fourth fee is paid to the examiner at the conclusion of the examination. It is computed in accordance with a schedule fixed by the Director in conformance with the act and regulations published in the Pederal Register. The schedule in effect during fiscal year 1955 was $56 per examiner day or 50 cents per $100 of the Federal credit union’s assets as of the effective date of the examination, whichever was lower, with a mini- mum fee of $25 per examination, except that no fee was assessed for the first examination made within 1 year after the charter was issued. Revenue from these fees totaled $19,850 for chartering, $335,774.21 for supervision, and $1,154,519.95 for examinations during fiscal year 1955, as compared with $21,575, $277,619, and $993,596, respectively, during fiscal year 1954. Strengthening the Program The growth in numbers and size of Federal credit unions is an important factor in the administration of the Bureau’s program re- sponsibilities. Solutions to new problems must be developed, trends must be studied, and probable developments anticipated in order that the necessary changes in procedures can be ready for installation at the appropriate time. \ Manuals and instructional materials furnished to the officials of Federal credit unions are revised from time to time to keep them up to date and pertinent. Advice and suggestions of the operating offi- cials, of the field examiners, and of the leaders of the organized credit union movement are solicited. This procedure has fostered good co- operation with instructions issued by the Bureau and has been of material assistance in the development of practical aids to credit union operations. ‘This procedure of proven value is being continued. An integral part of each examination is the instruction of the Fed- eral credit union officials. Since these instructions can be and are geared to prevailing or anticipated conditions in the credit union con- cerned, the examination program is a progressive rather than a static influence on the development of sound credit union service in the Nation. The knowledge this experience gives the field examiners is a valuable resource in keeping the Bureau’s policies and regulations in tune with the times. The Bureau is continuing efforts to collect and maintain basic sta- tistical data on Federal credit unions and to encourage research by graduate students and faculty members of colleges and universities in this field. The results of these efforts will provide the means for detecting need for change and for evaluating proposed legislation, proposed amendments to published regulations, and proposed revi- sions of manuals for Federal credit union officials. 70 Department of Health, Education, and Welfare, 1955 ee ee During the fiscal year, after considerable study and analysis, regu- lations prescribing minimum standards as to amount and type of surety-bond coverage for officials and employees of Federal credit unions were promulgated and published in the Federal Register. These regulations implemented the amendment to the Federal Credit Union Act approved during the second session of the Eighty-third Congress to clarify provisions as to the authority of the Director to specify minimum surety-bond standards. Responsibility for the supervision and examination of credit unions chartered by the District of Columbia was transferred to the Bureau during fiscal year 1955 by the provisions of Public Law 656, enacted by the Kighty-third Congress. OTHER SOURCES OF SOCIAL SECURITY INFORMATION GENERAL Social Security Bulletin—the official monthly publication of the Social Security Administration, available through the Superintendent of Documents, U. S. Government Printing Office, Washington 25, D.C. An annual statistical supplement, with calendar-year data, is included in each September issue. Selected Social Security Research Reports—a list of reports of the Division of Research and Statistics, Office of the Commissioner, in- cluding selected Research and Statistics Notes, available through the Director of the Division. Old-Age, Survivors, and Invalidity Programs Throughout the World, 1954, Division of Research and Statistics, Report No. 19. Social Workers Abroad Assess Their T'raining in the United States, April 1955, International Service Office, Office of the Commissioner. OLD-AGE AND SURVIVORS INSURANCE The Minimum Benefit Under Old-Age and Survivors Insurance— A Report on a Study Called for by Public Law 761, 83rd Congress, 1955, available through the Bureau of Old-Age and Survivors Insurance. Federal Old-Age and Survivors Insurance Trust Fund: Fifteenth Annual Report. U.S. Board of Trustees of the Federal Old-Age and Survivors Insurance Trust Fund. (S. Doc. 39, 84th Cong., 1st sess.) Washington: U.S. Government Printing Office, 1955. Actuarial Studies, Division of the Actuary, Office of the Commis- sioner: Long-Range Cost Estimates for Old-Age and Survivors In- surance, 1954 (No. 39) ; The Financial Principle of Self-Support in the Old-Age and Survivors Insurance System (No. 40) ; Analysis of Bene- fits, OAST Program, 1954 Amendments (No. 41) ; Present Values of OAST Benefits in Current Payment Status, 1940-54 (No. 42); Esti- Social Security Administration 71 mated Amount of Life Insurance in Force as Survivor B enefits Under OASI—1955 (No. 48). PUBLIC ASSISTANCE Administrative Costs of Public Assistance, Variations Among States, 1954. Public Assistance Report No. 25. State Methods for Establishing Workload and Staffing Standards. How They Do It Series, June 1955. Kit on the Development of Manuals and Written Instructions for Use in State Public Assistance Agencies, Part I, July 1955. Recipients of Old-Age Assistance in Harly 1953, Part I, State Data. Public Assistance Report No. 26, June 1955. Aid to Dependent Children: Continuing Effect of the Requirement That Law-Enforcement Officials Be Notified of the Furnishing of Aid in Cases Involving Desertion or SONU July 1952-December 1953. June 1955. Staff Participation in the E'valuation of a Policy on Case Recording. Current Practices in Staff Training, No. IX, June 1955. CHILD HEALTH AND CHILD WELFARE For current reports, see the Children’s Bureau section of this Annual Report. Table 1.—Social Security Administration: Funds available and obligations in- curred, fiscal years 1955 and 1954? {In thousands; data as of June 30, 1955] Funds available 2 Obligations incurred Item 1955 1954 1955 1954 0 Ag a $1, 552, 994 | $1, 496, 414 | $1, 538, 748 | $1, 483, 196 PERADESIORSTRLCS 2 ee ooo 2-5 spc dos oct nek ccoeoecoccest 1, 447,000 | 1,428,000 |° 1, 453, 199: 1, 415, 420 EAUDNCASSIGUANCOl = aco aco Se anole ooke bocce ee osckece 1, 487,000 | 1,398,000 a 423, 943 1, 386, 931 ee ine ee HIbOMHOMDIINGsa= eh s oe a 6, 467 , O61 Aid to dependent children..._--......-.....-.. 1, 437,000 | 1,398,000 |) 395° 933 347, 236 Aid to the nermanently and totally disabled - -- 81, 452 72, 423 Maternal and child health and welfare services- - --- 30, 000 30,000 29, 256 28, 489 Maternal and child health services__......_.---- 11, 928 11, 928 11, 919 11, 787 Services for crippled children.._.............--- 10, 843 10, 843 10, 614 10, 601 Child welfare services__........---------------- 7, 229 7, 229 6, 723 6, 101 mMoministrative expenses %:_...\ 0. 222.222. .-2 ea 85, 994 68, 414 85, 549 67, 776 Office of the Commissioner !_.._____.___-__-___----- 309 298 304 286 Bureau of Old-Age and Survivors Insurance 5_____. 81,020 63, 746 80, 688 63, 188 Bureau of Public Assistance__...........-.-----...- 1, 501 1, 551 1, 487 1, 529 Seman eesUPORN) ©. ei nk ce eee 1, 629 1, 525 1, 617 1, 521 Bureau of Federal Credit Unions..____-.-..___-__-- 1, 535 1, 294 1, 453 1, 252 1 Funds available and obligations reported by administrative agencies. 2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. 3 Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and reimbursement items for services rendered to other Government agencies. 4 Appropriations by Congress from general revenues accounted for approximately 57 percent of the admin- istrative expenses of the Office of the Commissioner in 1954 and 1955; balance from old-age and survivors insurance trust fund. 5 For administration of the old-age and survivors insurance program, which involved benefit payments of $3,275,000,000 in 1954 and $4,333,000,000 in 1955, 6 Includes’ expenses for investigating and reporting on matters pertaining to the welfare of children guthor- ized by the act_of 1912, as well as expenses for administration of grants to States. q2 Department of Health, Education, and Welfare, 1955 Table 2.—Financing social insurance under the Social Security Act: Contribu- tions collected and trust fund operations, fiscal years 1953-55 [In millions] Item 1955 1954 1953 Contributions collected under— Federal Insurance Contributions Act 1_.2..-.2s222.---2 2. 3223_- $5, 087 $4, 589 $4, 097 Federal Unemployment-Tax sh ct 226222225 os. So a kee sel eee 279 285 Pure State unemployment insurance laws 3 4_________-_.-------------. 1, 142 1, 246 1, 368 Old-age and survivors insurance trust fund: Receipts; totals == 2. 52322 i ee ee ee eo ae ae ee 5, 534 5, 040 4, 483 ‘Transters and appropriations. esos. 22s) aos a ee ee 5, 087 4, 589 4, 097 Interest and profits on investments 5__--__------------------ 448 450 387 Expenditures, total__---------- vak Af). 3 ee a ee ee 4, 436 3, 365 2,717 Monthly benefits and lump-sum payments ®______--..------ 4, 333 3, 276 2, 627 A dministration-2). 26 ees tek Sa ee ALE A See ee 103 89 89 “ASsets; end of yearsze et. Se 2os Ss ee Sn oe oe ae 21, 141 20, 043 18, 366 State accounts in the unemployment trust fund: Receipts; totales 222 o 2. oe ee ee ee 1, 333 1, 454 1, 560 Deposits) 4 saa. 53. Uk 2s St RUSE CEE ae? St eee 1, 146 1, 246 1, 371 Interests 28 2 = ake a St oe ee ae ee ee 187 208 189 Withdrawal for benefit payments).-o- 2=f235_L._ 9S 2 23st ea 1, 760 1, 605 908 ASSCTS, CNG OMVGOle! . . abo eee once ee eee ne 7, 983 8, 409 8, 559 1 Contributions on earnings up to and including $3,600 a year in 1953 and 1954 and $4,200 a year beginning Jan. 1, 1955. Contribution rate paid by employers and employees: 144 percent each in 1953 and 2 percent each beginning Jan. 1, 1954. Contribution rate paid by self-employed: 2% percent in 1953 and 3 percent beginning Jan. 1, 1954. Includes deposits by States under voluntary agreements for coverage of State and local employees. Includes deductions to adjust for reimbursement to the General Treasury of the esti- mated amount of taxes subject to refund on wages in excess of wage base. 2 Tax paid only by employers of 8 or more. Employers offset against this tax—up to 90 percent of the amount assessed—contributions which they have paid under State unemployment insurance laws or full amount they would have paid if they had not been allowed reduced contribution rates under State exper- ience-rating provisions. Rate is 3 percent of first $3,000 a year of wages paid to each employee by subject employer; because of credit offset, effective rate is 0.3 percent of such wages. 3 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. , 4 Contributions and deposits by States usually differ slightly, primarily because of time lag in making eposits. 5 For 1954 and 1955, includes interest transferred from the railroad retirement account under the financial interchange provision of the Railroad Retirement Act, as amended in 1951. 6 Represents checks issued. Source: Compiled from Monthly Statement of the U. S. Treasury, other Treasury reports, and State agency reports. Social Security Administration 73 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 1955 and 1954 [In thousands, except for average benefit; data corrected to Nov. 25, 1955] June 30, 1955 June 30, 1954 Family classification of beneficiaries Average Average eee 00. 0 & Number| Number| monthly | Number| Number! monthly of of bene- | amount of of bene- | amount families | ficiaries per families | ficiaries per family family AR SSR EH c= U° ML TSadpen ed gn e 5 42e38u7,, 000, 0 |i. wees oe 4,690.2 | 6, 468.8 |---._-___-_ Retired) worker families. ...........-|--....--- 4,214 8.1.6, 4021-3: 2 See) ee 3 O19U4 4 54a. 6 | seer enee RVOURe MOM yee ee er) en oe oe een 3, 067.4 | 3, 067. 4 $58.20 | 2, 545.4 | 2, 545.4 $49. 40 lcm tre ee 1, 962.0 | 1, 962.0 63. 70 | 1,669.9 | 1, 669.9 53. 80 LOGIE EL ek ae gi ve 1,105.4 | 1,105.4 48. 60 875. 5 875. 5 41.10 Worker and wife aged 65 or over___-_-_------ 1, 066.6 | 2, 183.2 102. 20 904.9 | 1,809.8 86. 30 Worker and wife under age 65 !______-___---- 4 -8 105. 00 .6 1 ay 95. 60 Worker and aged dependent husband_-.-_---- 9.2 18. 4 86. 50 7.3 14.6 75. 20 Weekorana Wenld 15.5 255 etek 10.0 20. 0 98. 70 9.2 18. 4 76. 00 Worker and 2 or more children_-_-_-__---_-__- 6.1 22.2 102. 20 5.8 20. 4 79. 40 Worker, wife aged 65 or over, and 1 or more CHU neMeer seo a sce Pe oe So 1.0 3.0 123. 30 .8 2.6 98. 90 Worker, wife under age 65, and 1 child___-____- 34. 5 103. 5 119. 20 28. 5 85. 5 100. 70 Worker, wife under age 65, and 2 or more Cri DO Me ee een ce gon 19.6 93. 8 112. 90 16.9 79.7 93. 40 DilnviVOGMaliliess= oo 2. oc ete cee LSI DE lee LUlye taeneee aoe. T1705 85) 1vs0l: 2: |e INSCORUAUOWe tee to 2s. - 2 oe sb ole ka 688. 2 688. 2 46. 60 585. 1 585. 1 41.00 Aged dependent widower_--.--------------- Wy 1,2 40. 70 .9 .9 34. 40 Widowed mother only !_._.2*22._..-.....-... ies 155 48.10 2.0 2.0 45. 20 Widowed mother and 1 child__-_-__-___--___- 120.9 241.8 104. 90 118. 5 237.0 91. 50 Widowed mother and 2 children_____________ 84. 5 253. 5 132. 30 78. 5 235. 5 114. 50 Widowed mother and 3 or more children_-_.- 74. 5 349. 5 129. 20 68. 8 322. 6 111. 80 Divorced wife and 1 or more children_-_---_- ay. 4 124. 00 WY TES 50 UL GLDEG) GYS) Ayia se 2 ae Ee aa a 202. 3 202. 3 47. 90 175.5 175.5 42. 20 PIGIMILLeM etn foe eo ok ese 80. 8 161.6 81. 60 73.5 147.0 72. 20 55 (GENIN ROTEL any eal pe An an Remeil e 29. 5 88.5 100. 20 25.9 HSH 88. 30 ArOrimore COMuaTeN 4252.2 2525--~bteesen- 19.9 87.2 104. 80 19.1 83.0 92. 60 1 aged dependent parent____._----__-------- 22.3 22.3 48. 00 Zino 21.2 42. 60 2 aged dependent parents_._..-.._---------- 1.7 3.4 92. 60 1.6 3.2 81. 40 1 Benefits of children were being withheld. 3868636—56——_6 74, Department of Health, Education, and Welfare, 1955 Table 4.—Old-age and survivors insurance: Number and amount of monthly benefits in current-payment status at end of fiscal year 1955, and amount of benefits paid in fiscal year 1955, by State [In thousands, distribution by State estimated; corrected to Nov. 15, 1955] Beneficiary’s State of residence ET A Wail: Mee eo 6 ee ee eee KMentuck y bins St S08 see enn Nees Louielanacs ie fete nse a enee aceon Wissotmni sss ee, Fe ee eee INGWAJCLSCY 25 Se cc chee see etna ene ae ING WoMOXICOL= =>) ot an ee eee eee OTeSON a aoe eee oe eae ee Pennsylvania isons se seca ee as ee es SEUIOR CO ACO Re terete eae ne eee eee eae Wermontenc 2 oot cee ee eee eee ee ViInginig.ee see ne eee cn eee 1 Less than $500. Monthly benefits in ecurrent-payment status, end of fiscal year 1955 Number Amount Benefit payments, fiscal year 1955 Monthly | Lump-sum i | a | | | 52. 2 82. 4 benefits payments $4, 333, 148 | $4, 232, 609 $100, 539 50, 705 49, 487 1, 218 2,085 2,022 63 18, 346 17, 929 417 30, 235 29, 551 684 362, 502 354, 303 8, 199 34, 1838 33, 424 759 83, 422 81, 488 1, 934 10, 290 10,007 283 16, 229 15, 749 480 110, 775 108, 778 1, 997 51, 906 50, 350 1, 556 8, 886 8, 760 126 12, 994 12, 765 229 278, 588 271, 483 7, 105 124, 193 121, 454 2, 739 61,022 59, 745 1,277 44,199 43, 177 1,022 59, 223 57, 812 1, 411 42,118 40, 931 1, 187 34, 727 34,019 708 60, 077 58, 365 1, 712 199, 730 195, 607 4, 123 203, 390 198, 608 4, 782 76, 173 74, 588 1, 635 23, 450 22, 880 570 107, 437 104, 819 2, 618 14, 636 14, 327 309 27, 456 26, 906 550 4, 442 4, 298 144 22, 359 21, 921 438 184, 118 179, 742 4, 376 9, 089 8, 854 235 521, 563 508, 868 12, 695 58, 440 56, 944 1, 496 7, 165 6, 992 173 272, 105 265, 744 6, 361 41, 586 40, 604 982 55, 938 54, 882 1,056 376, 669 368, 058 8, 611 7, 478 7, 346 132 33, 459 32, 718 741 29, 107 28, 249 858 10, 244 10, 009 235 52, 770 51, 517 1, 253 126,731 |, 123, 310 3, 421 15, 416 15, 080 336 12,024 11, 827 197 106 106 (1) 63, 411 61, 685 1, 726 84, 540 82, 925 1, 615 55, 747 54, 719 1,028 107, 311 104, 965 2, 346 5, 728 5, 600 128 26, 625 26, 362 263 Social Security Administration rie Table 5.—Old-age and survivors insurance: Selected data on benefits, employ- ers, workers, and taxable earnings for specified periods, 1953-55 [In thousands except for average monthly benefit and average taxable earnings; corrected to Nov. 14, 1955] Item 1955 | 1954 1953 Fiscal year Benefits in current-payment status (end of period): IS RMN SGT. es Go he 7, 563. 5 6, 468. 8 5, 573. 6 ee en een nee ee nro igs oa treme 4, 214.8 3, 519. 4 2, 977. 5 Wiles OleMSDaAn GS.) a. eo eee ee ee 1,131.3 959. 1 826. 6 5 as up lth glia il pe ea cea 1, 220.9 1, 111.9 1, 003.3 Wado waStOERWAGOWer S--- ole oc ee 689. 8 586. 3 499, 0 2 0 SS a Ge ale el a a 281. 2 267. 7 244. 8 ELC Ott G nee ee cerns ee endouec cowed weoew eu 25. 6 24, 4 22,5 Motalemonghiby amount. 2: 22 os Oe le Eee $384, 025 $278, 702 $232, 999 CONG NETS) = a pe a i gs ya ie Nine ee 257, 230 182, 334 150, 124 PaleOwt OF MISDaNG Sos. S222. ook bce ce nee 37, O11 26, 302 22, 050 io ee ne Nee aia 43, 730 34, 770 30, 541 RRM CIOW ON Se on com necateeasneanend 32, 150 24, 016 20, 332 oli | hE hain 12, 677 10, 249 9, 015 re ee ee 1, 226 1, 030 936 Average monthly amount (ONS REG as Se es LA eR $61. 03 $51. 81 $50. 42 VAVTBLSPS) (0) 0 21 DOS). O1 1 610 EA pep i i ee 32. 72 27. 42 26. 68 ridge Sarees eee | kee RS NE 35. 82 $l, 27 30. 44 VIG WesOL VIC OWELSe- oo ee oe twa a nee ees 46. 61 40. 96 40. 75 Mother’s___-- IRE AI oe an a a me SR od 45. 08 38. 28 36. 82 TEYDENSYIG’ She, se Sa lg See SI 47. 86 42. 26 41. 68 Benefit payments during period: ENP @vaU HT a1 B57" | BYSS CYS) 3 2 JA a a ee aa ee $4, 232, 609 $3, 185, 282 $2, 551, 224 O) dab creer ce Le ee bee 2, 802, 967 2, 068, 404 1, 624, 605 SHE SOFO) See aS ATTRA 5 A a ae ae a 428, 847 318, 614 252, 994 SUELO Eo a a ee 1, 000, 795 798, 254 673, 625 EOL || en eae re 100, 539 90, 175 76, 268 Estimated number of living workers with wage credits (mid- point of period—Jan. 1):1 OUND ci ee a 95, 200 93, 600 91, 000 ener ee nr eres ere or 69, 800 70, 800 67, 700 Currently but not fully insured____..-.....---.--------_-- 600 2 2 (OTINERCTS ERY. 52, 5 sp epee ete he pana el ay eeilaetei arable ioe 24, 800 22, 800 23, 300 Estimated number of employers reporting taxable wages, 1st QUATLOEOLlISCa sy Caress ce so ceseecesscesseteewecressenceeks 3, 700 3, 650 3, 663 Calendar year Estimated number of workers with taxable earnings---_--.._- (4) 60, 000 61, 000 Estimated amount of taxable earnings. --.--_--..-.-..--.----- (4) $134, 000, 000 | $136, 000, 000 Awveracotaxapile earings... 2. ss ne a oe en -- (4) $2, 230 $2, 230 1 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from: (1) provisions that coordinate the old-age and survivors insurance and railroad retirement programs and (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported on more than 1 account number. 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S| ee ee | ee 160 Defense support, Europe,. Executive! 0 2) 2.) 2] 22) eee ere 14 Administrative expenses, Mutual Security Agency Act, Executive (transferred to BEETS VW), me M5 oe SO 9 os I) oh i le a 107 Technical cooperation, general, Executive (transfersttovEL War Gi0 year). tes sate 2S. | Jc ey Be ee a) 602 Technical cooperation, general, Executive (iransters to FLEA) (atmnmal)a so |, ee Se ee ee 2, 471 Defense Support, Near East, Africa, and South Asia, Executive (transfers to aU 91 ne 7 aaa Se ae 3 SU a Ro a ee NE A POS ge ei No 8 Civil defense activities, Office of the DOCTOUAIV ES 2 oes eee etait 2 ee ne fe Sarna ci ie crete. eaeeeaeesere [he SLdaeer nent yen 614 1 Available for obligation in subsequent years. 2 $61, 204 available for obligation in subsequent years. 3 Funds transferred after June 30, 1955. 139 Public Health Service *S90UTB.1} 9G7 01 J40ddns sopnypouy ; ————— T&F 909 ‘8F] 628 ‘SC | $18 ‘EFT ‘T | LL EI ‘8ST ‘T| Zhe 096 ‘889 ‘F | 962 €F6 ‘GZT ‘e | 16z ZEP ‘Z9T =| OLE OLF ‘G6E ‘Z | 999 OSORTOG el Tose [5-8 ON OG Rcttet ae ie ee mer ea a Ae oo Ske ge ee ee na ee £86 OSE | 286 = pea Zio “S86 'E | OLF. | (sjuBy Yorees -OY JO UOISIATC) [e190ue4) RCROL) Si) OlceemiGg -— waeaiee | ete |” hie 668 ‘SEL ‘E1| SEZ SF8 ‘299 CO ho a eee > a 128 ‘98T SP 18, 08g 6 | ecole Wot ae WieoH [eq USL COO-TSE LE: O0GiaiS = era Cneno6e |) O0bani ys <- fanli> 788 ‘T9E ‘% | 60T 898 ‘OT FZ SIF ‘298 9% O66-OPL EI Gie i oko a ee qIveH Dyeceencar toe. te Be Aa a ae | ase | eta ail 2 a eeaniogs rere teen mgs Pel ‘CIT GE EOIN 60I or) eee ice or ee AZOLOIQOIOI AL 662 ‘61S AS SN EES See et ose oN gICEE Le” Ge aeons Rae el (ae 47 AS 080 ‘sz$ | ¢9 022 ‘OL SI 666 ‘OZF ORE ING ee ae [equed SOF ‘6G8 ‘ZI| 8S ‘T | FL8 ‘EFT ‘T$] LL VSO Sop a Oeh. Stee wee eee TOG OG ee POCk es ie ete ee GZL ‘098 Z&S PCO GGi eS OCL aces ee “""""J9DUBO ROGHGO GainLee? lc a 180 ‘e0t | Te 292 ‘068 CC eel wa cee eo a iach cain erie cs 128 ‘6FT 162 685-908, Ga) OOF ly oa ee ssoupuly[q pues SosvesIp [BOISO[OINAN LUE CCE iS eC ee ee CO Rae 216 ‘681$ | 9F 628 ‘69$ 8 Sass al ge eo = ee ae eee 6IL ‘6FI$ | 68 LE6 636° SS| 2h tS ie ee SOSBESIpP Ooqeyour pus sq — | | J0q Jaq Jaq Jaq req Joq Jaq Jaq qunowy |-UINN | JUNOUTY |-WNN |} JUNoWY |-uMN| JUNOoUTY |-uNN| JUnNOoMY |-uNN | JUNOUTY |-mNN |} JUNOUTY |-wWNnN} JUNouTY | -wNN — 3 OUT} -VIe I OUT} -[[ OY wWeIZ01g quel [210,L UO0l}VSI{SOAUL Sdtyssourely, SJUBIS SUIUICIT, | SJUBIS SUIQOBAT, | SJUBIS YOIBISOY Pley to0ueD SAIYSMOT[9} YOIeesey CC6[ ADaXk JvasUf ‘spinpmy puDd szUuDAs YIMMASAY—Z IG, Department of Health, Education, and Welfare, 1955 140 8 198 ‘Ss 08 acy ‘% 19 98 ‘T 91 GSI S 0&8 1 £96 % T TS le oo cae ie ats atte aah c j Tr1 rat Gcl 99% Ir ayn te eek TL ee eee ad ee Fy ee es wel ee oh Se 6 6 9 | QT eee sc ee rat atadee | es ee 428 1 a oe ¥Z8 L8 7G 6F1 09% 61 Tel “¢ CPL BOS ‘C 108 €60 ‘9 See fey eee g g eer iran Sei ee ee GL 6 18 g OL 8 18 86 FOP 1Z Ae Lg ose Bee oh Seem eS ee ee ee Dire eee pe er pe oe ee Il II P cI ws fe ear a Pe ae eee a ee eee 62 6L be 18 ee ape ere as I T Ge SEY ETFS SE AES 8 ¥ oL 601 o6 SCT Z9E 6IT 919 “¢ SLI ‘T £16 ‘9 6FI ‘T Zol ‘8 eS eee mee | cos cog eee od ce Mee eters tal a ee seinen F271 ot 91 Ree le ee er ee ete re ee oe I LF Sf g g¢ Sei I T € SF ger a Saga €9 89 z WA T T if ee ai ae ee hee cf ek OZ OZ ZI ZEl Peete a | ce] . Sen SE TAREE a OT 68 GOL 9 oat eee wee e SRte 3 aoe ct ee ft ee 611 611 ee Ge tea I Sencar estes Seeley Tae Saas alee 71 CT 9 12 T g ré Stee ien ie Ca oS SCP GLP LF Go OFT O6F Ze P6S « $6 OST GBS ‘2 S9T ‘9 829 “ST LOS ‘G1 Zz “OT Bole $aqe1g ueqiod O1Yes posordwe 9ull} poyUug $93819 -0.140T 104 1210,], S190 qo ou} J0uIO -ued m100 Ayrenjoe -y.1ed 9pIsIngO -SUIYSB MA pouors -[ny ynoqit Mw uel MA. 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SDA G9 I 99 (TTT sprepueys Sopsopord JO WOIstAT a ge Ot eee a Ole ee te eee eee ga 669 669 16 06) el i ae oe ae ee ee JoyU9O [BOTUTTO ene ht eee ay eee Gr |S eS eee fee coe 601 60T 5 ell 22 squedgy Yorwosey JO WOISTATT I I I ASE RCE SS Sat 6rL 806 LS 8h 00S 2S PERS eee 94NFIISUT [BOTSOTOTGoIOT AY [BUOTISN i ees ba eta or DN winner fre pee T G01 FOr 1% GOL. — oi dnd SO gee pe) a ee ssoupulld pues sesevostq [BOISO[OINONT JO 94nITIsUy [BVUOTIeN, 7 g 6 Shire co, ead et 9% 261 81z £9 nae ie a : Wea sO eS es 2138, 500 202, 900 Grand. total cst. 4 OE ee a ee ee 38, 118, 500 36, 114, 900 1 Office of Education estimates. 2In addition to those provided for in day schools. a Office of Education 147 Approximately 60,000 public elementary and secondary classrooms and related facilities were constructed in the United States during the 1954-55 school year. It is estimated that the capital outlay investment for these facilities was in excess of $2 billion. In spite of this all-time high in school construction, the country still faces a large school building program because of increasing enrollments, popula- tion mobility, school district reorganization, and wide demands for an extended and enriched program of education and community services. The nationwide School Facilities Survey conducted by the Office of Education revealed that States have projected their plans for meeting school plant needs to the extent of 476,000 classrooms during a period of five school years (1954-55 to 1958-59, inclusive), at an estimated aggregate capital outlay cost of more than $16 billion, exclusive of planned rehabilitation. The primary source of school construction funds has been school district bonds supported by local property taxes. There are trends, however, toward school district reorganization and State aid for capi- tal outlay which will broaden the fiscal base and improve methods of financing school construction. Planning school plants is becoming more and more a cooperative procedure. School architects, administrators, supervisors, teachers, pupils, furniture manufacturers, and lay citizens cooperate in plan- ning school facilities. School buildings and equipment are thus be- coming more functional and better adapted to educational require- ments. Specialists in curriculum, school buildings, and furniture and equip- ment, in Federal and State governments and in colleges and universi- ties, are assisting local school officials and architects in the initial planning for the space required for different courses and learning activities, the equipment needed for effective instruction, proper light- ing for a variety of seeing tasks, and suitable heating, ventilating, sanitation, and sound control. Final decisions on these matters, how- ever, are made by local school officials, subject to State regulations. School programs today include a variety of learning situations which entail many activities and instructional materials. Such pro- grams demand classrooms designed for multiple purposes. The trend in elementary school planning is toward a self-contained classroom of 900 or more square feet with work counter, sink, toilet, storage com- partments, chalk and tack boards, display cases, and movable furniture and equipment. Such rooms are readily adapted to accommodate a variety of activities. Secondary school plants are usually designed with special classrooms for science, art, music, homemaking, business education, crafts, and various types of vocational and prevocational shops. The trend in secondary school planning, however, is toward 148 Department of Health, Education, and Welfare, 1955 some multi-use classrooms which will serve more than one specialized subject area. The shortage of teachers continued during 1954-55, and elementary and secondary schools will need a total of 229,700 new teachers when the schools open this fall. These teachers will be required (1) to replace 91,200 emergency teachers; (2) to replace 83,300 qualified teachers who will leave the profession; and (8) to provide the 55,200 teachers needed for the increase in enrollment. It is estimated that 25,000 of the emergency teachers will become qualified by the time school opens. In addition, 95,186 teachers completed certification re- quirements in 1955, but only 63,400 of these are expected to accept teaching positions. With only 88,400 new qualified teachers entering the profession, there will be a deficit of 141,300 teachers when schools open in the fall. The 141,300 shortage will have to be made up by more emergency teachers, by teachers returning to the profession who did not teach during the last year, and by more overcrowding. The figures given above do not include any teachers to reduce present overcrowding nor to enrich the curriculum. The annual estimates submitted to the National Education Asso- ciation by the State departments of education showed an average an- nual salary per member of instructional staff in 1954-55 of $3,932. The average elementary school classroom teacher’s salary was $3,615 ; among secondary school teachers the average was $4,194. Supply and demand for elementary and secondary public and nonpublic school teachers, 1955-56 Them, ik Spy hl! Supply: secondary Total teachers, 1954-56 *iuii_ Le lollo_l Ocul _ 1) eee 1, 201, 800 Less emergency teachers, 1954-55___-+_ +222 ssn s4_ cu ee 91, 200 Total qualified teachers, .1954-55_._.______________ 1, 110, 600 Less 7.5 percent turnover=—_-_ 0" 2 at oe ee 83, 300 Qualified teachers returning for 1955-56.__i._-L._-2 12.8 1, 027, 300 Emergency teachers qualifying for 1955-56___.__._____________ 25, 000 New supply of qualified teachers (79 percent of elementary and 56 percent of high school teachers trained in 1954-55)________ 63, 400 Total qualified, supply, 1955-56 Lonel ee elee Tee eee 1, 115, 700 Demand: | Total teachers, 1954-55202 o2U on Pe Dee 1, 201, 800 Teachers needed to meet increase in enrollment in 1955-56 7____ 55, 200 Total demand, 1955-06__.-_.-. 1... 1, 257, 000 Shortage: of ‘qualified: supply_o<.cxes)_2i ne _ le ee | 141, 300 1See footnote 1, on following page. Source: Office of Education Circular No. 417, Revised, and estimates for 1955-56 ; and The 1955 Teacher Supply and Demand Report of the National Education Association. / . 4 4 ‘ I : r : ; eee ee ae CHS ed jay te« hae ne Shee Sh ciect Office of Education 149 JUNIOR HIGH SCHOOL During fiscal 1955 the staff of the Office of Education gave con- siderable attention to the reorganization of secondary education and problems associated with the junior high school. Studies indicate that the reorganization of schools to include some form of Junior high school has gone forward rapidly in recent years, especially since 1946. The number of seventh- and eighth-grade pupils enrolled in the secondary schools rose almost continuously from 142,000 in 1920 to 1,993,000 in 1952. During the same period, enrollments in these grades in the 8 schools fell from 2,778,000 to 2,025,000. This drop is due chiefly to the shifting of these grades to the new junior high school forms of organization. In 1920 there were less than 5 percent of the seventh- and eighth- grade pupils in the reorganized schools; by 1952 this proportion had risen to almost half (49.6 percent) of the total. The rapid increase in total secondary school enrollments coupled with the reorganization of secondary schools has necessitated the construction of many new school facilities. These developments have caused some educators to raise questions concerning the junior high school as a unit in secondary education. Has the junior high school been set up because of expedient ad- ministrative and building considerations, or is it the best organization to provide general education for early adolescents 12-15 years of age? Does it clearly demonstrate superiority over the traditional 8-4 plan? Have its purposes changed so much since its origin in 1909 as to suggest that the junior high school needs a new redirection? These questions have stimulated a surgence of professional interest in the junior high school. Because of the wide and growing interest in the junior high school, the critical demands for more buildings for youth of this age group, and the unavailability of recent data the office staff sponsored a National Conference on Junior High Schools. An analysis was also made of State department of education policies and regulations affect- ing the junior high school. As a result of these activities several national professional organizations and State departments of educa- tion are now making studies of this important segment of secondary education. 1The number of elementary and secondary school teachers in public schools, in the fall of 1954, was 1,065,803 (Office of Education Circular No. 417 Revised). ‘To this must be added the number in nonpublic schools (private and parochial), in model and practice schools of colleges and universities, in residential schools for exceptional children, and in schools operated under Federal auspices. The number of teachers in this group of schools was estimated as 136,000, on the basis of 1 teacher to every 33 pupils—the ratio prevailing in the Roman Catholic schools which enroll 88 percent of the pupils in this group. 150 Department of Health, Education, and Welfare, 1955 hr haan rma en EDUCATIONAL TV At the beginning of fiscal 1955, there were 7 non-commercial edu- cational television stations in operation. During the year, 1 of the 7 suspended operation pending reorganization, and 9 new stations went on the air, bringing the total of the educational television stations to 15. At the close of fiscal 1955, 11 additional stations were actually under construction, 16 more had already received their construction permits from the Federal Communications Commission, and appli- cations for 18 more had been filed. A look at the 15 educational TV stations in operation at the end of fiscal 1955 reveals 5 distinct types of licenses. Six of the 15 are owned and operated by State universities. Four stations are owned and operated by non-profit educational television corporations formed specifically to serve educational and cultural needs of all elements of the population of the local metropolitan areas. Three of the stations are owned and operated by State educational broadcast councils financed from State appropriations. One station, KUHT of Houston, is owned and operated by a city university, the University of Houston. One station, WGBH-TV of Boston, is owned and operated by the Lowell Foundation, an endowed foundation serving educational and cultural needs of the Boston metropolitan area. On the whole, educational television station development, already involving an expenditure of more than $10 million for equipment alone, is showing a decidedly healthy growth. Now that educational station planners no longer feel themselves under compulsion to get their stations on the air immediately, lest locally reserved educational television channels be re-assigned for commercial use, more attention is being given to planning educational program services, and to develop- ing sound bases for financing station operating and programing costs. In fact, the trend today seems to be to select and train the production staff first, starting actual production over closed circuit facilities on an experimental basis while funds for station construction and opera- tion are being raised. The growth of educational television development seems in no way to have dimmed the interest of schools and colleges in radio broad- casting. In the year just ended, some 30 new educational FM sta- tions have gone on the air, bringing the total of non-commercial educational radio stations in operation to 160. EXCEPTIONAL CHILDREN During the year, the Office of Education continued to give leader- ship to the nationwide study on the Qualification and Preparation of Teachers of Exceptional Children. A study was made of the distinc- tive competencies needed by teachers of the blind, crippled, deaf, gifted, hard-of-hearing, mentally retarded, partially seeing, special Office of Education 151 health cases, socially maladjusted, and speech-handicapped. In- cluded also was an evaluation of. the competencies needed by special education personnel in colleges and universities, and in administrative positions in State and local school systems. Four publications have now come from the study and others are nearing completion. The results of the study were presented at vari- ous National, State, and regional meetings throughout the year. It is anticipated that the findings will form the basis for improved programs for exceptional children through the development of better in-service and pre-service preparation of teachers. CIVIL DEFENSE EDUCATION A. delegation of authority by the Federal Civil Defense Adminis- tration to the Department of Health, Education, and Welfare gave the Office of Education the responsibility for planning, developing, and distributing materials which will assist schools in teaching civil defense skills, knowledge, and fundamentals of behavior during emer- gencies. Contractual agreements were made with State departments of education in Connecticut, Michigan, and California to establish pilot centers for the development of civil defense instruction materials for teachers in various subject areas and at all levels. The Office of Education aided the State pilot center staffs by reviewing and evaluat- ing technical reports developed by the Federal Civil Defense Admin- istration and other government and non-government agencies. ASSISTANCE TO SCHOOLS IN FEDERALLY AFFECTED AREAS * A major activity of the Office during the 1955 fiscal year was admin- istration of the grant programs authorized for those school districts which have experienced a severe financial burden as a result of activi- ties of the United States. The fiscal year 1955 was the fifth year these programs, authorized by Public Laws 815 and 874 of the 81st Congress, had been in operation. Public Law 815 authorizes financial assistance for construction of school facilities needed to house increased school enrollments resulting from new or expanded Federal activities, mostly military installations. Public Law 874, the companion law, provides Federal assistance for current operating expenses each year to take the place of local revenues lost primarily because of the nontaxable status of federally owned land on which the school children live or on which their parents work. Passage of these two Acts in September 1950 marked the first attempt by the Congress to establish a uniform policy governing the allocation of financial assistance to school districts seriously affected by Federal 1 For a more detailed discussion of the operations of this program under Public Laws 815 and 974 (81st Cong.), as amended, see Fifth Annual Report of the Commissioner of educa- tion concerning the administration of Public Laws 874 and 815. 152 Department of Health, Education, and Welfare, 1935 a ne a a activities and to place the administration of this program in one ad- ministrative agency. The Laws also attempted to establish an objec- tive method of determining the extent of the Federal financial burden and the amount of Federal assistance to which each district was en- titled. Accordingly, each Act established specific requirements for eligibility, defined the categories of Federal impact for which payment would be made, and included a formula for determining the amount of assistance. In addition to grants to local educational agencies Pub- lic Law 815 recognized the necessity for and authorized the construc- tion of temporary schools in certain situations and the Federal con- struction of schools on Federal bases where necessary in order best to serve the children. Public Law 874 recognized the necessity for and authorized the Commissioner of Education to arrange for providing free public education for children living on Federal enclaves when no State or local educational agency was responsible for or was able to provide suitable education for such children. The original Public Law 815 provided Federal assistance for in- creases in school enrollment which resulted from Federal activities which occurred from the beginning of World War II in 1939 to June 30, 1952. This program was extended in August 1953 by the passage of Public Law 246 to provide for increases in school enrollment occur- ring from June 30, 1952, to June 30, 1954. Karly in the 1955 fiscal year, Congress again extended this program by the passage of Public Law 731 to provide for school enrollment increases occurring during the period June 30, 1954, to June 30, 1956. An appropriation of $70 mil- lion was made early in the 1955 fiscal year for allocation to projects filed by June 80, 1954, and for completion of that program. In April 1955 Congress made available an additional $70 million for the first year of the newly authorized program. ‘Thus, a major activity of the Office during the year has been the analysis of applications submitted for the new 2-year period, an allocation of funds to approved projects, and the completion or moving toward completion of projects already approved from prior years’ appropriations. By June 30, 1955, a total of $585,000,000 had been appropriated for construction of school facilities in federally affected school districts. In addition, an estimated $230,000,000 had been added to the projects from local funds. These funds were used or will be used to help build 2,700 school buildings in local districts and 134 federally constructed projects located on 83 Federal installations. It is estimated that this program will have helped provide approximately 25,000 classrooms and related school facilities which will be sufficient to house an esti- mated 750,000 children. During the fiscal year, 2,831 school districts applied for assistance under Public Law 874 for maintenance and operation of school plants. Of these, 2,700 were determined to be eligible for approximately $75 Office of Education 153 million. In addition there were 31 federally operated on-base proj- ects under the provision of section 6 of the Act. The eligible school districts had an average daily attendance of 910,000 federally con- nected children on which payments were authorized and an estimated total attendance of over 5,500,000 pupils. While Federal activities, particularly those connected with defense contracts, have stabilized throughout the country there continues to be a number of new Federal impact areas resulting primarily from new or expanded Air Force installations, reclamation project activities, and atomic energy projects. Continued construction of housing for mili- tary personnel on or near military installations also increases school enrollment in the Federal impact areas. Thus there was an increase of 177 eligible school districts in the 1955 fiscal year over 1954 and an increase of about 3 percent in the cost per pupil resulting in an increase of approximately $10 million in the cost of the program. Another major activity occupying the Division during the year was securing compliance with the January 1954 order of the Secretary of Defense that no school located on military installations could be oper- ated on a segregated basis after the fall of 1955. There were 24 schools located on Federal property operated by local educational agencies on a segregated basis during the 1954-55 school year. Com- pliance with the order of the Secretary of Defense required ascertain- ing whether local educational agencies operating on-base schools could in the 1955-56 school year operate those schools on an integrated basis or whether Federal operation under section 6 of the Act would be necessary and, if so, preparing the necessary budgets and arrang- ing for such operation. Of the 24 schools located on Federal property 20 were federally owned schools located on military installations and operated by local educational agencies on a segregated basis during the 1955 fiscal year. Four of these have been discontinued, 8 will be operated on an inte- grated basis by local educational agencies in the 1956 fiscal year, and 8 will be operated by the Federal Government on an integrated basis. The remaining 4 projects are locally owned schools located on prop- erty leased by the local educational agencies from the Department of Defense. ‘These schools will be operated on the same basis as are other schools in these districts. VOCATIONAL EDUCATION The Office of Education administered approximately $31,000,000 of Federal vocational education funds appropriated for allotment to the States and Territories for the fiscal year ending June 30, 1955. This was an increase of $5,000,000 over the previous year. The addi- tional funds were used primarily to extend the program to communi- ties not previously having vocational programs. 368636—56——11 154 Department of Health, Education, and Welfare, 1955 en UST Peco french or (Pie chat oe The Assistant Commissioner for Vocational Education was made an ex-ofticio member of the Federal Committee on Apprenticeship. The Office participated in several Federal-State apprenticeship agency joint conferences called by the U. S. Department of Labor. Closer working relationships were established in the apprenticeship program in the matter of understandings of the respective responsibilities of this Office and these agencies in the gathering of statistics and the development of programs of related instruction for apprentices con- ducted by public schools. A conference of State directors of vocational education was held to consider policy matters in the administration of the total program of vocational education. Areas studied included vocational guidance, distributive education, home economics, trade and industries, and agri- culture. The recommendations of the conference will be used as a basis of future considerations of policy. The Office also held a planning conference on research in agricul- tural education in which recommendations made by the National Com- mittee on Research in Agricultural Education were considered. As a result, a comprehensive study is to be made of the Young Farmer Program and a publication on the subject issued for use by vocational leaders in agricultural education. Staff members met with representatives of producers of both natural and synthetic fibers to plan a training program in textile fibers for salespeople employed in stores, including high school students enrolled in cooperative distributive education programs. The shortage of teachers of home economics persists although 7,693 persons were enrolled in college courses in 1954 preparing for the teaching of home economics. The shortage is due to the facts that home economics teachers marry after a few years of teaching and leave the profession, and that programs of home economics are being estab- lished in many more schools each year. The shortage of coordinators of local cooperative programs in dis- tributive education and persons qualified for State level positions in the program has become acute. The shortage in this field is due in part to the fact that increased Federal funds were available for 1955 following several years of decreases in Federal funds which resulted in the curtailment of teachers and coordinator training programs in some of the States. The shortage of vocational agriculture teachers has become more acute than at any time since World War II despite the fact that 3,479 persons were being trained by the colleges as such teachers. The shortage in this field is due largely to the fact that most of the voca- tional agriculture teachers are trained in the land-grant colleges where they take military training and become reserve officers. After serving several years, many go into other than teaching occupations. Office of Education 7 155 Increased demand for agricultural college graduates by commercial concerns and State and Federal agricultural programs also contributes to the shortage. LAND-GRANT COLLEGE AND UNIVERSITY FUNDS Each year the Office of Education initiates certification as to each State and Territory (1) whether it is entitled to receive its share of the annual appropriations for the land-grant colleges and universities and (2) the amounts it is entitled to receive. The certification for the year ending June 30, 1955, for the Bankhead-Jones funds (annual appropriations) amounted to $2,501,500 and that for the Morrill- Nelson funds (permanent appropriation) amounted to $2,550,000, a grand total of $5,051,500. COLLEGE HOUSING PROGRAM The Office of Education provided advisory service to colleges and universities and the Housing and Home Finance Agency on new appli- cations in the amount of $70,000,000 during fiscal 1955. These loan requests are anticipated to provide residential facilities for 20,928 single students, 1,020 married students, and 323 faculty members. The prevailing interest rate of 3.25 percent deterred many appli- cants from completing loan requests and financing needed residential facilities. Privately operated institutions used the program to a greater extent than publicly operated institutions because the 3.25 interest rate is still favorable to the private college or university. Publicly supported institutions tended either to delay construction or, in some favorable instances, to secure loans at interest rates slightly under the College Housing Program rate. Associations in higher education continued to request lower interest rates, preferably under 3 percent, and a release of all remaining funds for immediate use. Private investors continued to participate in the program. During Fiscal 1955, individuals and syndicates are reported to have purchased approximately $8,000,000 in college housing revenue bonds when opened to competitive bids under the College Housing Program. A few 40-year issues were sold to private investors, but the usual pattern was that only the earlier issues were purchased by private investors. ADULT EDUCATION During the year the Office of Education gave recognition to the rapidly growing movement of adult education by creating an Adult Education Section. Its purposes are to: (a) provide consultative services to State and local school officials, teacher-education institu- tions, professional and lay organizations, and Federal agencies on needs in and problems of adult education; (6) conduct and publish 156 Department of Health, Education, and Welfare, 1955 studies in the field of general adult education, including the education of the aging and aged; (c) participate in conferences and workshops on the various phases of adult education; and (d) establish and main- tain cooperative relationships with professional and lay organizations and voluntary agencies interested in the field. INTERGROUP EDUCATION The Office of Education cooperated actively with the National Education Association and the American Teachers Association in developing a packet of materials and a leader’s guide on intergroup education for leaders of adult community groups. The purpose of the packet and leader’s guide is to provide an overall orientation to the several aspects of the problems involved in achieving improved human relations. While the packet is concerned with the general subject of intergroup relations, it will be found useful to persons interested in the implementation of the Supreme Court’s opinion on school segregation. INTERNATIONAL EDUCATION Education has an increasingly important role in international af- fairs. First, it is one of the best ways to help people to become acquainted with each other. Various cultural programs designed to promote understanding seem to grow in scope and effectiveness with each passing year. Secondly, education is a necessity for people who are learning new technical skills needed to improve their standard of living. Technical assistance to people less advanced mechanically than sri ama is an increasingly important component of our foreign policy, and is in fact a program of education. Substantial funds of the United States and other governments are supporting international educational programs, both on the country- to-country and on the United Nations basis. Private organizations also are investing large sums in educational enterprises designed to increase international understanding, and to improve economic con- ditions. The Office of Education has a growing part in supporting many of these programs, although it has direct operating responsibility for only a small part of the Federal investment in international education. The Office serves as adviser and agent for a number of Federal inter- national activities, and also is frequently asked to provide advisory services to numerous private organizations and individuals. One evidence of the growing importance of education in relations between nations is in the agendas of international conferences. The Office has an increasingly important responsibility in advising the Department of State concerning important educational issues, and oO. a es a oe 7 Office of Education 157 in preparing position papers for the guidance of American delegates to a variety of international conferences. The new role of the United States in international affairs is reflected in schools and universities by the need for new courses, the revision of existing courses, and in a variety of research programs. Lay groups and organizations are carrying on related activities. The Office is asked advice concerning curriculum development for children in elementary schools of the United States to help them become acquainted with the peoples and cultures of other countries. Secondary schools are experimenting with programs designed to stim- ulate in young people an interest in, and a better understanding of, current affairs. ‘Teaching about the United Nations and its specialized agencies is another approach to international understanding. School systems, State departments of education, private publishing com- panies, and Government agencies are publishing bulletins, yearbooks, and articles to assist schools in developing programs of international understanding. ‘The Office serves a useful function in helping edu- cators to avoid propaganda, and to develop a sound approach to international education which is in harmony with our national interest. Both Government and business are turning to the universities for specialists in international affairs. Institutions of higher education are providing more area programs, more facilities for overseas re- search, and improved collections of source materials and training for scholars specializing in international relations. Exchange of persons programs sponsored by the United States Government and by private organizations are bringing thousands of students and educators from other countries to the United States, and have greatly stimulated an interest in international education. Col- leges and universities, State departments of education, thousands of schools, private educational organizations, as well as community groups and private citizens, have cooperated in providing for these visitors educational experiences and an insight into American life and culture. The opportunity to assist in this program has given countless citizens of our country an opportunity to obtain firsthand information about, and to develop a deeper understanding of, the people and lands from which these visitors came. In cooperation with the Department of State during the year 1954-55 the Office of Education arranged exchange and one-way teaching assignments for 486 teachers and school administrators from the United States and cooperating countries. In addition, 305 visiting educators came on 6-month training grants under the Teacher Educa- tion Programs. During the 1954-55 school year the Office of Education continued to work with the Foreign Operations Administration in the development 158 Department of Health, Education, and Welfare, 1955 of technical assistance programs of education in 34 countries. One hundred thirty-four educators were recruited by the Office for appoint- ment by the Foreign Operations Administration to serve in educa- tional missions in these countries. Professional and technical con- sultation was provided by the Office, and the Foreign Operations Ad- ministration was advised on the development of university contracts for carrying out assignments in education overseas. Under this same program, 700 educators from more than 30 countries were brought to the United States for training in a wide variety of fields to promote their countries’ economic, social, and educational development. Assistance was continued to university and college registrars, State Boards of Licensure, and the U. S. Civil Service and other Federal agencies in the interpretation of credentials for study in other coun- tries, totaling 2,900 requests. The Veterans Administration also con- tinued to call upon the Office for recommendations regarding the level of instruction in certain courses offered by foreign schools for United States war veterans. The Clearing House in the Office of Education, established at the request of the Department of State to maintain a file of information concerning persons entering and leaving the United States under the various Federal Government-sponsored exchange programs, including that of the Foreign Operations Administration, increased its list from 15,000 to 21,000 individuals this year. To date, some 80 different statis- tical studies have been prepared by the Clearing House for the Depart- ment of State. The Office of Education, through its Educational Materials Labora- tory, has provided an opportunity for visiting educators from other countries, as well as educators and laymen in the United States, to examine representative textbooks and materials used in schools in this country. In cooperation with specialists of the Office of Education, it has assisted FOA missions, the United States Information Agency, and Ministries of Education, in selecting texts and materials for use in other countries. The Laboratory also maintains a permanent ex- hibit of materials produced in the FOA missions and in connection with fundamental education programs around the world. There is a substantial and growing interest among American educa- tors in international education. The success of these programs, both governmental and private, results from the strong public support they are receiving both in this country and abroad. There is a growing belief that education is an effective means for achieving the foundation of international stability and peace. Office of Education 159 OTHER SOURCES OF INFORMATION U. S. Government Films for Public Educational Use. Bulletin 1955, No. 1. State Accreditation of High Schools. Bulletin 1955, No. 5. Statistics of Land-Grant Colleges and Universities, Year Ending June 30, 1954. Bulletin 1955, No. 8. Summaries of Studies in Agricultural Education, Supp. No. 8. Vocational Divi- sion Bulletin No. 256. Statistical Summary, 1951-52. Chapter 1, Biennial Survey of Education in the United States, 1950-52. Statistics of State School Systems, 1951-52. Chapter 2, Biennial Survey of Edu- cation in the United States, 1950-52. Statistics of City School Systems, 1951-52. Chapter 3, Biennial Survey of Education in the United States, 1950-52. Statistics of Higher Education, 1951-52. Chapter 4, Section II, Biennial Survey of Education in the United States, 1950-52. Federal Government and States. Part 1, Education Directory, 1954—55. Counties and Cities. Part 2, Education Directory, 1954-55. Higher Education. Part 3, Education Directory, 1954-55. Education Associations. Part 4, Education Directory, 1954-55. Resident, Extension, and Adult Education Enrollment in Institutions of Higher Education, November 1958. Circular No. 414. Harned Degrees Conferred by Higher Education Institutions, 1953-54. Circular No. 418. Fall Enrollment in Higher Educational Institutions, 1954. Circular No. 419. Engineering Enrollment and Degrees, 1954. Circular No. 421. Current Expenditures per Pupil in Public-School Systems: Large Cities, 1953- 54. Circular No. 436. Current Expenditures per Pupil in Public-School Systems: Small and Medium- Sized Cities, 1953-54. Circular No. 488. Statistics of Public Elementary and Secondary Education of Negroes in the Southern States, 1951-52. Circular No. 444. Salaries and Other Characteristics of Beginning Rural School Teachers, 1953-54. Circular No. 446. Statistics of Negro Colleges and Universities, 1951-52 and Fall of 1954. Circular No. 448. Public-School Finance Programs of the United States. Misc. No. 22. The State and Education—The Structure and Control of Public Education at the State Level. Misc. No. 23. Digest of Annual Reports of State Boards for Vocational Education to the Office of Education, Fiscal Year Ended June 30, 1954. Fourth Annual Report of the Commissioner of Education Concerning the Admin- istration of Public Laws 874 and 815, June 30, 1954. Education in the United States of America. Special Series No. 3. School Facilities Survey—Projected Plans for Meeting School Plant Needs. HicgHER EpucaTION (9 isSues—September 1954—May 1955, inclusive). ScHOooL Lire (9 issues—October 1954—-June 1955, inclusive). 160 Department of Health, Education, and Welfare, 1955 Table 1.—Grants to States: Office of Education, fiscal year 1955 * ; Colleges White Mainte- for Coopera- | survey and | nance States, Territories, and Total Gintoretion a Oe ve sunook aotey att pea Possessions nD eM pp ceene struction tion of mechanic | educ Education ante schools Totals: to. a eco eee, $238,974,453 $608,048 | $5,051, 500 |$30, 522, 885 |? $120, 932, 499 |3 $81, 859, 521 ATADSI Sc oh en oee send wse 4, 417, 953 12, 557 100, 541 819, 070 2, 590, 998 894, 787 ATi z0naesaves. 5 TUS a ae 3, 148, 719 5,000 ) 77, 477 176, 617 2, 175, 368 714, 257 APKAMSAG So oe ete ee ae 2, 509, 425 7, 698 89, 048 604, 431 1, 132, 542 675, 706 Californiat 122 VAit Shee 42, 573, 053 49, 155 175, 599 | 1, 462, 830 25, 566, 322 | 15, 319, 147 Coloradosee tees eres 4, 600, 514 5, 698 83, 218 264, 598 2, 339, 366 1, 907, 634 Connecticite es wae ee 3, 536, 341 8, 718 90, 023 296, 851 1, 493, 759 1, 646, 990 Delawarete: a. Tes riper se © 369, 509 5,000 73, 173 165, 000 102, 073 24, 263 ‘Rlorida ae ce eee gens 5, 186, AIG | Seo ece aa 97, 644 471, 508 2, 989, 822 1, 627, 442 Georgia esti ee een 7 953, 966 14, 456 104, 360 877, 478 5, 157, 584 1, 800, 088 UGG P34 0s nee pag ete as apart peti 1, 455, 968 5, 000 75, 872 183, 629 757, 710 433, 757 DMN Oise sos een eee eee 5, 048, 707 36, 304 156,905 | 1,319, 265 1, 363, 173 2, 173, 060 indisn aera: feet ea weeneee 2 OGR LOU aoe Sens see 109, 245 791, 108 1, 143, 720 954, 028 lowes. 22 ste sete 1, 196, 551 10, 505 96, 146 677, 803 116, 834 295, 263 Kansas ee ere eee ee 6, 280, 570 8, 089 89, 006 447, 258 2, 333, 609 3, 402, 608 Kontak 4o-3ce 30 een ds 2, 404, 880 11, 956 99, 375 831, 933 694, 690 766, 926 Howisianasces: ere eee 2, 091, 656 11, 6380 96, 769 597, 088 833, 863 552, 306 IGS ree oe ea a es See 1, 789, 914 5,000 79, 115 182, 301 915, 335 608, 163 Maryland te isse 10 sense eee: 9, 202, 216 10, 246 93, 372 368, 864 5, 871, 720 A. 858, 014 Massachusetts.........-.---] 1, 965, 333 19, 759 116, 789 578, 702 365, 219 884, 864 Michigan 222 atsnoe eee ee 7, 277,073 27, 630 133, 559 | 1,068, 101 4, 818, 472 1, 229, 311 Minnesota: sass eee eae 1, 788, 762 12, 311 99, 751 695, 523 856, 624 124, 553 Mississippit... cei cise: 1, 778, 164 8, 803 91, 735 756, 771 437, 213 483, 642 Missouria est ot 3, 865, 391 16, 517 109, 448 842, 619 1, 573, 472 1, 323, 335 Montana eee Ce ee ae 1, 272, 258 5, 000 75, 896 177, 374 667, 346 346, 637 Nebraska. 2224 ect ee 1, 778, 760 5, 432 83, 222 350, 854 271,088 1,068, 164 ING yadacns cue ee ce ime 1, 777, 956 5, 000 71, 597 139, 937 961, 865 599, 557 New Hampshire_-...____-_. 695, 289 5, 000 75, 319 162, 420 27, 064 425, 486 New: Jersey... #2222 3 oe 3, 508, 970 20, 731 118, 233 580, 067 I; 464, 102. i 325, 837 IN6w:Mexicoten a> eee 5, 287,021 5, 000 76, 795 180, 335 3, 673, 202 |. i 351, 689 INGW VOT Rees peed oe 7, 869, 339 61, 426 217, 934 | 1,866,018 3, 883, 417 1, 840, 544 North: Carolinal it =lgire.. 2, 538, 487 16. 908 110, 518 1, 169, 633 672, 253 569, 175 North) Dakota tess 2ivuen a 564, 726 5,000 76, 181 241, 993 28, 174 213, 378 COT es ae es HS ee rena 9, 245, 196 33, 747 149, 269 1, 335, 914 4, 598, 671 3, 127, 595 Oklahoma s4e bes ee | os 7, 789, 277 9,077 92, 278 534, 841 4, 188, 054 2, 965, 027 Oregon coe sek eo. ook ee 1, 470, 870 6, 460 85, 176 320, 287 528, §22 530, 425 Pennsylvanians. 320 nus 3, 859, 025 42, 970 174,720 | 1,752, 240 561, 659 1, 327, 436 Rhodé¢dsland’ <2 eaes 1, 923, 278 5, 000 77, 899 121, 678 1,018, 735 704, 966 South’ Carolina sess eee 2, 909, 521 8, 851 91, 118 602, 801 1, 169, 239 1,037, 512 South Dakotas. 22.2222 ee5 iy 350, 150 5,000 76, 511 238, 440 450, 242 579, 957 Tennessee). 2 isk. tn Oe 3, 217, 645 18, 424 102, 835 872, 729 1, 388, 580 840, 077 "LOXASSELL 225% Meee eee ae LSS TO RAST Wie beet es ee 146, 921 1, 512, 498 8, 146, 833 5, 373, 185 Gane oa ee ee sean 2, R16, O26 bes ates 76, 872 172, 329 1, 757, 221 809, 604 Vermonts_2 5. Bes eS 336, 579 5, 000 73, 768 162, 083 44, 570 51, 158 Vircinid g: sarge. ees ee 18,027, 649 Wess cees ee 103, 104 780, 631 9, 986, 932 7, 156, 982 Washington t23 25icset 12, 300, 913 9, 993 93, 731 436, 685 7, 516, 491 4, 244,013 WestiVinreiolas sons j=) see 652, 907 7, 811 90, 006 504, 398 ih 36 eee ee 50, 692 Wisconsin. 3355 2b esses 1, 445, 491 14, 186 104, 260 » 745, 322 130, 956 450, 767 Wiyoming. a. 35 a thee 675, 054 5, 000 72, 898 165, 000 205, 685 226, 471 Alaskan Sit aihics ac seo 3, 326, 368 5,000 V1, 283)! Levee Sees 648, 201 2, 601, 884 District of Columbia_______- 110, 139 0, O00] Sat a ae ee 105, 139- | 25.5 eee See Plawaliee~ 22.1 stb a 2805! 807) 5,000 74, 986 165, 000 1, 309, 478 1, 341, 433 IPCONCORIRICO Se eee a ten eee OiS956) | fas 2 see = 50, 000 613, 911 10, 319 —274 Mirslnulslendsie esa. cnes aoe 37,092 0, QUO! | 2ueeece eee 32, 980 OSS sae PATS 1 On a checks-issued basis. Does not necessarily agree with allotments or expenditures for a given fiscal year. 2 Does not include $6,725,000 paid to Housing and Home Finance 3 Does not include $319, 716 paid to Air Force, $2,363,051 to ‘Aetivee $13, 532 to Commerce, $5,380 to Interior, $676,161 to Navy, and $13, 326 to Veterans’ Administration. | * = By a NERA at EET BR ICE PT EUS ON Food and Drug Administration Tus REPORT records the activities of the Food and Drug Administra- tion to enforce the Federal Food, Drug, and Cosmetic Act and four less comprehensive related acts, in the fiscal year 1955. ‘The enforce- ment staff averaged 800 for the year, with an appropriation of $5,100,000, and the certification staff, supported by industry fees, was 186. The foods, drugs, devices, and cosmetics regulated by these statutes have an annual commercial value of around $60 billion for domestic shipments, and $3 billion for foreign items offered for import. Many of the products involved are used daily in every home in the country. Three important trends continued to affect the efficiency of law- enforcement operations: (1) Growth of population and the volume of goods produced by the food, drug, and cosmetic industries. (2) Growing use of advanced technological processes and new ingredients. (3) A continuing shift in consumer buying to factory-processed goods instead of those prepared in the home or local pharmacy. With reduced funds in recent years, enforcement time had to be reapportioned to continue major attention to those types of violations that would most adversely affect the public. A project sampling pro- cedure was followed to check on compliance as a whole, and then regu- latory activities were directed to careless or deliberate violations. Available facilities have been used to assist the industries to improve operations. Industry groups have cooperated in these programs. In his 1955 State of the Union message, the President called for “better consumer protection under our existing pure food and drug laws.” Congress added $384,000 to FDA’s appropriation for next 161 162 Department of Health, Education, and Welfare, 1955 year. A recruitment program in the latter part of the current fiscal year succeeded in locating candidates to fill the new positions thus made possible. These are the first new inspectors or chemists to be appointed since the drastic cut in 1958. Seeking means to better protect the health and well-being of the millions of American consumers of foods, drugs, and cosmetics, the Secretary asked Congress for funds to have the Food and Drug Ad- ministration’s activities reviewed by a representative citizens’ ad- visory group. Appropriations were made in July 1954 and a 14-mem- ber committee appointed about the middle of the fiscal year. The committee included representatives of consumers, industry, labor, educational institutions, medicine, law, and the judiciary. The first meeting with the Secretary was on February 38, 1955, and its re- port was filed on June 30, 1955. This was later published as House Document 227 (84th Congress, Ist Session). The report states that the Food and Drug Administration is not presently staffed or equipped to render the degree of cousumer protection which the committee believes Congress intended the public should have. It recommends a three to fourfold expansion of the Administration within 5 to 10 years, and the application of more effective techniques to broaden con- sumer protection. The committee’s findings will be very helpful in the future administration of the act. Food, Drug, and Cosmetic Act DISASTER AND. DEFENSE ACTIVITIES In the aftermath of a disaster, the primary obligation of food and drug officials is to supervise the salvage of damaged goods and prevent the use of those that would endanger the public. The most serious such catastrophe in the fiscal year, from the standpoint of volume of foods affected, was hurricane “Carol,” which caused a $5 million loss of commercially stored food in Rhode Island and Massachusetts. At Providence the products dumped included 110 carloads of fresh fruits and vegetables, 500,000 cases of canned food, and 550,000 pounds of flour that had been polluted by flood waters. Other large lots were salvaged and returned to food channels after their safety was checked. Flood damage in Chicago, southern Colorado, and along the Ohio River also required supervision of the disposal of damaged foods, principally by local and State officials, since large wholesale stocks— primarily a Federal responsibility—were not seriously involved. Knowledge of the hazards that may exist in the consumption of foods exposed to atomic explosion must be developed before adequate plans can be formulated for the sorting of foods exposed and the dis- posal of those that might injure the user. Food and Drug Administration 163 In May 1955, tests of the effects of atomic explosion on foodstuffs were conducted in cooperation with the Federal Civil Defense Admin- istration. Participating with the Food and Drug Administration were the Meat Inspection Service and Agricultural Research Service, U.S. Department of Agriculture; the National Canners Association ; the National Association of Frozen Food Packers; and the American Meat Institute Foundation. About 60 varieties of food staples in representative types of packaging were exposed at varying distances from the explosion. The participating groups are testing the 15 - tons of food exposed, not only for immediate effects, but also for long- range toxicity and nutrition changes. A report on similar tests of drugs previously conducted was released in January 1955. It showed that of the 42 important common drug items exposed, only 2 (insulin and vitamin B,.) were reduced in potency. Another FDA testing program for radioactivity was conducted in connection with “Operation Wigwam,” an undersea atomic test several hundred miles off the California-Mexico Coast. Nearly 50 million pounds of tuna and other deep-sea fish taken from the exposed area were monitored with Geiger-Mueller meters, and no radioactive fish were encountered. Late in the fiscal year, FDA began a training program for State and local officials, designed to help equip them to safeguard the food and drug supplies of the Nation in case of enemy attack. This pro- gram, under a delegation of authority to the Department from the Federal Civil Defense Administration, is designed to meet the extra- ordinary needs of food and drug inspection in attack areas. The classes will continue throughout the forthcoming year. ON THE FOOD FRONT Potential Health Hazards Agricultural poisons.—EKarly in 1954, a new investigation began of ° practices in the spraying of fruits and vegetables during the growing season, and of spray residues on products reaching the market. The results were reassuring in some respects, disquieting in others. On the whole, the residue levels for such pesticides as lead, arsenic, DDT, BHC, and parathion were well within the range of safety. On the other hand, the rapidly increasing number of pesticides be- ing developed and the greater toxicity of some of these compared with those now in use are matters of concern. If used in agriculture under conditions which leave any residue at all on edible products, the mar- gin of safety will be narrower than has heretofore been considered desirable. Of concern also is that improper use of these highly toxic substances is occasionally encountered. 164 Department of Health, Education, and Welfare, 1955 One incident particularly alerted food processors to the danger of misuse of toxic pesticides on crops not specified in their labeling. When FDA learned that a highly toxic dust restricted to use on cab- bage seedlings had been used close to harvest on a variety of leafy vegetables sold to frozen food processors, it began an intensive investi- gation. Analysis of 140 samples of the frozen foods showed high resi- dues of the poison in 83 samples. The packers and distributors voluntarily withheld shipments pend- ing the investigation and destroyed about 190,000 pounds of frozen broccoli and kale containing toxic levels. Subsequent discussions at trade association meetings have brought the matter to the attention of the entire canning and freezing industries. The field inspection and analytical coverage which can be given to the problem as a whole make surveillance inadequate. Also, more re- search is needed to provide suitable analytical methods. Animal feeds——There has been a rapid increase in the use of anti- biotic and hormone drugs administered to poultry and meat animals to enhance growth, tenderize the meat, or increase the efficiency of feed utilization during the finishing period. The nature of these drugs and the manner of use are such as to classify most of them as “new drugs.” Before they can be marketed, convincing evidence must be furnished that the subtances are safe for the animal and do not result in the addition of drugs to edible tissues. There is also a problem of suitable disposition of the byproducts of slaughter so that organs carrying residues of the drugs will not harm animals to which they are fed. Diethylstilbestrol for fattening beef steers and dienestrol diacetate for improving the market quality of broilers are the first estrogenic drugs for mixing in feedstuffs to be released under the new-drug pro- visions of the act. After a manufacturer received clearance for a premix of the diethylstilbestrol product, FDA was swamped with hundreds of supplementary applications from feed manufacturers wanting to employ it. Legal Actions.—The proportion of potentially dangerous foods en- countered each year is extremely low in comparison with the good, but immediate action is required to remove the former from the mar- ket. During the fiscal year, 1,214 tons of food were seized because the food contained deleterious ingredients, and three firms were pros- ecuted for permitting such contamination. One of these was an ex- terminator who was fined and placed on probation for 3 years for the careless use of “1080,” a deadly rodenticide, in places where it could contaminate stored food, despite repeated warnings that such prac- tices might cause irreparable harm. Preponderant in volume of foods seized was grain treated with mercury for seed use and later mingled with untreated grain and con- Food and Drug Administration 165 signed to mills. Since the chemical could be removed, some grain firms, in an effort to avoid having to clean large intermingled batches, offered to pay the same rates for treated batches if kept separate from the untreated lots. Three other carload lots of grain were seized be- cause they were contaminated with borates, lead, arsenic, and zinc re- maining in uncleaned railway cars that had previously been used for commercial chemical shipments. Other foods seized because of the presence of deleterious chemicals were 5 shipments of frozen shrimp containing a quaternary ammo- nium preservative and 2 lots of imitation vanilla flavor containing coumarin. Glass in a pack of olives resulted in another seizure. To Keep Food Clean Food seized because it was filthy or decomposed, totaled 3,909 tons, and accounted for 88 percent of the food seizures. Of the 94 criminal cases instituted in the food field, 84 were based on filth charges. The Food and Drug Administration and many industries concerned are continuing efforts to improve the sanitary handling of food all along the line from the farm to the market basket. In January, the Secretary announced resumption of the program of seizure of grain contaminated by insects and rodents, which was tem- porarily suspended in the spring of 1953 pending study of the problem by a 17-man committee appointed jointly by the Secretaries of this Department and of Agriculture. The committee recommended an expanded educational program, resumption of a regulatory program on rodent-contaminated grain, and an accelerated research program on prevention, detection, and evaluation of insect infestation in grain. Steps have been taken to implement these recommendations. The Secretary of Health, Education, and Welfare concluded, after study and discussion with the Secretary of Agriculture, that the re- sponsibility for enforcement of the Food, Drug, and Cosmetic Act could not adequately be discharged without an enforcement program, against rodent-contaminated and insect-infested grain. Twelve car- loads, involving more than a million pounds, were seized between Jan- uary 1 and June 30, and 15 carloads were voluntarily removed from human food channels. Levels of contamination upon which the seizure program was resumed are to be “tightened” as progress is made. The Department of Agriculture announced that wheat which does not meet the requirements of the clean grain program will not be ac- cepted under the Government’s loan program, and if found in posses- sion of the Government will be diverted from food channels. Both Departments, aided by the Fish and Wildlife Service of the Department of the Interior (which is particularly concerned with rodent control), are conducting intensified educational programs 166 Department of Health, Education, and Welfare, 1955 I calculated to teach those who handle grain at every stage from the farm to the mill to accord it sanitary care. Operations under the factory inspection procedure, established 2 years ago, have helped materially to educate plant management. For example, in the New England fish-processing area, 5 concerns that received reports of decomposition in the factory samples collected inquired about FDA’s criteria for fitness. Their quality control men came to the District laboratory for a joint examination of suspect fish—piece by piece—with an FDA expert commenting on decomposi- tion encountered. Such information will afford processors a basis on which they can refuse to accept questionable lots. Table 1.—Actions on foods during the fiscal year 1955 Criminal ee : - prosecu- njunction Projects Seizures tions ins petitions stituted PLOGALE So: boa wore eer me Seer Se re ae ee eee ere 868 94 3 Beverages and beverage materials__...._.......-.-...-....--..-_-__- 11 5 0 Bakery and macaroni products 2 ee ae nee nee eee ee 12 14 1 Cereals and grain products: Humanctuse? Sarr: 2 Bees Sa es ee ee eee 203 13 0 BATTING WATS Se he py te ee te 2 es ee es ee 9 2 0 Chocolate, confectionery, and other sugar products___---.----------.- 42 11 1 Dairy products: Butterdt:s2e2s. fou) SoBe Se Se ee one ee ae oe 12 2 0 Cheese:and.other dairy products." oe ese ae ee te eee 7 8 0 Wgesiande22 productS:22.-2 . = eo. See teen eee eee 27 2 0 Hlavors; spices) condiments 2:22 -22 2205" [he eee ee aor eee 45 0 0 Broits andrait- products: | 2 eee eases. Seen te eee Lee ae ee 95 3 0 Mead progictsS:and: poultry x: se soe ee Soe er 32 8 0 NUtS'and nut products 2/0624" 22 ER Fes ee eee eee ere 57 6 0 Oils) fats and. oleomargarin0ss232 3" a ee ect een eee 5 0 1 Seatoodss 834. te eee Se eee ee Sh eee ee ee ee 135 6 0 WVecetables and vegetable products... 32) eae eee 106 7 0 Miscellaneous foods and food adjuncts___._--..--.---.-.----_----_.--- 33 6 0 Mood forspecial dietary alses: 2. = eee ee ee eee ee 37 0 0 Violative serving of oleomargarine 225 Seo. ect steer ae. elaoke aoe eee 1 0 Improvement programs are under way in the dairy industry, with industry associations participating actively in the development of methods to eliminate unfit milk, The American Butter Institute is cooperating in an educational program designed to insure rejection of unfit cream at the cream station and at the creamery and to bring about improvement in the collecting and marketing practices which contribute to cream spoilage and contamination. Cooperative activity with State enforcement agencies is continuing. The poultry business is at a crossroads. It has mushroomed from a largely local industry to a mass-production one in a relatively short time. The ensuing problems included a higher disease rate in concen- trated broods, necessity for rapid handling in processing lines, changes in dressing practices from New York dressed to eviscerated and cut-up birds, and the rapid development of frozen, precooked items, such as pies and “dinners.” On the Atlantic Coast, hurricane damage required Food and Drug Administration 167 many small processing plants to shut down, and larger ones to consoli- date. Competition for raw stock is so active that some “undergrades” are accepted, which poses additional regulatory problems. Of the 82 shipments of poultry seized, 21 contained diseased birds. The Food and Drug Administration has worked with the Public Health Service, industry representatives, and State and local officials during the past year in the development of model ordinances on poul- try plant sanitation and inspection, for consideration by cities and States desiring to regulate local and intrastate commerce in dressed poultry. Another program to improve the quality of poultry resulted in the assembling of a panel of poultry-disease experts to discuss poultry inspection. Among the decisions reached, one of most signifi- cance to public health, was that adequate poultry inspection requires ante-mortem examination of the birds. The principal problem encountered with eggs was the accumulation of incubator rejects and their transportation in privately owned trucks to other areas where they were intermingled with sound stock. It is estimated that 11,000 dozen incubator rejects are diverted to human consumption during an average week in the Southeastern States alone. Detection of the shipments is difficult because of the racketeering methods of operations, but some progress has been made by State embargoes and destruction of frozen egg products at destination points. In the Middle West, two eggbreakers were fined $2,000 for breaking out reject eggs supposedly denatured with kerosene and mixing them with edible eggs for freezing. A large quantity of the egos was seized. Cooperating officials in four States assisted in tracing the movement of the eggs and securing evidence which was presented in Federal court. The short crop of peanuts, because of drought, resulted in the first import problem on peanuts since 1949. Early in 1955 the quota restrictions were raised for shelled peanuts, and later an unlimited quota was announced through the end of July. The first peanuts ad- mitted under these provisions came from bordering countries and were of excellent quality. Later boatloads from distant tropic areas were heavily infested with live insects, and examination of every lot was required. By the end of June, 14,480 tons had been detained, of which a substantial part was later released after the nuts had been cleaned under FDA supervision. Some improvement was noted fol- lowing these heavy detentions. Pocketbook Protection As in the previous year, most of the actions against economic cheats were primarily a byproduct of work done on sanitary and health violations. Exceptions were made, however, in a few cases where 168 Department of Health, Education, and Welfare, 1955 practices of one or two concerns were seriously hampering efforts of the industry as a whole to comply with the law. As an example, in the oyster-packing industry most of the trade has shown marked improvement within recent years in putting out an unwatered pack. One concern, however, persisted in adding up to 80 percent of water to its pack, and 15 lots were seized. In another case, foreign shippers took advantage of FDA’s relative inactivity in the economic field to ship cocoa powder adulterated with 30 percent or more of cocoa shell. The situation, which had become so bad that the shippers began to use grade designations for the adulterated cocoa, broke up promptly when entries were refused. Seafood Inspection Service Shrimp processors and oyster canners who meet Government re- quirements for sanitation and controls may apply voluntarily for Government seafood inspection service, which is supported by in- spected packers’ fees. Nine shrimp packers processed 12,520,864 pounds of whole shrimp and 117,520 pounds of headless shrimp under continuous Federal inspection. Five of these firms also produced 75,743 cases of canned oysters. PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE Foods for special dietary uses may be divided roughly into two gen- eral categories: Those to supply an increased concentration of nutri- tional factors, such as vitamins, and those to omit or limit one or more nutritional factors, such as carbohydrates for the diabetic or sodium for those who must restrict their sodium intake. The Food and Drug Administration is obligated to check such products for composition and accurate and informative labeling. At the same time, it recognizes that the vast majority of people have no need for special dietary products and can obtain all their nutritional needs by a balanced diet of the wholesome foods that are abundant in this country. Consequently, the activities of those who attempt to scare the public into buying “health foods” as the only means of ade- quate nourishment, or for the cure or prevention of disease are dis- couraged by all available means. One such promoter was convicted in January 1955, and sentence is still pending. Meanwhile, he has had many experiences with State and city agencies trying to prevent false claims and the illegal practice of medicine during a series of “health lectures.” Prosecution cases have been forwarded to the Department of Justice, against 3 house-to-house salesmen of a vitamin preparation for oral claims beyond those permitted by an injunction order stipulated to by the distributors. These cases have not yet been tried. 3 ; ! ‘ ; Food and Drug Administration 169 There has been a notable increase in the use of vitamin B, in multiple vitamin preparations during the year, stimulated, no doubt, by the occurrence of convulsions in babies who had been fed a formula found deficient in Bg. The interest in the development of commercially prepared foods limiting basic ingredients or seasonings is increasing rapidly. Physi- clans are prescribing more special diets for the management of certain diseases, and a growing percentage of the public is counting calories in weight control efforts. Just as the housewife was gaining new freedom in providing normal diets through factory-processed foods, many women found it neces- sary to do most of the processing of fede foods in the home because the ready-to-eat foods contained more sodium than is nor- mally present in home-prepared foods. To meet this demand, manu- facturers began to provide various mixes with a low-sodium content, as well as various unsalted canned foods. The low-sodium food regulations which went into effect September 29, 1954, provide that products purporting to have a low-sodium content bear label declarations of the sodium present in terms of milligrams per 100 grams of food and per average serving. During the year, seizures were made of beets and soup mix that failed to conform to these labeling requirements, and of spinach, applesauce, and soup mixes that contained more sodium than labeled. Artificial sweeteners, formerly confined to food for diabetics and others whose sugar intake required control, have recently been used extensively for foods offered for their low-calorie count. The Federal law bans the use of such nonnutritive substances in confectionery prod- ucts, but permits their use in other unstandardized foods under proper labeling if they are not deleterious and do not conceal inferiority. The only provision in the food standards for canned fruits without sugar is for a water pack, without artificial sweetening. Several packers, operating under temporary permits from the Secretary, have been shipping water-pack canned fruits with artificial sweeteners, and a petition has been filed to have such sweeteners included as optional ingredients in the food standards. At the close of the fiscal year the FDA was awaiting a report from the Food Protection Committee of the National Research Council on further investigations to determine the maximum safe intake levels of one sweetener proposed for use. Earlier recommendations of the National Research Council estab- lished a distinction between special purpose foods and those for normal consumption and its opinion that foods containing artificial sweeteners should be used only by those who must restrict their intake of ordinary sugar. 868636—56——-12 170 Department of Health, Education, and Welfare, 1955 The Food Protection Committee also submitted recommendations on “Principles and Procedures for Evaluating Chemical Additives in Foods,” which will be most useful. DRUGS AND DEVICES FDA held numerous conferences with the drug industry and medical specialists during the year to exchange information and views on the safety and appropriate labeling of drug products. To correct the present paucity and disorder of reports on the un- toward effects of drugs encountered by physicians and hospitals, FDA has undertaken a pilot study on voluntary reporting in coopera- tion with the American Association of Medical Record Librarians, the American Medical Association, and the American Society of Hospital Pharmacists. If this is successful, efforts will be made to extend it to a widespread system of permanent reporting, with the assembled information made available to all interested parties. Recalls —Twenty-nine drug and device recalls were supervised by FDA during the year. Eleven of the products involved were below labeled potency and five were nonsterile injectables. Another non- sterile product recalled was an eye solution which was the subject of injury complaints. Three others involved Rauwolfia of a species other than the serpentina species covered by new-drug applications. Other reasons for recalls were: Marketing without effective new-drug applications, variations from U. S. P. specifications, defective pack- aging, and untoward reactions when injected. Two devices were recalled—blood donor and intravenous administration sets with mechanical imperfections. Prescription drug sales.—Illegal sales of prescription drugs were charged in 141 of the 154 drug and device prosecutions instituted dur- ing the year. The 142 prosecutions tried during that period on charges of illegal sales included some that were filed in the previous year. Penalties ranged from nominal fines to $5,000, the highest fine assessed for any violation of the act during the year; 5 of the 6 jail sentences served were for illegal drug sales. Two of the latter were imposed on men who issued prescriptions for dangerous drugs but were not licensed to practice medicine. One self-styled practitioner had been operating as a physician and sur- geon for 19 years without a license, which had been refused because he could not fulfill educational requirements. He was sentenced to 10 months’ imprisonment for sales of barbiturates without prescrip- tions. Another case involved an Indian octogenarian who had been deprived of his license to practice in Oklahoma because of violations of the Narcotics Act. In 1954, he had been fined, given a 1-year sus- pended jail sentence, and placed on probation for 5 years for illegal sales of amphetamine. One of the conditions of the probation was % vA z 3 s Food and Drug Administration 17] that he cease handling drugs in any form. When he persisted in selling amphetamine despite these conditions, the court committed him to an old soldiers home for the duration of his probation. In addition to the small minority of pharmacists who disregard their professional obligations, there are peddlers who obtain drugs illegally and sell them promiscuously. For example, one woman who was placed on probation ran a massage parlor and dispensed ampheta- mine to obese patients as an adjunct to her weight-reducing treatments. Also, she was reported to have been supplying these drugs to airmen on furlough, to enable them to stay awake on long auto trips home. Reports of similar traffic in “lift pills” to truck drivers are under cur- rent investigation by FDA inspectors. Adulterated or misbranded drugs and devices—Of the remaining 13 prosecutions filed, 9 charged false and misleading curative claims. Other charges were based on faulty composition and failure to bear the labeling required by law. There is a ready market among gullible persons for new “miracle” drugs and contraptions to cure or alleviate their ailments. Promoters capitalize on this market on the heels of articles appearing in popular magazines, “health” lectures, and other means designed to launch the product and establish its purported virtues so firmly in the minds of purchasers that they will continue their patronage even after regu- _ latory agencies restrict the claims. Although it will always be a problem to eliminate active exploitation in this field, the success of these promotions varies inversely with the time available for enforce- ment activities. In September 1954, a prosecution case against the promoter of a diabetes “remedy” was lost on the ground that a 1923 patent contain- ing statements as to the efficacy of the drug for the treatment of diabetes established the validity of similar current claims. The Gov- ernment had presented the testimony of eminently qualified medical and pharmacological witnesses to the effect that the preparation,’a mixture of wild sweet pea and lithium citrate, has no effect in the treatment of diabetes. The decision is being appealed since if it is permitted to stand the public will continue to be exploited by this worthless remedy when there are effective measures available to con- trol the disease, failure to use which will bring disastrous results. A contempt action against another worthless diabetes remedy pro- moter, who had continued shipping a weed concoction despite injunc- tion orders, was dropped when the court held that he was mentally incompetent and warned that he would have him committed to a mental institution if he persists in distributing the product. A number of seizures, followed by a permanent injunction, were initiated to stop shipments of a device consisting of a cabinet fitted 172 Department of Health, Education, and Welfare, 1955 8 ee ee ee with a sunlamp and shortwave unit and colored slides assembled so that jugs of water could be irradiated. The treated water was recom- mended for apoplexy, tumors, ulcers, virus infections, and a variety of other serious diseases. State officials assisted materially in develop- ing these cases. } Another device case, in which the defendant received a 90-day jail sentence, was based on false and misleading curative claims for color lamps. The defendant was an itinerant “health” lecturer who claimed that various serious diseases and abnormal conditions are caused by specific colors. He offered other colors shining from his lamp to off- set them. For example, “yellow diseases,” such as jaundice, diabetes, and consumption, required a green treatment light, while “violet dis- eases,” such as laryngitis, goiter, and heart trouble, needed yellow. One device not only was promoted by fraudulent claims for breast development but also was potentially dangerous to users. Medical consultants for the firm agreed that it might aggravate incipient cancerous conditions if it were used without competent medical ex- aminations, but it was being promoted through mail-order solicitations and newspaper ads on a nationwide scale. Stocks of the devices were seized, and a permanent injunction was required to stop shipments. Uranium ore treatment “tunnels,” pads, blankets, and other con- tainers for slightly radioactive ore and sand continue to attract suf- ferers from arthritis. The radioactivity is of too low a degree to have any effect whatsoever on any disease condition. Six seizures were effected against interstate shipments. Other actions were under- taken by State authorities. Some of the blankets and hot water bottles containing the supposedly radioactive material were not for sale but could be leased for $25 a month. One of the “tunnels” was erected in a treatment building to which arthritics were encouraged to come and sit on ore-upholstered benches, with additional emanations sup- posedly coming from linings of the floor, walls, and ceiling. Previous reports have discussed an injunction to restrain mis- branded drug shipments from a Texas cancer clinic. Last year the operators of the clinic established a branch in Pennsylvania where a large quantity of its drug supplies were seized. Some, however, were apparently moved before the U. S. marshal arrived, so that the new clinic could continue treating patients until new supplies could be secured from intrastate sources. The seizure is now under contest. Another injunction, filed in 1954, also required continuing atten- tion. It involved an elaborate sales promotion scheme, including false foreign addresses, for an inert glandular product misbranded with sex rejuvenation claims. A permanent injunction was granted in November 1954, and a criminal prosecution case is pending. Food and Drug Administration © 173 New Drugs New-drug applications submitted during the year numbered 606. Of these, and those under study at the close of the previous fiscal year, 433 were allowed to become effective—348 drugs for human use and 90 for veterinary use. In addition, 2,277 supplemental applications went into effect, of which 1,163 were for veterinary preparations. Some of the important drugs considered during the year were prepa- rations for the treatment of arthritis, allergic conditions, tuberculosis, and skin conditions; radioactive agents; nonbarbiturate hypnotics; antitussive agents; antibiotics, such as mycostatin and anisomycin; anticholinesterase agents; nonmercurial diuretics; blood volume ex- panders; ganglionic blocking agents; anesthetics; and growth promo- tion agents in animals, such as diethylstilbestrol. COSMETICS AND COLORS — Two cosmetic preparations were recalled because of a dangerously high carbon tetrachloride content that would endanger users through inhalation and skin absorption. Both were intended as rapid driers, one for nail polish and the other for hair following shampoos. Four shipments of the latter were seized. Other products recalled from consumer channels were a shampoo that exploded on dealers’ shelves because of a highly chlorinated water used in diluting its hydrogen peroxide content, and a hair dressing containing an uncertified coal-tar color. Two shipments of coal-tar colors were seized which were destined for food use but had not been certified for that purpose. The four colors in one lot were falsely labeled “U. S. Certified Food Colors.” CERTIFICATION SERVICES Coal-tar colors.—All coal-tar colors used in foods, drugs, and cos- metics (except hair dyes) must be from batches certified as harmless by FDA. In 1955, 4,655 batches, representing 5,140,202 pounds, were certified, and 20 batches, representing 13,144 pounds, rejected. Insulin.—The act provides for predistribution testing and certifica- tion of all batches of insulin marketed. Examination of 330 samples resulted in the certification of 286 batches of insulin and 48 batches of materials for use in making insulin-containing drugs. One trial batch of NPH insulin was not approved because it contained excess protamine. Antibiotics —The predistribution testing and certification of certain antibiotics is also provided by amendments to the act. Examinations were made of 20,728 batches of penicillin, dihydrostreptomycin, tetra- cycline, bacitracin, chlortetracycline, streptomycin, and chloram- 174 Department of Health, Education, and Welfare, 1955 a ee ee phenicol during the fiscal year. Sixty-six batches were rejected for failing to meet the following standards: Potency (25), sterility (21), pyrogens (18), moisture (1), and syringeability (1). In addition, manufacturers withdrew their requests for certification of 19 batches because they failed to meet sterility and other standards. During this period, 354 amendments and 34 new monographs were added to the antibiotics regulations, reflecting continued scientific research and development in this field. CHANGES IN THE LAW AND REGULATIONS Pesticide chemicals—The Pesticide Chemicals Amendment, which became law on July 22, 1954, was intended to provide a simplified, ex- peditious procedure for establishing safe tolerances for pesticide chem- icals which are useful in agriculture. It was scheduled to become fully effective in 1 year with regard to chemicals for which tolerances had not been established, unless conditions existed which necessitated an extension. If so, extensions for specific chemicals were permitted up to an additional 12 months. Interpretive, procedural, and fee regulations under the amendment were issued in February 1955. In March, tolerances were established for 69 chemicals on which hearings had been held before the enactment of the amendment. These included a number of pesticides not re- quiring tolerances because they present no foreseeable hazard. Ex- tensions of these tolerances and exemptions to include additional crops (or raw agricultural commodities) will be made under the provisions of the 1954 amendment. Before a tolerance is set under the new amendment, the Secretary of Agriculture certifies the usefulness of the pesticide for the pur- poses proposed in a petition for tolerances and gives his opinion of the residues expected to remain on crops following its use; then FDA chemists ascertain that the proposed method of analysis is reasonable and sufficiently accurate, and its pharmacologists determine from the applicant’s data on toxicity what residue of the chemical would be without hazard if it remained in the food supply. During fiscal year 1955, 24 petitions for tolerances or exemptions were received under the new amendment; 18 were filed; 1 was with- drawn without prejudice to a future filing; and 5 were in pending status at the close of the year. One permanent and 3 temporary tol- erances had been established. One manufacturer had requested re- ferral of his petition to an advisory committee of experts selected by the National Academy of Sciences. Because the date on which the law was scheduled to become fully effective fell in the middle of the 1955 growing season, it became apparent that the effective date of the law should be extended for a number of pesticide chemicals until the end of the growing season Food and Drug Administration 175 or about October 31, 1955, if the health of the consumer would not be endangered. Criteria for judging requests for extension of the effective date were published in the Federal Register, and shortly after the end of the fiscal year, a number of extensions were granted. Food standards.—This is the first full year of operations under the new procedure for initiating proceedings looking toward the adop- tion, amendment, or repeal of food standards, prescribed by an amend- ment to the Federal Food, Drug, and Cosmetic Act on April 15, 1954. No public hearing has been requested. From the date of enactment to June 30, 1955, 10 petitions were received from interested parties proposing the adoption or amend- ment of food standards. One proposal was published on the initiative of the Secretary of Health, Education, and Welfare. Four final or- ders have issued amending standards for tomato catsup, canned vege- tables, cheese, and enriched farina. ‘The others are in various stages of consideration. (See “Products of Special Dietary Significance” for comment on proposals for the addition of artificial sweeteners to canned foods.) Experience with the new procedure indicates that it has many advantages over the old. The whole food-standards formulation program has had to be curtailed because of limitation of funds and no new work was under- taken. Formulation of standards for canned tuna is progressing and the standards may be promulgated under the new standard-making procedures. Drug regulations.—A. regulation issued in November 1954 provides an orderly basis for changing to over-the-counter sales, with appropri- ate labeling for lay use, of drugs previously limited in new-drug appli- cations to prescriptions sale, when experience in use establishes that they are safe for unrestricted distribution. This regulation became necessary because of the requirement in the Durham-Humphrey Amendment that only drugs that are not safe for unsupervised use by laymen may be labeled with the prescription legend. NEW COURT INTERPRETATIONS The U. S. Court of Appeals for the Second Circuit affirmed the conviction of a corporation and its secretary for misbranding butter while it was held for sale after receipt in interstate commerce. The butter had been repacked into cartons labeled “One Pound Net Weight,” although the prints each weighed less. The appellate court held that it was not necessary for the Government to prove that the defendants knew that the butter they repacked had been shipped interstate or that it was short weight when repacked. The U.S. Court of Appeals for the Third Circuit upheld a district judge in his refusal to permit defendants to retract a plea of guilty to charges of violating the Food, Drug, and Cosmetic Act. The court 176 Department of Health, Education, and Welfare, 1955 £08 Ee —————— pointed out that the original plea had been not guilty, that against the advice of their counsel, in an unhurried decision, defendants changed their pleas to guilty, and therefore the district court did not abuse its discretion. In affirming a conviction for illegal dispensing of prescription drugs after shipment in interstate commerce and while they were being held for sale, the U. S. Court of Appeals for the Tenth Circuit held that the method of transportation of the drugs in interstate commerce was immaterial. The evidence showed that the capsules sold by the de- fendant in Colorado were manufactured in Illinois, and the court held that the inference was inescapable that they had been transported in interstate commerce, and that how they were transported, when, and how the defendant obtained possession of them was immaterial. In the same decision, the court ruled that there had not been entrap- ment when the inspector called and asked the defendant to sell him the capsules but merely offered an opportunity for defendant to make an illegal sale. A district court in refusing to permit distribution of seized ultra- sonic devices to chiropractors ruled that chiropractors licensed under the laws of California were not authorized to use or direct the use of ultrasonic devices, and that ultrasonic therapy is part of the prac- tice of medicine, but not of chiropractic. After seizure, the claimant had reconditioned the devices mechanically to comply with the act and then moved for a court order permitting him to distribute them to chiropractors. A district court extended the doctrine that the falsity or misleading character of labeling is to be measured by its significance as read by those to whom the labeling is directed. A corporation and its man- ager were convicted of shipping in interstate commerce vitamin prod- ucts accompanied by false and misleading labeling claiming that the product was effective to remedy the feeling of growing old and con- sequent loss of vitality and strength. The judge, in reaching the decision that the claims in the labeling were “cruelly” false and mis- leading, stated that the test was not the reaction of the average person reading the label but rather the reaction of those elderly people who “need little more than a vagrant suggestion to lead them to hope in _ the restorative ministry claimed.” A district court, in interpreting Section 303 (ce), which provides exemption from penalty provisions of the Food, Drug, and Cosmetic Act, held that for conviction it was necessary to establish bad faith on the part of the defendants when they received in interstate com- merce goods covered by a guaranty. That Government inspectors had notified the defendants of the misbrandings, or that seizures of the product had been made on the defendants’ own premises, was not Food and Drug Administration 177 construed by the judge as sufficient evidence to prove that the de- fendants had acted in bad faith. . In granting the Government’s motion for summary judgment in a seizure action involving a spaghetti product which failed to comply in protein content with the prescribed definition and standard of identity for spaghetti, a district court reaffirmed the principle that the use of qualifying labeling cannot correct deviation from the stand- ard, unless it is in fact an imitation product, labeled and sold as such. On rehearing, the court affirmed its former decision in spite of claim- ant’s argument that the product had a separate identity, since it had been marketed for many years prior to adoption of the standard of identity for spaghetti. The claimant has filed a notice of appeal. SCIENTIFIC INVESTIGATIONS All of FDA/’s scientific studies are applied directly to regulatory activities and the certification services rendered. New products and processing methods require evaluation for long-range safety to consumers. Methods of quantitative analysis must be devised before the toxicological studies of a new substance may be undertaken. Earlier in this report the use of a toxic chemical on leafy vegetables for which it was not recommended was discussed. To test the samples of frozen vegetables suspected of containing this pesticide, acceptable methods to determine trace quantities had to be devised. By a bio- assay test using flies, amounts ranging from 0.12 to 0.98 ppm were found. After chemical separation, the pesticide was identified by paper chromatography. Definite analytical patterns are beginning to emerge from the studies being conducted on other pesticides. For example, nine of the more common chlorinated organics can be separated into groups because of their stability to acid or alkali. The slower bio-assay tests are still required for those where specific chemical methods are not avail- able. Paper chromatographic studies are proving useful, not only for various pesticides but also for rodenticides, artificial sweeteners, chain and ring organic phosphates, the fruit acids, volatile fatty acids, and various fungicides. Several studies were made of the results of the use of antibiotics in the treatment of diseases in food-producing animals and in feed sup- plements to promote growth. Methods were developed for the deter- mination of four antibiotics in feed supplements and mixes. One study made of chickens treated with oxytetracycline showed enough retention of the drug in the tissues so that the manufacturer changed the formula. The new product is now under study. Trace amounts of penicillin were found in 11.6 percent of 474 samples of market milk tested. 178 Department of Health, Education, and Welfare, 1955 a ee Other antibiotic studies were made of: Cycloserine, for its value in tuberculosis; combinations of antibiotics with therapeutic vitamins and with certain hormones for topical application; the standardiza- tion of penicillinase, an enzyme that destroys penicillin and is useful in sterility testing of penicillin ; the correlation between bacteriophage- type and antibiotic resistance of staphylococci; new methods for the assay of polyene antifungal antibiotics; and modification of the assay of penicillin, so that new, highly insoluble salts can be measured chemically. Considerable variation exists in the therapeutic efficacy of veratrum alkaloids on the market. Methods for the chemical separation of some of these substances were developed, but tests on animals do not correlate well with the actual alkaloid content of the drug. Potency control remains unsolved. Continuing potency control of insulin and corticotropin, on the other hand, may be maintained at a constant level through the evalua- tion of new U. S. P. Reference Standards in terms of the old standard. New or improved chemical methods have been developed for tetra- cycline, conjugated estrogens, norepinephrine, and nitroglycerine. Paper chromatography is being used increasingly as an analytical tool for drug determinations as well as in the food field, and a new technique for continuing ascending paper chromatography was developed. Work on the identification of the various species of Rauwolfia by histological methods was done during the year and is continuing as new species are being introduced into commercial drug channels. These botanicals, which provide the active ingredients for a number of important drug products used in hypertension and other related diseases, have been involving substitution of other species for ser- pentina, the only one covered by new-drug applications. Colorimetric and chromatographic procedures were developed for determining reserpine, a drug extracted from Rauwolfia serpentina. Special attention was given also to identification of prescription drug tablets to establish proof of interstate origin in illegal sales cases when shipping records are not available. A continuing pharmacological study of ipecac included in barbi- turate preparations to cause emesis before dangerous amounts are ingested showed that amounts of ipecac retained caused pathological changes that preclude its use as a “built-in antidote.” Cutaneous toxicity studies of talcum powders containing 5 to 12 percent of boric acid led to the conclusion that their absorption is in direct proportion to the abrasion of the skin, with no penetration of the intact skin. They are absorbed in toxic quantities by severely burnt skin where weeping serous surfaces are exposed. Food and Drug Administration 179 Bacteriological investigations included work on sterilization of and efficacy of bacteriostatic agents in various pharmaceuticals, on frozen strawberries, eggs, and precooked foods, on staphylococcus food poisoning, and on methods for detecting Salmonella. Microanalytical studies on foods continued toward better methods of filth extractions and identification. A method for whole-can test- ing of cream was put into field use. Chemical methods for the de- termination of water-insoluble fatty acids and butyric acid were adapted for use in detecting the use of decomposed cream in butter. A diagnostic method was developed which is effective for visually detecting moniliasis in live chickens and turkeys with a Pan-Endo- scope. Before this development, accurate diagnosis could be made only by post-mortem examination of test birds. Using this new method, controlled experiments have been developed to establish that copper sulfate is worthless at any safe concentration either as a treat- ment or preventive of moniliasis. Other tests were conducted on veterinary products recommended as anthelmintics, coccidiostats, coccidiosis treatments, internal treatments for external parasites, and turkey histomoniasis (blackhead) preventives and treatments. Enforcement of Other Acts A total of 96,798,446 pounds of tea was examined under the Tea Importation Act, in contrast with totals of approximately 124 million in the fiscal year 1954 and 102 million in 1953. Rejections for failure to measure up to the standards set by the U. S. Board of Tea Experts totaled 132,283 pounds, or 0.14 percent. Four rejections were ap- pealed to the U. S. Board of Tea Appeals, which upheld the decision of the FDA examiner in each case. Five caustic poisons were seized for failure to bear the labeling re- quired to warn users of their potential danger if misused. Included were drain, radiator, pipe, and toilet bow] cleaners. Two permits were issued for importations of milk from Canada. No violations of the Filled Milk Act were encountered. Enforcement Statistics The 11,161 establishment inspections conducted by FDA were divided into 8,900 for foods, 1,901 for drugs and devices, 282 for cosmetics and colors, and 78 for miscellaneous products and items covered by other acts. Of 19,469 samples collected, 10,697 were foods, 8,259 drugs and devices, 400 cosmetics, and 113 miscellaneous. In the 275 criminal actions terminated (or terminated for some defendants) in the Federal courts during 1955, the fines paid, or 180 Department of Health, Education, and Welfare, 1955 assessed in cases pending on appeal, totaled $160,403.80. The heaviest fine in a single case was $5,000. In 50 actions the fines were $1,000 or more. Jail sentences were imposed in 21 cases involving 24 individual defendants. The sentences ranged from 8 days to 45 months and aver- aged about 11 months. Six individuals were required to serve the imposed sentences, and for 18 individuals the jail sentences were suspended, on condition that violative practices be discontinued. Records of actions terminated in the Federal courts were published in 1,440 notices of judgment issued during the year. Table 2.—Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1955 Total Criminal prosecu- Seizures accom- tions instituted plished Injune- Item ; oo Oe Violative ; Violative . Violative | | : quested samples Actions samples Actions samples Actions Wotaleesee = ee een ee 2, 676 12307 1, 079 248 1, 597 1, 049 10 BP OOdS Pee fee ae, eer es 1, 583 965 302 94 1, 281 868 3 Drugs and devices_--__-------- 1, 076 331 777 154 299 170 7 Cosmetics and colors._._..--_-- 11 6 0 0 11 6 0 Caustic poisons_-......-..------ 6 5 0 0 6 5 0 Table 3.—Import inspections and detentions during the fiscal year 1955 Inspected Inspected Item Total and refused and re- entry leased Totals. tee eS hee eer 2 eee ee a eee ee 24, 151 6, 167 17, 984 FOOdS: 2) REE os oe ee oe ee eee peat Siler ae 21, 077 3, 626 17, 451 Drugsand'devicese zis Si 2 A AE De eae Bee See 2, 991 2, 515 476 Cosmetics, colors, and miscellaneous.._) . i222. le om ee 83 26 57 ee eee a ee Office of Vocational Rehabilitation Fiscal 1955: The Battle Against Disability Gains Momentum Fiscab YEAR 1955 was the first year of operation of the State-Federal vocational rehabilitation program under the mandate set forth by Congress in Public Law 565 dated August 3, 1954.1. It was the first year of a new era in vocational rehabilitation—of an expanded and intensified attack against disability. To a great extent, 1955 was a year of tooling up for the expanded program called for by P. L. 565. But it was also a year of genuine progress both in the rehabilitation of the handicapped and in the development of public awareness of the problems posed by disability. Nineteen hundred and fifty-five saw the reversal of a 3-year down- trend in the number of handicapped persons returned to productive work through the public vocational rehabilitation program. It saw the inauguration or expansion of numerous facilities for service to the disabled. It saw a number of basic research and demonstration proj- ects launched—projects dedicated to the study of disability problems of nationwide concern. It saw educational institutions throughout the nation collaborating wholeheartedly with the Office of Vocational Rehabilitation and with associated State agencies in a drive to remedy the drastic shortages of trained personnel in the rehabilitation field. BASIC INGREDIENTS AND OBJECTIVES OF PUBLIC LAW 565 Public Law 565 represented the greatest legislative impetus ever given the public vocational rehabilitation program since the inception 1 Unless otherwise indicated in the text, all subsequent references to 1955 will be to the fiscal year—that is, to the period between July 1, 1954, and June 30, 1955, inclusive. 1él 182 Department of Health, Education, and Welfare, 1955 of the existing State-Federal partnership. The law gave the Federal Office and the 88 State agencies which make up that partnership the most powerful weapons they have ever had to cope with the awesome problem of disability. In the post-World War IT period, the public program has returned more than half a million handicapped people to productive work, an average of about 56,000 per year. However, it is estimated that some 250,000 Americans come to need vocational rehabilitation annually. The gap between those who are receiving vocational rehabilitation services and those who need them is a large one. Public Law 565 was designed to close that gap. It was enacted with the understanding that the task would require time, great effort, and maximum cooperation between public and private organizations con- cerned with the welfare of the handicapped. It was enacted in aware- ness of the terrible toll disability has been exacting from America both in terms of human dignity and of concrete material loss. The law’s avowed aim is to assist “the States in rehabilitating physically handicapped individuals so that they may prepare for and engage in remunerative employment to the extent of their capabilities, thereby increasing not only their social and economic well-being but also the productive capacity of the Nation...” | Public Law 565 authorized $30 million for Federal grants-in-aid for 1955, $45 million for 1956, $55 million for 1957, $65 million for 1958, and such sums as the Congress may decide upon for each succeeding year. The amounts actually appropriated are determined annually by the Congress. For example, $27.9 million was appropriated for grants to the States and other agencies in 1955 and $35,825,000 for these purposes in 1956. Public Law 565 authorizes the use of Federal funds for the training of doctors, nurses, rehabilitation counselors, physical therapists, occu- pational] therapists, social workers, and other specialists to meet the personnel needs of the expanded rehabilitation program. It encour- ages co-operation between public and private agencies at all levels— Nation, State, and community—with a view to co-ordinating the all- out drive against disability. The 1954 legislation set up a new three-way grant system composed of basic support, extension and improvement, and special project grants. The basic support grants, which account for the great bulk of the grant money, are designed to help the States meet the costs of administering their basic vocational rehabilitation programs. Federal funds for basic support are allocated in keeping with a legislative formula which takes into consideration State population, per capita income and other factors. Each State is called upon to provide a specified sum—a sum deter- mined in keeping with the aforementioned legislative formula—to Office of Vocational Rehabilitation 183 match the Federal basic support funds allotted to it. If a State does not provide the full sum specified, Federal law requires that its basic support grant be reduced accordingly. Extension and improvement grants are made to the States for extending and improving services to the disabled. Here, again, the Federal grant must be matched in a specified ratio by the recipient. Federal extension and improvement funds have gone into such proj- ects as the extension of services to the mentally ill, the setting up of programs for working with the rural blind, and the improvement of supervisory, consultative and casework methods in use by State agencies. The third type of grant—that for special projects—is dedicated to two objectives: (1) to pay part of the cost of research, demon- stration or training projects which hold promise of making a substan- tial contribution to the solution of vocational rehabilitation problems that are common to several States and (2) to aid in a substantial nation- wide expansion of rehabilitation programs in the States. HIGHLIGHTS OF 1955 The number of persons rehabilitated through the public vocational rehabilitation program during 1955 was 57,981, a 4 percent increase over the preceding year. This represented the reversal of a 3-year downtrend. Total expenditures for the public vocational rehabilitation program during 1955 amounted to $40,752,809. Of this total, $25,462,214 was spent by the Federal government, the remainder by State agencies and cooperating nonprofit organizations. Those rehabilitated during 1955 are now paying Federal income taxes at the estimated rate of $8.5 million per year. At this rate, they will repay the equivalent of the entire Federal investment in their rehabilitation within three years. Those rehabilitated during 1955 increased their combined annual earnings from an estimated $15 million prior to their rehabilitation’ to an estimated annual rate of $105 million afterwards. The 1955 rehabilitees are adding about 89 million man-hours of production to the national economy each year. The average cost per individual rehabilitated through the State- Federal program during 1955 was $666. 184 Department of Health, Education, and Welfare, 1955 During 1955, the Office granted $299,000 for 18 special research proj- ects being conducted by public or private nonprofit organizations for the purpose of solving rehabilitation problems of nationwide sig- nificance. The Office made grants to 91 teaching institutions which had ar- ranged their curricula and plans to co-operate in the training of badly- needed rehabilitation specialists. Federal funds also went to provide traineeship grants for more than 1,000 qualified students in fields such as physical therapy, occupational therapy, medicine, social work, re- habilitation counseling and psychology. 7 Forty percent of the $22,300,000 spent by the public program for the purchase of services for handicapped clients during 1955 was spent in the field of medicine—for such things as examinations, treatment, prosthetic appliances, and hospital and convalescent care. The Rehabilitated: Some Facts and Figures CHARACTERISTICS OF THE DISABLED Among the men and women rehabilitated through the State-Federal vocational rehabilitation program during 1955 were those with vir- tually every type of physical impairment. The eight broad categories of disability represented among the rehabilitants are shown in Chart ip s1S5 | The orthopedically disabled accounted for 40 percent of the total number rehabilitated. About three-fifths of the persons with ortho- pedic disabilities were injured in accidents, and about one-fifth became disabled as the result of poliomyelitis, arthritis, or osteomyelitis. Chart I also shows the major vocational fields which the rehabil- itants entered. The distribution of the rehabilitants as to vocation has not changed significantly over the past several years. It is inter- esting to note that only 6 percent of those rehabilitated were in the unskilled category. Physicians, health agencies, and hospitals continued to be the most important sources of referrals, such referrals accounting for 34 per- cent of those rehabilitated through the public program in 1955. Fif- teen percent of those rehabilitated during the year were referred by public welfare agencies. All of those rehabilitated received counseling and guidance services and most were placed in gainful employment through the rehabilita- tion program. Forty-three percent were provided with physical res- toration services and 31 percent were given some sort of training. Ten percent received both physical restoration and training services. 185 I TWASIA O02? S31VS GNV 1V9INS19 Zl SISOTNOYSEAL AYVNOW Nd 29 G3TMUYASNN fed. TWLINSV! % Ol TIINSOVNUW “IWNOISSSIJONdINAS “IWNOISS3IONd h 62 LNSWUYIVdWI 2 69S oe re G3TIUMSINAS : 3 GNV GQ371IyMS SYNLINONYOV E re sa Ngfier i 3 S3AIM3SNOH o2ON NOLLWILAdWY fe ‘SYSNYOM o ™ ee = AMWY3 Q> 3 § tt) 3 Q S) SN Se, ° SNOILVdNO00 HWOLVIW SHLLITIAVSIG o . = SS6T “wah yoosy ‘asnsoja 40 dno.s6 ywouo1ndns00 lofnu fiq pun aounjidao0n 4p Ayaprqnsip fo sodhy fg ‘squnpinqnyas [0 2ua040g ° SdNOYD TWNOILVdNDIO YOFVW GANV SFILITIGVSIG—' L 4PYD oe Tee ee ee ee ae eee 368636—56——_13 186 Department of Health, Education, and Welfare, 1955 chsh cribs lcci nh anion nia RR DOES REHABILITATION PAY? Rehabilitation does pay dividends in the economic as well as in the social and humanitarian sense. | An estimated 11,600 of the 58,000 rehabilitants during 1955 were receiving some form of public assistance at the time they were ac- cepted for services or at some time during rehabilitation. About 43,000 of the rehabilitants were unemployed at the time they began rehabilitation. 7 Rehabilitation has thus converted these thousands of unemployed and public relief recipients into wage-earners who are contributing a sizeable sum to the support of their government. Not only are they currently paying Federal income taxes at an estimated rate of $8.5 million per year; it is also estimated that, during their working lives, they will pay $10 in Federal income taxes for every Federal dollar invested in their rehabilitation. But Federal tax revenues are not the only economic benefits that accrue to the nation through vocational rehabilitation. The increased buying power of 58,000 newly rehabilitated Americans and of the fami- lies which many of them head means more taxes for State and com- munity government. It also makes for stability in the economy as a whole. Wage earners are spenders and spending is essential if the wheels of industry are to be kept moving. Strengthening the Program at the Grassroots Armed with a legislative mandate for stepping up the attack against disability, the Office during 1955 concentrated upon strengthening the public vocational rehabilitation system at the grassroots—in the communities of the nation. Emphasis was placed upon giving State agencies maximum authority and responsibility consistent with the requirements of Federal law, upon expanding and improving existing programs for the rehabilitation of the disabled, and upon fostering interagency cooperation. THE STATE PLAN The State Plan is a blueprint of the State vocational rehabilitation program. It describes the organization of the program and the major policies and procedures to be adhered to in its operation. Under Public Law 565—which gave the States considerably more discretion and latitude in the development and operation of their re- spective programs than was previously the case—the States were called upon to submit new Plans for approval by the Office. To assist the States in the preparation of these new Plans, the Office produced and issued a special guide for State agency use and worked closely with the States to see to it that their Plans covered all points required by law and regulation. 2 See eee ee ee eee ee Office of Vocational Rehabilitation 187 By the end of 1955, all 88 State and territorial vocational rehabilita- tion agencies had submitted new Plans and had had those Plans approved. EXTENSION AND IMPROVEMENT PROJECTS During fiscal 1955, 70 extension and improvement projects in 38 different States were approved. Such projects involve the providing of services to the disabled above and beyond those already available in the State. About half of the projects for which extension and im- provement grants were made had to do with specialized counseling services or specialized programs for facilitating the rehabilitation of seriously disabled persons such as the mentally ill and the epileptic. About one-fourth of the projects were concerned with the improve- ment of medical consultation and supervisory methods and techniques, the development of organized programs for demonstrating the employ- ment potential of the disabled, and research into techniques to aid in the rehabilitation of the seriously disabled. The remainder of the extension and improvement projects involved the establishment of sheltered workshops, rehabilitation facilities and other activities designed to improve various types of programs and services to the disabled. EXPANSION GRANTS The expansion grant, which is dedicated to a substantial expansion of the nationwide services available to the civilian handicapped, played an important role in the Federal-State vocational rehabilitation pro- gram during fiscal 1955. During that year, 60 projects were initiated in 388 States for which Federal expansion grant funds were provided. Funds were made available on the basis of two Federal dollars for each State or local dollar involved in the project. About one-third of the expansion projects were undertaken by the State vocational rehabilitation agencies themselves, the remaining two-thirds being developed by the State agencies in co-operation with voluntary nonprofit organizations. Thirty of the projects related to the establishment or expansion of sheltered workshops and rehabilita- tion facilities. Among these facilities were speech and hearing cen- ters, adjustment training centers for the blind, and facilities for other types of seriously disabled persons. INTERAGENCY COOPERATION Public Law 565, amendments to the Social Security Act, and allied legislation enacted in 1954 provided a framework for closer coopera- tion at the grassroots among the vocational rehabilitation, public 188 Department of Health, Education, and Welfare, 1955 i tcc at Ae ABTA assistance, and old-age and survivors insurance programs. Such cooperation made itself felt in a very concrete manner during 1955. The social security amendments brought into being the “disability freeze” program which—as of June 1955—saw more than 60,000 per- sons referred to State vocational rehabilitation agencies by district offices of the Bureau of Old-Age and Survivors Insurance. The “disability freeze” is designed to protect the benefit rights of persons in employment covered by the social security law who are unemployed over a long period of time because of disability. State and territorial vocational rehabilitation agencies play a two-fold role in the “disability freeze” process. They determine whether or not an applicant for “freeze protection” has a disability which qualifies him for such protection. Secondly, they seek to rehabilitate the applicant af he desires rehabilitation services and is eligible for such services. As of June 1955, working agreements between Old-Age and Sur- vivors Insurance and State vocational rehabilitation agency offices had been completed in 33 jurisdictions. And vocational rehabilita- tion agencies in 46 States or territories had been designated to make or share in the making of “disability freeze’? determinations. The Office has sought to foster the same sort of cooperative rela- tionship with public assistance program officials as it has with those of the old-age and survivors insurance program. It has made funds available to conduct surveys in selected areas with a view to deter- mining how many of those on public assistance might be helped by vocational rehabilitation. Working with representatives of the State vocational rehabilitation agencies and of the State public assistance programs, members of the Office and Bureau of Public Assistance staffs prepared a guide de- signed to foster the best possible cooperative relationship between the State vocational rehabilitation and public assistance programs. The guide was scheduled for release during 1956. Special Projects: Research and Demonstration Public Law 565 made it possible to launch a number of pioneering research projects into disability problems of nationwide significance. The first major step into research of this nature was taken in Jan- uary 1955, when the Secretary of Health, Education, and Welfare announced the appointment of a 12-member National Advisory Coun- cil on Vocational Rehabilitation. Mary E. Switzer, Director of the Office of Vocational Rehabilitation, was named chairman of the Coun- cil. The Council’s purpose—as set forth by law—is to make recom- mendations on applications for Federal grants in partial support of research and demonstration projects which show promise of contrib- Office of Vocational Rehabilitation 189 uting to solution of a vocational rehabilitation problem of concern to a number of States. During the period between its inauguration and the close of the 1955 fiscal year, the Council considered a total of 46 applications for special project grants. The Council recommended approval of 22 of these applications, disapproval of 17 and, as of June 1955, had deferred action on 4 others pending the receipt of further information. Fed- eral funds awarded during 1955 for special research and demonstra- tion projects totaled approximately $299,000. The recipient organi- zations provided at least one dollar for each two dollars in Federal funds awarded. APPROVED RESEARCH AND DEMONSTRATION PROJECTS Of the 22 applications for Federal special project grants recom- mended for approval by the Advisory Council, there were 18 for which funds were actually awarded during 1955. Following are the organi- zations to which special project grants were awarded, the Federal sums awarded, and a brief description of each project: Association for the Help of Retarded Children, New York City; $48,700 for determining the effectiveness of rehabilitation training in fitting mentally retarded young adults, who cannot be helped by other means, to become employable. New York State Psychiatric Institute, New York City; $27,823 for establishing and conducting a mental hygiene clinic for the deaf, the purpose of which is to help the deaf to overcome their work and social handicaps. Georgia Division of Vocational Rehabilitation, Atlanta; $15,756 for study and development of employment opportunities for blind persons in greenhouses and nurseries. Federal Employment and Guidance Service, New York City ; $9,399 _ for study of employer policies and practices in hiring handicapped - workers. Division of Services for the Blind, Topeka, Kansas; $6,519 for evaluation of the effectiveness of music therapy as a part of an overall program for rehabilitating the blind. National Rehabilitation Association, Washington, D. C.; $18,770 for study of functions and training needs of vocational rehabilitation counselors and the development of an accrediting system under which needed training may be offered. American Foundation for the Blind, New York City; $10,019 for a survey of professional and administrative personnel in work with the blind with a view to improving standards. Saranac Lake Rehabilitation Guild, Inc., Saranac Lake, N. Y.; $10,800 for a survey of the rehabilitation needs of disabled persons in rural areas. 190 Department of Health, Education, and Welfare, 1955 National Industries for the Blind, New York City; $16,000 for de- velopment of a demonstration program of industrial homework for shut-ins in a rural area (the State of Vermont). University of Pennsylvania, Philadelphia; $26,568 to conduct a pilot program in speech and hearing rehabilitation in connection with an existing rehabilitation center. | Adelphi College, Garden City, New York; $20,320 to study handi- capped workers who are or who have been associated in some way with two industrial plants on Long Island with a view to determining the importance of some social factors in job placement and community life of the handicapped. Anderson Orthopedic Hospital, Arlington, Virginia; $5,000 to plan a program of services for a national pilot demonstration center in the metropolitan Washington, D. C. area. University of Connecticut, Storrs, Connecticut; $15,000 for deter- mining the problems encountered in child-care and family relations by mothers with orthopedic handicaps and to develop work simplifica- tion methods for performing activities involved in caring for children. Idaho State Department of Health, Boise, Idaho; $6,500 for deter- mining the extent of physical disability of vocational rehabilitation significance among seasonal workers migrating annually from the Southwestern United States to the Snake River Valley. The John Tracy Clinic, Los Angeles, California; $14,500 for study- ing the intellectual and personality factors associated with success in lip reading. George Washington University, Washington, D. C.; $2,851 for a survey of the metropolitan Washington area to determine the type of pilot rehabilitation center which would best serve as a model for the Nation. Institute for Crippled and Disabled, New York, N. Y.; $17,716 for the purpose of developing an evaluation and work classification sys- tem for cerebral palsied adults. Attending Staff Association of the Los Angeles County Hospita, Ine., Los Angeles, California; $26,719 to explore the vocational re- habilitation potential of respiratory and nonrespiratory poliomyelitis patients. The Training Program The Office’s training program, inaugurated at the beginning of the year, is designed to train “short-supply” personnel for work in the rehabilitation field, to improve the knowledge and skills of profes- sional personnel already in the field, and to develop an increased awareness of rehabilitation philosophy and methods among personnel in related fields. Office of Vocational Rehabilitation 191. By June, 1955, 80 Federal grants for the teaching of rehabilitation subjects had gone to institutions: and organizations throughout the country. These grants totaled $536,000. In addition, about $254,- 000 in grant funds were made available for 1,074 long and short- term traineeships in priority occupational fields. Funds were also granted for the holding of 37 workshops and institutes—short-term training sessions in such fields as nursing, physical therapy, occupa- tional therapy, rehabilitation center direction, work for the blind, speech therapy, rehabilitation counseling, and social work. Among the fields in which teaching grants were awarded were social work, rehabilitation counseling, occupational therapy, physical ther- apy, rehabilitation center administration, public health, supervision of vending stand operations, clinical psychology, teaching of blind piano tuners, rehabilitation of the tuberculous, rehabilitation nursing and the supervision of rehabilitation training facilities. INTERNATIONAL ASPECTS OF TRAINING While the Office has been active in fostering the training of badly- needed vocational rehabilitation workers at home, it has not overlooked the need for such workers in those foreign countries which have re- quested assistance in solving their own rehabilitation problems. Work- ing in co-operation with the State Department, the United Nations and the Foreign Operations Administration, the Office last year planned and supervised the rehabilitation training programs of 100 individuals from 28 different countries. The foreign trainees enrolled at educational and allied institutions throughout the nation, the Office maintaining constant contact with them and holding itself ready to work out any problems that might arise during the course of training. The foreign nationals’ training program has shown concrete results as those who have participated have returned home to practice what they have learned. In countries like Egypt and the Philippines, for example, former trainees head up the national rehabilitation programs established—to a great extent—through their efforts. In Guatemala, a physician who took training in this country in 1953, directs a reha- bilitation center he was instrumental in establishing. Guidance and the Setting of Rehabilitation Standards Providing grants-in-aid for the expansion and improvement of rehabilitation facilities in communities throughout the country, help- ing State agencies to develop effective operational plans upon which to base their rehabilitation programs, training badly-needed special- ists in the field of vocational rehabilitation—these are some of the 192 Department of Health, Education, and Welfare, 1955 broad “direct action” activities of the Office of Vocational Rehabili- tation in its overall nationwide attack against disability. Of equal importance, however, are those Office activities which involve consultation, guidance and the setting of standards . . . activ- ities designed to assist the State vocational rehabilitation agencies to meet specific problems of every conceivable type. GUIDANCE AND STANDARDS: THE SEVERELY DISABLED The past year was a fruitful one for advances both in delineating the nature of the problems of the severely disabled and in recommend- ing techniques and methods for coping with these problems. Fifty-four of the 88 State rehabilitation agencies sent representatives to the 8th Annual Guidance, Training, and Placement Workshop sponsored by the Office in Washington, D. C., in June 1955. The Workshop explored the broad range of rehabilitation counseling activ- ities, paying particular attention to improvement of means and methods for evaluating eligibility of applicants for rehabilitation services. } : Office specialists concerned with the blind conducted training ses- sions or helped in the conducting of such sessions for personnel work- ing with the blind in areas throughout the country. Counselors from State vocational rehabilitation agencies as well as from associated voluntary groups were among those in attendance at these confer- ences—all of them dedicated to fostering higher standards and more “know-how” in dealing with the problems of the blind. ‘Twelve such conferences were held during the year. During 1955, there were a number of significant developments in the very complex field of hearing impairment. The Office cooperated with the American Hearing Society in the development of a workshop on community organization for attack on the problems of the hard-of- hearing and the deaf. More than 200 hearing specialists from all over the Nation participated. One of the important projects for assessing the problem of the “shut-in” whose disability prohibits his leaving his home environ- ment—was a survey which resulted in publication of the report: The Study of Programs for Homebound Handicapped Indiwiuals. The report, which was made to Congress, was prepared by the Office in collaboration with the Social Security Administration, the Office of Education, the Public Health Service, and the American Printing House for the Blind. Stimulating Employment for the Handicapped Kmployment is, of course, the end product of the vocational re- habilitation process. During 1955, the Office greatly expanded its Office of Vocational Rehabilitation 193 efforts to help State vocational rehabilitation agencies and interested private organizations to foster the placement of the handicapped. THE EDUCATIONAL CAMPAIGN Considerable emphasis was placed upon educating the public in gen- eral and the employer in particular as to the abilities of the handi- capped if placed in the right job. This emphasis was fully in keeping with Public Law 565 which provides that the Secretary of Health, Education, and Welfare, the Secretary of Labor, and the Chairman of the President’s Committee on Employment of the Physically Handi- capped “shall develop and recommend methods which will assure maximum utilization of services . . . in promoting job opportunities for such individuals.” As the representative of the Secretary of Health, Education, and Welfare, the Office has cooperated fully with all governmental departments in this great educational effort—an effort which has been continued on a sustained year-around basis. Grassroots promotional efforts—both in keeping with P. L. 565 and with earlier legislation—have actually been brought to bear by joint effort in communities throughout the country: Governor’s Commit- tees on Employment of the Physically Handicapped, the State voca- tional rehabilitation agencies, State public employment service offices, veterans employment service representatives of the Department of Labor—all of these have been and are working together to foster the employment of the handicapped and an understanding of their problems. But the educational campaign to foster employment of the handi- capped has not only concentrated upon broad, promotional objectives but also upon providing immediate, specialized assistance to placement specialists concerned with the handicapped. Examples of this type of assistance are numerous. One such was the issuance by the Office of a publication entitled Small Business Enterprises for the Severely Handicapped, which is now in wide use. Another is the work being done by the Office in surveying industries throughout the country with a view to obtaining information which will help the blind to secure employment and then making the results of such surveys available to the public in general and the blind in particular. THE VENDING STAND PROGRAM The Vending Stand Program for the Blind, one of the most im- portant media through which employment opportunities have been developed for the blind, continued to have healthy growth during the year. Future years hold promise of even greater expansion be- cause of the 1954 amendments to the Randolph-Sheppard Act, the law under which the program operates. Reports from all States showed that a record 1,721 blind vending stand operators were employed on June 30, 1955, as compared to 1,659 194 Department of Health, Education, and Welfare, 1955 site ORIN Ta ne NUM Acasa Ae at the end of the preceding year. The blind operators had a net average income of $2,300 during the past year, an increase of more than $100 a year per operator. The operators and their employees earned $5.3 million in the year ending June 30, 1955, an increase of $500,000 over the preceding year. Gross vending stand sales were $23.5 million as compared to approxi- mately $22 million the preceding year. Much progress was made during the year in implementing the amendments to the Randolph-Sheppard Act. The amended Act pro- vides for preference to blind persons in the operation of vending stands on Federal property as well as in Federal buildings, and re- quires that the head of each agency in control of Federal property prescribe regulations to assure preference for licensed blind persons in the operation of vending stands on such property. The preference regulations for property under the control of the Department of Health, Education, and Welfare were developed and issued, and the Office provided consultation to officials of a number of other departments and agencies to assist them in the development of their preference regulations. Regulations governing the operation of the program by the State licensing agencies were developed and issued and guide materials were prepared to assist the State agencies in developing new application forms (for licenses) and new State rules and regulations. OTHER PLACEMENT ENTERPRISES The Office has worked steadily with the U. S. Civil Service Com- mission in promoting job opportunities for the handicapped in the public service. Promotional and information materials relative to the handicapped have been sent to the approximately 15,000 appoint- ing officers of the Federal establishments. State vocational rehabilitation agencies are also working closely with public employment service offices throughout the country in the placement of the handicapped. Most public employment agencies maintain selective placement services designed to help the handi- capped find suitable jobs. Advances in the Field of Medicine and Physical Restoration Nineteen hundred and fifty-five saw advances both in the medical treatment of the handicapped and in the expansion of medical facilities for service to them. This expansion was carried through under the terms of Public Law 565. Office of Vocational Rehabilitation 195 PROGRESS IN AIDING THE MENTALLY ILL With mental health becoming a problem of increasing concern to the American people, the Office during 1955 played a vital role in the development of plans whereby the relationship between State mental hospitals and vocational rehabilitation agencies could be strengthened. The planning was carried through upon the premise that thousands of mental patients previously doomed to prolonged existence in mental hospitals could and should be restored to a community environment and to productive employment. During 1955, seven States requested that the Office make funds available for the employment and training of vocational rehabilitation staff to work with the mentally ill. Office personnel rendered consulta- tive services to some of these States and, in addition, co-operated with the National Institutes of Health, the Veterans Administration, vol- untary agencies, and mental hospital staff personnel in providing training courses for State agency people concerned with the mentally ill. | Concrete steps were taken to accelerate and improve the rehabilita- tion of patients in State mental hospitals with the holding of regional workshops in Washington, D. C.,in March and April 1955. The March workshop was attended by administrators and administrative person- nel from the State vocational rehabilitation agencies, State hospitals, and State health departments in Maryland, the District of Columbia, Virginia, West Virginia, North Carolina, Kentucky, and Puerto Rico. The April workshop was attended by operating personnel from these same agencies. Cosponsored by the Office, the National Institute of Mental Health, and Saint Elizabeths Hospital, the workshops were devoted to a de- tailed discussion of common problems relating to establishment of policy for rehabilitating the mentally ill, the allocation of responsi- bility among the organizations involved in the rehabilitation process, and case management. The success of these workshops was such that three additional regional conferences in the mental health field were scheduled for 1956. PROGRESS IN OTHER FIELDS OF MEDICINE The Office placed major emphasis during fiscal 1955 upon strength- ening cooperation with the American Heart Association and its affili- ates with a view to improving the techniques and methods for re- habilitating persons suffering from heart disease. This cooperative effort has helped to foster the establishment of work classification units In many communities—units which aid the heart patient by evaluating his disability, estimating his work capacity and developing 196 Department of Health, Education, and Welfare, 1955 with him plans for his future work and for meeting the problems of daily life. The work classification unit is a rehabilitation team generally com- posed of a cardiologist, a medical social worker, and a vocational counselor. Its operating base may be a community hospital, a Heart Association affiliate or a public agency. The work classification unit is a development of the post-World War II era which has more than proved its effectiveness. Medical Officers on the Office staff participated in the development of medical standards and policies for use in determining the eligibility of clients for the “disability freeze.” (See page 188 for discussion of the “disability freeze” program.) These officers worked with the medical advisory committee of the Social Security Administration and also helped to direct training courses for medical and medically related personnel of the State vocational rehabilitation agencies. THE DEVELOPMENT OF REHABILITATION FACILITIES In 1954, Congress amended the hospital survey and construction provisions of the Public Health Service Act of 1946 so that Federal funds could be used to assist in the construction of rehabilitation facilities. Under the terms of the amended law, the Office has col- laborated with the Public Health Service in the development of reg- ulations and informational materials as guides to the States in the planning and survey phases of the facility construction program. As of the end of 1955, eight States had submitted broad, comprehen- sive plans for the construction of various types of facilities. No specific proposals for construction of individual facilities were re- ceived during the year. However, the amended law provides that funds for such construction shall remain available during 1956 and it is anticipated that a number of individual project proposals will have been received prior to the end of that year. International Cooperative Efforts In addition to its assistance to foreign students pursuing rehabili- tation study programs in this country, the Office during 1955 engaged in a number of activities designed to help other countries cope with various disability problems. During 1955, the Office worked with the Foreign Operations Admin- istration in recruiting rehabilitation specialists for employment in Latin-American countries. Two such specialists were sent abroad on long-term assignments, one to provide services to the tuberculous and the other to provide such services to the blind. The Office also recruited specialists for short-term assignments in Mexico, the purpose ; Office of Vocational Rehabilitation 197 of such assignments being to assist the Mexican government to develop special services to the blind, the deaf, the hard of hearing and amputees. Office personnel also assisted in the development of consultative and training programs in a number of countries as well as in fostering the expansion of such programs. The Office played a leading part in the development of the Inter- national Recommendation on Vocational Rehabilitation which was unanimously adopted by the International Labor Organization’s 38th annual session in June 1955. In its development of policies and plans for assisting foreign coun- tries to meet their rehabilitation problems, the Office has worked closely with both public and voluntary agencies in the international field. Among such groups are the American Foundation for Overseas Blind, the International Society for Welfare of Cripples, the World Veterans Federation, and the international associations for physical therapy and occupational therapy. 198 Department of Health, Education, and Welfare, 1955 Table 1.—Number of referrals and cases, by agency, fiscal year 1955 [Corrected to September 15, 1955] Referrals Cases During fiscal year During fiscal year en Closed from active load ce Agency ! Not | ing | Total |——___ ting pied | eek) ata ee After | Bef at cepte oa fter | Before Total | for | cepted te (receiv-| pong. | rehabil-/ rehabil- ar serv- A ing 71%" | itation | itation| _ ° ices | SCV: | year? | cory. | bill, | plan | plan | Year® ices ices) | tated | initi- | initi- ated 4 | ated 5 United States, total.__|257, 521 | 82,269 | 81,886 | 93,366 |209, 030 | 57, 981 6, 441 | 17,035 | 127, 573 AAD AINA ieee see eee ee ee 6, 740 2, 511 658 3, 571 6, 897 1, 960 202 323 4, 412 Adagkanirs ¢ 2 FS Sitee Er Cr res 113 24 42 47 107 16 23 6 62 Arizona: Géneral: 2.03 Sa 1, 089 290 219 580 639 203 21 15 400 Blind. eee 132 41 35 56 110 24 6 1 79 Arkansasc ees cas. pr ats 4, 819 1, 531 2, 234 1, 054 3, 884 1,111 131 578 2, 064 California.) ae eee 20,027 | 38,426 | 18,455 | 3,146] 8312] 1,618 569 809 5, 316 Colorado: General ee fe eae 1, 841 771 493 577 | 1,655 457 216 80 902 Blind fee Soe. Fak ea 222 53 10 159 154 21 3 2 128 Connecticut: General tae ee 2,676 | 1,405 509 762 | 3,409 801 143 352 2,113 Blind: Beet te ee 191 90 56 45 160 50 8 102 Delaware: Gencrals= arses 1, 190 555 405 230 | 1, 234 456 14 81 683 Blinds se wee 37 12 13 64 18 38 District of Columbia____-.-- 1, 791 529 709 553 1, 366 302 118 170 776 Florida: Generales. oe eee 7,644 | 2,301 | 2,488] 2,855] 5,519} 1,619 216 524 3, 160 Blind. BIS palb ihe aed © 3, 201 331 1, 823 1, 047 840 240 40 49 §11 Georrig eae: 2k teh ee 20,879 | 5,003 | 6,687] 9,189} 11,866] 4, 552 262 996 6, 056 Hawaii Generali: -S22 58. anes 833 208 307 318 586 159 35 5 387 IVC tt wrote oar Pear 52 30 7 15 116 24 8 14 70 Idabo: General f.2 03 oe 1, 329 191 543 595 428 122 20 9 277 Blind eae Vase ee 44 16 16 ie 35 9 4 1 21 TWinoisg uy ak eas Se 7,998 | 4,889 | 1,017] 2,092 | 10,898] 3, 406 185 598 6, 709 Indiana: Genorala t2 sat oe 2,623 | 1, 458 527 638 | 4,070 941 74 352 2, 703 : Blinds) eae 250 85 60 105 251 45 18 10 178 owa: General. 255 arse Se 3, 248 | 1,039 613 | 1,596} 2,740 651 54 209 1, 826 BiG ae oe eee 133 19 31 83 66 19 7 1 39 Kansas: Generals »- hn ee 3, 159 888 991 1,280 | 1,914 550 40 182 1, 142 Link: See ee ees 219 43 60 116 156 30 4 6 116 ICON TN CKY sex nose ee 3, 452 813 | 1,085} 1,604] 2,240 459 64 208 1, 509 Louisiana: Generale soehu-co 222 wee 3,920 | 1,598 959 | 1,863} 4,766] 1,174 84 350 3, 158 Blind eens Bee 668 141 205 322 464 11 11 351 Maine General. s22- 292 ves 1, 552 360 289 903 914 198 25 75 616 UNG eee et ees 164 16 88 60 64 18 5 i] 40 Marvianden 5 sv ec Sees 3,964 | 1,924 951 1,089 } 4,626] 1,075 156 761 2, 634 Massachusetts: Gentraltzs ee 3,241 | 1,011] 1,183] 1,097] 2,633 717 114 241 1, 561 Blindes fee ae eee 263 84 37 142 254 45 2 14 193 Michigan: Generals eee eee 6,758 | 3,062 | 1,314] 2,382] 8,447} 2,862 374 154 5, 057 Blind atti See 8 8 433 116 35 42 240 Minnesota: General ot see ee 4, 205 897 | 1,282} 2.076 | 3,367 582 111 98 2, 576 IBIING Eee eee re pene ees 342 135 146 61 414 92 15 48 259 Mississippi: Generali. et. 2 ees 2) 50k 711 860 | 1,000 | 2,906 876 76 218 1, 736 Bind: See ieSa. rae 701 408 186 107 787 202 23 23 539 Missouri General: 3.22 ee es 2,764 |} 1,480 719 666: |) 13,1128 2177 110 239 1, 586 Blind Mae lesa eae en 441 165 155 121 448 113 25 16 294 Montana General ease eee 1, 360 454 374 532 | 1,086 390 14 22 660 Blind eee seca ae 175 ily) 138 20 67 16 6 UT 34 Nebraska: Genoralese. ere ee 1, 049 712 129 208 | 1, 563 518 29 15 1, 001 lind Sacer 3 30 31 52 9 31 2 0 59 Nevada ote te Eee ae 298 70 93 135 131 46 10 0 75 See footnotes at end of table. Office of Vocational Rehabilitation 199 Table 1.—Number of referrals and cases, by agency, fiscal year 1955—Con. {Corrected to September 15, 1955] Referrals Cases During fiscal year During fiscal year Re- P Re- : Closed from active load Agency ! ae al SL OtS. main- ee Not ing nett ing cepted | _ 2° at ete After | Before at p J Total for cepted | end (receiv- rehabil-| rehabil- end serv: for of in Reha- | itation | j of o) iidelrs it ete g bili- ation | itation year 6 ices ices'3 SOry- sated plan plan ices) initi- | initi- ated 4 | ated 5 New Hampshire: Gencraieee. - 522 220 140 162 425 95 16 68 246 SUNG ae a 42 24 5 13 75 14 6 8 47 New Jersey: Creneraieass Biss #2 2, 484 973 842 669 | 2,550 619 84 371 1, 476 18100 | 2 SURO Se 4 132 148 150 471 93 26 35 317 New Mexico: EGR Rs 1, 065 217 386 462 615 225 17 26 347 2G a a 151 31 41 79 102 28 17 6 51 New York: CSI ee eee RS 14,935 | 4,921 | 4,708] 5,306 | 11,885] 3, 424 300 lenlsolo 6, 790 23H 0 | ae a 957 356 223 378 805 243 51 59 452 North Carolina Cpneralers sas. Fo 6,782 | 3,489] 1,948] 1,395] 7,810] 2,689 124 545 4, 452 (SLANG (oe ea SS a ea 914 382 341 191 1, 463 306 28 14] 988 i Wakota-t tes 30k 952 249 179 524 587 173 3 17 394 0: energie ee 4,820 | 1,512 | 1,321 1,987.|) 3,525 | 1,152 58 209 2, 106 Mirae 442 234 83 125 715 141 38 54 482 Oislaagmas. 22> -2.-..--...- 6,164 | 2,084} 2,832] 1,248] 6,178] 1,160 86 549 4, 383 Oregon: (General. - = - =. 222... 5,018 | 1,088 | 1,730 | 2,250] 2,646 577 63 211 1, 795 3 Oa 162 3 51 68 144 34 3 103 Pennsylvania: (emerale = seve 28k 16,058 | 6,010 | 4,445 | 65,603 | 11,934] 3,337 490 987 7, 120 (iracheeeeee eet ee 1, 774 367 692 7155/2 11, 269 149 86 197 837 Paerto Rieo= 25 ss. jy2_-..- 4, 464 OL ek 070.1) 2; 483) 1) 2,747 814 69 129 1, 735 Rhode Island: Grenlerals ens 2) oe 773 403 244 126 955 307 117 34 497 15:00 0(0 by hes cen Me eee eS 30 29 0 1 173 25 5 8 135 South Carolina FON Crane BOR tee 4,868} 1,446] 1,549] 1,873 | 4,296] 1,313 77 161 2, 745 Te WIG = te aa 335 112 127 96 252 75 9 41 127 South Dakota: Citlen eee a 664 178 61 425 704 141 7 15 541 [S)ehto bcs. a Se ee 105 19 62 24 61 17 4 6 34 Tennessee: Gpariera lt te, 8 5,075 | 1,951 1,273 | 1,851 | 4,510] 1,695 88 200 2, 527 tense 756 177 162 417 602 118 13 67 404 Texas: ON OV Ale sto oe 10, 177 3, 021 2, 565 4, 591 9, 560 2, 189 135 820 6, 416 lee 1,172 312 368 492 793 267 42 64 420 TREN) 51008 Nts IES SR ea Sea 1, 152 307 232 613 1, 080 254 32 19 775 Vermont: Genetnl ee eee es 767 2a0 198 312 556 110 31 38 377 Blinds 22062 2 sb2t co 25 45 26 10 9 65 15 2 6 42 Virginia: Generdie os nee 10,431 | 3,074} 3,841] 3,516 | 6,761 1, 821 108 | 1,051 3, 781 Tel b Ua | es ee ae 364 110 61 193 186 69 4 5 108 Washington: Ct 6,915 |} 1,119} 1,899 | 2,897) 3,370 860 123 229 2, 158 EAC ee 161 36 57 68 169 24 4 44 97 Westavinginiae .2--222...... 11,116 | 7 2,896 |7 2,498 | 5,722 | 7,333} 1,607 84] 1,313 4, 329 Wisconsin: 3 romerale ce hee an 3,610 | 1,388 884 | 1,338] 4,671 1, 365 149 50 3, 107 ing iss Se ee 167 68 48 51 253 81 44 7 121 Wi vOUrmg@evce oslo 2-22 ok 868 157 400 311 444 153 25 3 263 1 In States which have 2 agencies, the agency under the State board of vocational education is designated - SC eal and the agency under the State commission or other agency for the blind is designated as 66 in. Cee 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, etc. 3 Eligibility for rehabilitation not determined. 4 Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabili- colar service but never reached the point of employment because of personal factors, illness, aggravated isability, ete. § 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, 1955. T Adjusted. 200 Department of Health, Education, and Welfare, 1955 a Table 2.—Federal grants made to State vocational rehabilitation agencies and cooperating nonprofit organizations, fiscal year 1955 a : pee eS j p uppor and im- xpansion State or Territory Total grants provement grants 1 grants Motaleye rete aes ie ee Soe Se eee $22, 153,088 | $21, 242, 164 $347, 966 $562, 958 PUGH osc 000s ely panier abun SA Sates Ase PE se eat 687, 890 643, 825 28, 636 15, 429 ATIZONG Ua SORE Fo Nees 6 eS ae ee 120, 708 109, 598 7, 425 3, 685 Arkansasr tants seta ek |e eae peual les 437, 238 410, 124 17, 556 9, 558 Califor it 22eSt } SAS Rer Yor hee tS eee ee 1, 799, 036 1, 746, 0572222 eee 53, 979 Colorados: See ie BAU E oe ees Sees re 161, 608 149, 593 6, 765 5, 250 Connecticut = bones se aa a ee ee 296, 351 276; 369. | ee 19, 982 Delaware. ere. a Pee Oe ee ae ee 132, 088 127, 088 5. 000: 222 ee eee SOLOTIDG ws Sceentennn | eee et eeceeuenceseeeee 629, 810 593, 315 23, 495 13, 000 Georcia Fe a oe ee See ee 1, 531, 419 1, 510, 262 21,.157.3|saane eee BAS EEN DY fear en De ste e SS ek Ae aa a SO Rae ahi ae 53, 311 63; 811 |. 52 ee TUM OIS Se oe Lee ee Oe ee Ee ce 1, 274, 632 1, 2372881) | 2 See 36, 751 Trdianaes. 02. 2s RR So. et Se ay See ee 346, 377 3415377 | so eee 5, 000 TOWOhe Sos. Sain he ee 291, 768 291, 768. |- 22 eS eee IK nSaste 5. 2 Nis cb ee ee NE a ee ee 206, 850 195, 784 11,066... 23832 sea oe Kientuick Vite. : Jae ho ee ee ee ee 201, 376 159, 418 27, 267 14, 691 LOUisiana= ee en Pe os Pe ee 476, 474 464,329 (22 2. 22 eee 12, 145 Moainetene. 28 522 2 otk oo Dns Sanat ee a 82, 114 82,114 |. o2-23 elon ee Maryland? .2.2. 1 bees Se eh ae ee hy See 305, 001 305, 001 | cue eee Wiassiehiisetts [sence Ue ok Ss eee ea ae 252, 403 245, 042 7, O61. |... See ee Michigan's 265k. bates oe wee eh ES ak BO 989, 708 952, 491 18, 917 18, 300 Minnesota2 2 2) oe Ee ee ee 283, 615 260/049 | 2 oS 23, 566 IMISSISSID Dll eee eee ee eae ee ee 265, 434 265, 434 |... 2222222 ae eee Missourietite tc 22 kek vs ee ee ee 494, 681 396, 080 1,119 97, 482 Montana. 2fts2es beh «Sch WA ae ee. 126, 419 124,019 |--eeee 2, 400 Nebraska: 5*... 2.5282. oe aS ek 187, 673 173, 330 7, 743 6, 600 ING@Vada ES eo. 2 steer ae otaes Ne 2 ee 25, 346 25,346 |4....5 2S NeweHampshire:-4-22 2.42 Soh ee ee ae 42,073 42,073 |-Secc ene ee eee New Jersey.2te Leek so hae De Le ee 386, 741 3/3; 156 |-2 eee 13, 585 INe@wislexicomes 2. £ 28s fol 2 See ee ee ee 104, 581 885 247> | 2 See 16, 334 ING wisYOT katt i we 8b See ee SS Pee 1, 276, 835 1, 276, 835 .|_2 5. oe ee | North: Caroling.2 cbse 2225 a ee eee ee 618, 200 618, 200: | cee le | NorthtDakota 224.2522 25 eee ee oe 103, 049 99/972. |. eee cee 3, 077 | KOLA on Oe Se ees Me iS Ie eae oe es Pa 389, 750 389, 750 |. 2..-...: 2. | eee Oklghomates: 22 PE 2k ee ae Oe 529, 175 514, 667 14,.508: 4.2. See Oregon Sits Mee. eee cel Me Ee 2 eee ke ee 310, 218 278, 881 11, 000 20, 337 Pennsylvania- oof ce 0 2 ee ee 1, 582, 406 1, 449, 672 37, 937 94, 797 Rhodevdslnndse: |e eee eR is a 92, 515 86, 103 6, 412. |S ones ose South Carolina: .f. 528 fo ee ee ae ae 417, 681 417,681 | poten eee Pouth Dakotas... 2.4 25-< is oo bs t Sim 0 eo te i? i - ‘ ai t ue ~ » hl (vale, eral i h Oey i ia Rhee i vi * ¥ ‘ iH e BAL ‘ , ¥ H +4 ae H i} 7 * Lie r \ Lid — a ohn ’ 7 i 5 ¥ A y y ‘ | ' ‘ =) , be , = (i i , , : \ = wireless ee . 5 , " Nits rr oy ae ha yt ap i 1 ‘ Al ; i > ah t ‘ 5 { ; ; j : P\ i : ; j t { i A oe q ia } i : - - CO : | eae Si : ’ we t ’ j } ; ( i ti > ns c f 4 1 i 2 { ‘ \ % H i ay “Ss “ ay 1» ff J ’ oe A x 4 : \ “— a ! ok aR ee i ‘ ir 1 sia Mink al al ate ke aefiade Re i y : i F; , * Sa { i ! ‘ ( x {q * 5 ; 0 - ’ \ : Saint Elizabeths Hospital DvuRING THE YEAR just past there has been no essential change in the organization of the structure of the hospital. The medical care 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 of the hospital, such as Social Service, Nursing, Dietet- ics, Maintenance and Construction, are auxiliary to the work of these four branches. Before considering the detailed operation of the hospital a few gen- eral remarks are in order, particularly in view of the fact that January 15, 1955, marked the One Hundredth Anniversary of the reception of patients at Saint Elizabeths Hospital. The Centennial of any institu- tion is worth remarking, and particularly so in the case of an insti- tution which has meant so much to the Government of the United States and to American psychiatry as Saint Elizabeths Hospital. It was the desire of the hospital administration to carry out a dignified observance of the Centennial, and particularly to pay respect to the memory of the founder of the hospital, Dorothea Lynde Dix. Steps were taken to organize a non-profit Centennial Commission, which was fortunate in securing generous donations from the Ford Foundation, the Smith, Kline, and French Foundation, the Medical Society of Saint Eliza- beths Hospital, and from several interested and generous individuals. A scientific program of two days was held in May. Papers were read and greetings were brought by distinguished psychiatrists, both from the United States and from six foreign countries, several of them former members of the staff. The scientific contributions were of a high order, and plans are being made to publish them in an anniversary volume. In connection with the scientific program the patients wrote and acted an historical drama, entitled “Cry of Humanity”, based on the life of Dorothea Lynde Dix. They likewise devised and built the 203 204. Department of Health, Education, and Welfare, 1955 ee ee ae stage sets and planned the choreography. The play received a great deal of public attention from dramatic critics, and a portion of it was shown on a coast-to-coast television program. Gevet a0, | = Oe eae cg ea es We GOO aa aicge sk sas laey £62) FOL] ¥2 | F le Zen ese oe. alslei|¢ Pit 8 lg 5 a|& n i) © a zs TST | SG | 681} EE | GE CPL | CG | LyT| SE | FS 1G i See lag Is ZL €hL | co | LPL] Zé | TE Sees Aaa Wsi----|=-2" €FL | oo | SFT] GE | TE ¢ Gon cemieb. (e E € OF a Sant0 9-10 8 Genlehyole belek a ee a Val pees |e IST | SG | PHT] €E | GS ieee ce o 8 |e} 2° = 5B @i23| 8 ree o | s| @ 41 | 81 | 69 | F |Z z G9 OL ZEA LS: eh, |S T HGS page © pcre | lat iain SP Es eee ame |] | OL -ZE | 88 | & |G i om OT | 2b | 88 |r | 2% T oc te) (el Oa pte aa 0 0 Ona 8 a i T OT T I ee |e |e T OL ZT | 81 | 68 | F | @ G G9G ale a ocd | Oy eae B/E |e Seieee(884| & 4/2/28 |BS|seee%S| < — |2e|2-4% S; S Qi Ni as |e" |c8 o/eB eligi ® |t.|°&e| Of Elelsios| Sel EB a) 12 lee] Be] 32 2 |? ¢] BE) 85 squor}ed efqesiInquIlaIqoN Teyoyqns Jeuostid e72IS— S80 16E | 6L | I8T| 968 '9) 92 9ce | 68 | ¥8 | HE'S) EL a a AM es ZOE | 68 | 88 | 99'S) EL A i ad AP pee | 6 | 68 | TE9°S) ZZ cb | 6@ | 48 | THE | 0 ST | 1k |9 | ver | 8 Lg | OF | 2 | G92 | & v | LE | G6 | 9F6 | & 198 | GF | 68 | OF ‘S| 32 Sf) Sel so ts Cae Ba | lin Puce ee By ny” . v > © Be 1S! |g fe aor [ene pa |BS 2] 2 |ES a - |B EB] o [a5 Be. ee ee eee oe Se | gaee B sjueljed fq esq UIE Tej07qQng 6LL ‘8 C82 ‘L 62S ‘2 SPL GOS 062 ‘T 6rE ‘I Oe? ‘2 Tej0.L “QG6T IB0A [eIsy pozBe1} [810], “-"“@c6r ‘0g oun ‘Teidsoy uy sah ache <7 3 Sar hee CS6I ‘OS eunr “4uommedoO[e 10 JISIA UO SOERENG. i 7 ae Sees SS6T ‘og sung ‘sTjo1 ao peysnipy ~------------ Ccél IB0A [eS ‘MOICOYISse]o Ul sosuByo SF eae SS6T ‘Og eUNL ‘sT[OL UO “-@g6T Ivod [eosy ‘suoT]BIedeg ~""@c6r ‘og ouNnr 04 pe apy ge ie PS6L ‘Og oUuNL ‘s[jol UO SG6[ Avad poasif ‘uonnasifissn2 4q ‘stuaijnd fo quawmaaow fo Juauiajyys pawp1josuo}—°¢. 9[ qe], i ENE os : ‘fa 5 " wey =e ~ Se ae ue Seg gpeincmmtnai skids penne rent in he Csr an me crm a American Printing House for the Blind As Tue 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, au- thorizes 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 periph- eral 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, Talk- ing 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 7,520 blind children enrolled in the residential and public school classes for the blind being served by the Printing House. During the 1955 fiscal year, Braille books, educational periodicals, and music made up approximately 58.26 percent of the materials re- quired by the schools; Braille slates, Braille writers, maps, and other mechanical devices about 17.42 percent; Talking Books about 4.37 per- cent; and large-type books about 17.35 percent. Approximately 2.40 percent was used for miscellaneous items, 215 -— at ‘ tant : 4 : i ¥ - re ’ ol ' ie * bs pik speaiceiev iain ah and acatbianeaiantahadawinaeadliniles oll 1 mah Se rcs “Aart hee hm, Ym ape Neal py epgelglanl aag ¥ " i Or ' : * a ' 9 \ ’ > 1s i ra - sa a) ed My i at ie pa ele ¢ af t & 4 ae t z ‘ Ns i Pee Ly Bae My c ’ . % wy * a. ae , r | ey i a | it 7 a | = d- P, a i * { ‘ ee se % butik a eee 4 Ps Br ieee a | z ‘ ‘ ‘ 3 ‘ n + 4 1 \ F | ag ; i ; ony PERL: NALS ie i ke RAMP k Ay 3k A, 7 " ry { e ri * = 4 ; i f : : " j } j yu 4 a } A ek A 4 " ¢ f i seuniy ra Ff oF c "4 } Ae an vt ; ‘ o ie BX i is: iv aa?2 ol ‘ ra Fa mA Se U Fy st La r » a + . 1 i) ‘ } sr rR ¢ WF Phe 5 ie Si ol ‘ hi , I O era ha) ; J iE Se # ¥ ‘ Pade: Tees: v4 Tiny Oh pe | er ne § titans i a eh ed , " Mu se i 'g 7 He ‘Fs { & ated se oe ou PRL Mh 4 ae . e Yi ; i rh A Ws ¢ q P 4 y fh i of #0873 ace: Lists Di met es: (3 bcs Ped ; gr ~ = . 4 c E 7 7 i , N ' ) ¥ . ie ‘ pS aw 2 , . { a : @. ; i 5 4 : 7 Ps Soe H j re ‘ 1 & +4 ; I : Ly 7 , 5 ‘ : whiney F a Ban O4 f rere \ : y . fe 4 ‘i i s ime ad f H f ? ae - ¥ bot 7 Mi é i) ee, » j - ‘ j y 3 3 C2 a jAZ é Soar x Z SAF : 7 . t . ¥ t : ee ‘ 4 i f y! * ~ F rae y , % y 23 cee ? ? ry ‘ 7 “es5'e j ra 2 3 , te: ¢ 1 : £ 3 £5 3 4 eh mie : ioe o a ‘A y “ y : 2 9 fs 5 ae aaved os ; “4 Ter yi 4 rey e ha ee " “ne ae te ue ee Le a. Dm ae rey | % i EMS: aS. NOTIN R@ISDIR KA Sl WORT SATIS AS Lemos a ieee at is Mya iy wv rt rye ; BARE + IGOR EU aet pre aioe | Gallaudet College GALLAUDET CoLLEGE is devoted to the education of deaf persons who because of their handicap are unable to make satisfactory progress in schools and colleges for hearing students. The college, located in Washington, D. C., is the world’s only college for the deaf. In addi- tion to education, it conducts research into the educational problems of deafness. It consists of the Kendall School and the college proper. KENDALL SCHOOL Primary and secondary schooling is provided for deaf children in the Kendall School, which also serves as a laboratory school for teach- ers training in the college. The oral method of instruction is used for all pupils except those who make no progress under it. Enrollment last year was 87, of which 73 came from the District of Columbia. GALLAUDET COLLEGE The college, established in 1864 by act of Congress, offers the associ- ate’s degree after 2 years of study and a bachelor’s degree in the liberal arts and sciences. The Preparatory Department provides the senior year of high school for students who are unable to obtain it in the State schools for the deaf. The Graduate Department of Education offers a master’s degree and a professional diploma in the education of the deaf to students with normal hearing. Total enrollment in the college last year was 285 with students from 43 States, the District of Colum- bia, and 9 foreign countries. 868636—56——15 217 ie es SPE ener I Pata ep men) RUTLAND RABAT TOTES etch amp Sy a reat mS "th fe tm r rt wy ‘ is > rye Tw"t ei 5 37254372 AM 5 risk ie = - é m 1. ¢ ign rls "it O07} hss CaS) rst » Oi 229 ii ms aes? Agree - wv ml _ Sf oat ba deild area Tints se aTnoy bet) od itorg B' bite $6 3 | sitiaed Leavion dai aia -cittio’) to tivieil edt 2aiate &2 on i etnebuta dite 288 ip ote TOS ff ois ie PA ey a b Dim Howard University Howarp Universiry was established by an act of Congress dated March 2, 1867. Its charter provides “That there be established in the District of Columbia, a university for the education of youth in the liberal arts and sciences.” The university has afforded an opportunity for advanced education to students from every walk of American life without regard to race, creed, color, or national origin. The university is composed of a college of liberal arts, a graduate school, and now, beginning with chemistry, is offering work leading toward the degree of Doctor of Philosophy, and schools of engineer- ing and architecture, music, social work, medicine, dentistry, phar- macy, law, and religion. Summer and evening schools offer work in adult education. ENROLLMENT OF STUDENTS During the academic year 1954-55 Howard University served 5,144 students : 3,774 during the regular school year, 1,101 in summer school, and 269 in adult evening classes. Of the 4,204 students in the 10 regu- lar schools and colleges, 3,710 were seeking degrees. Of these, 3,384 came from 42 States and the District of Columbia. The remainder came from 30 foreign countries, the British West Indies, and United States possessions. The 3,384 students from the continental United States: emotes Tce SI 8 nn tr ee el cee ed Ie 73 RET IGTICI@ (SLA LCS ee 518 Meee E Central States. clo ee ee 187 SSUES gc UD) i 9 io, ee el 56 SIE IGG i os We a et a ee eee 2, 044 Reem Central Statesccro.) occiccies TC esso S00) eysapetl wore 250 EEL EN OMY ALS A106. ct ae as cl eee Eel TK AO on 220 Nb ones eco hE Bier cle Sorin 12 Ne aes 0 0 ge a PO 2 24 3, 384 220 Department of Health, Education, and Welfare, 1955 The 326 students from outside the continental United States came from Africa, Asia, Europe, and North and South America. Fifty-two students came from Egypt, Gold Coast, Liberia, Nigeria, and Sierra Leone; 17 from India, Indonesia, Iran, Malaya, Syria, and China; 18 from Belgium, England, Germany, Greece, Holland, Poland, Latvia, Turkey, and Yugoslovia; 2 from Canada; 16 from British Honduras, Dominican Republic, Cuba, Haiti, Panama, and Spanish Honduras; 88 from British Guiana and Brazil; 148 from the British West Indies; and 34 from the Canal Zone, Hawaii, Puerto Rico, and the Virgin Islands. THE COMPREHENSIVE PURPOSE OF HOWARD UNIVERSITY From the beginning, Howard University has welcomed students from every area of American life. It has likewise welcomed any and all such persons to membership in its faculties, on the basis of their ability and character as individuals. One of the major purposes of the founders of Howard University was the admittance of Negro youth, among others. The institution has pioneered in offering professional training to Negroes. During its 90 years, Howard University has been the only university of public support in the Southern States which has offered to a substantial num- ber of Negro youth any approximation of the wide scope of under- graduate, graduate, and professional studies characteristic of Ameri- can State institutions. Since 1948, public institutions in 12 Southern States, hitherto closed to Negroes, have opened their doors; but in 1955 Howard University still enrolled a larger number of students in accredited schools of medicine, dentistry, pharmacy, music, engineering and architecture, and social work than in all other universities and colleges together in the entire area of the Southern States. VETERANS There were 626 veterans enrolled at Howard University during 1954-55, an increase of 52 over the previous year. Of this total, 147 were veterans of World War II and 479 were veterans of the Korean conflict. The number of veterans of World War II decreased by 207, while there was an increase of 259 Korean veterans. ARMY AND AIR RESERVE OFFICERS’ TRAINING CORPS The Army Reserve Officers’ Training Corps enrolled 224 students during 1954-55. The fourth year course was completed by 24 students in partial fulfillment of the requirements for commissions as second lieutenants. The Air Force Reserve Officers’ Training Corps enrolled 253 students. In June 1955, 30 students were commissioned. Howard University 221 THE FACULTY During 1954-55 the university was served by 459 regular teachers, 268 giving their full time. From the beginning in 1867, the founders invited to the faculties of Howard University men and women, on the basis of their ability and character as individuals, without discrimination as to sex, race, creed, color, or national origin. Today, there are men and women represen- tative of every racial stock in America and of virtually all the major religious affiliations in the world. But it was a major purpose of the founders to employ Negro teach- ers, among others, on every faculty. ‘Today the Negro members of the faculties, exclusive of the school of religion, constitute a group of Negro 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 has been an 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. From them came the founder of the first blood plasma bank in the world, the most distin- guished Negro industrial chemist in America, the first Negro governor of an American possession, the first Negro in the Secretariat of the United Nations, the first Negro member of the United States Court of Appeals, and the first Negro cultural attache in the diplomatic service of the United States to a major European nation. CONTINUATION OF THE BUILDING PROGRAM In January 1955 the College of Dentistry moved into its new build- ing, designed to accommodate 400 students. Modern equipment is installed to accommodate 225 students. Facilities include four pre- clinical laboratories, a 62-chair general dental clinic, a library, cafe- teria, and student and faculty lounges. This building and its equipment were made possible by an appropriation of $2,565,221 by Congress. During the year 1954-55, also, the construction work for transform- ing the old general science building into a building equipped for mod- ern instruction in physics was completed and the installation of equip- ment had proceeded far enough to enable work in physics to begin during the second semester. This work was made possible by an ap- propriation of $320,000 made by Congress in 1948 and 1949. Work continued on the new Pharmacy and Biology-Greenhouse Buildings with the goal of having them ready for occupancy in the fall of 1955. Construction was begun on the new Administration Building and the building for the School of Law. 222 Department of Health, Education, and Welfare, 1955 Plans and specifications for the new pre-clinical medical building had been completed, and the plans and specifications for the Audi- torium-Fine Arts Building and the new Men’s Dormitories were well under way. RECOMMENDATIONS OF FREEDMEN’S HOSPITAL SURVEY The Findings, Conclusions and Recommendations of the Freed- men’s Hospital Study Commission, appointed by the Secretary of Health, Education, and Welfare, were finished and made available in May. The Chairman and members have listed and carefully studied every important question bearing upon the future of Freedmen’s Hospital and its relation to the School of Medicine of Howard University. GRADUATES During the year Howard University graduated 514 persons. Since its origin it has graduated 18,709 persons. These graduates are at work in 43 States and 27 foreign countries. They constitute a cross section of the leadership of the Negro people. Together, these gradu- ates constitute the largest and most diversified group of trained Negro public servants related to any single institution in the world. SERVICE IN FOREIGN COUNTRIES Howard University students and teachers have associated daily with teachers and students representative of every race and color and many of the major creeds of the world. In recent years many of those teachers and students as individuals and in groups have traveled on missions to many countries in Europe, Asia, and Africa, as now in India, Iraq, and Indonesia. Again and again the responsible leaders in Government and the friends of America have acknowledged their services as being of great value to their country and to the cause of democracy. Detailed Contents THE SECRETARY’S REPORT Page EL rents ATH. Cer. Ye ieee ee ty is es 2 PPD UCRTIONOOS Toe ot lee Se ee ee Be 8 PROGRESS IN SoctAL SECURITY AND PuBLIC WELFARE__________________ 10 Re eee IN PROGRAM: DEVELOPMENT... 2) oe ee 12 DR I VEANAGUMENT.. oo cin o ote ee Ce eee ee eee 16 TABLE 1.—Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1955__.__.__.___________ 18 SOCIAL SECURITY ADMINISTRATION ee eee WEL Y--LN- 1955... 222. 202A. SOLVING youonil) 6 19 PemenAtt ADMINISTRATION IN 1955_.....-....-..-.--_._.____--______- 23 OLD-AGE AND SURVIVORS INSURANCE..-_-______._____________ 25 ne ROCEAM 16 WOING”.. 0 22 ee 27 Peeerries ane pencnt AMOunts... ~~~. so one ot ee eee yee nnMEnna Ol TOVICCU Ss ieee 28 me Coverage of the Program: =. ==:=-:22ssss2s2ssesseezeeeeeeeee5e-- 28 Tacome and-Disbursements = ==-s222ccccscceesal2 eee Pees 29 Mee rING THE. ROGRAM. 22.622 e ele tk ee ee wee ie ee en ees 29 Pecruatine the 1954 Amendments. -.-_-.___........-.---..--.------- 29 memmmerering tie Disability “Hreeze” = ee ee 30 Pener soministrative Dévelopmicnts. = ee 32 PENNE ROGRA MARS 8 | sclipeaao bcs icowe tuse beteailoecaahuwtis 33 A Strupy or THE MINIMUM BENEFIT____________-_______--__---_-_--- ee 34 PeGisLA TIVE |LEVELOPMENTS IN 1955__- =. 36 Pee ADDIS LANG bol) fe SOR etiieol BTOVINAUS DS Gah oe 72 38 Dente ee COLIC ASSISTANCB: 56+ 0 tee ot Bln erect aneeeseee 38 TRENDS IN CASELOAD AND EXPENDITURES___-_____-----L-_----- eee 40 ner Rennie a Oe ede 30) BRU AISS CRBS DEB SIORIOW hI VO 40 faa to Pependent Children— 1 TL S22 so ed poe cae 40 eer see OT AD. PO fee ORT BUTE ey Pe 41 Aid to the Permanently and Totally Disabled_____._..-.-_--------+--- 41 Sremerar Aesistances =~: oso ooo scccscccceccccrccc4 ee SUES L pes 41 Errect on Pusuic ASSISTANCE OF THE ExpaNpING OASI PRrocRaM fe og 4l Aged Persons Receiving Both Insurance and Assistinedsisese: Soin osu cibs 42 Families With Children Receiving Both Insurance and Assistance- - -~--- 43 eee JV ULOPMENTS2 ooo on ene wee cee e eens eens 43 224 Department of Health, Education, and Welfare, 1955 Page Improvement in Services to Needy Individuals___.__._._.-.-.------------- 44 Increased Understanding of the Public Assistance Program Through Citizen Participation... 228.8 wee ee en oe oo 49 Improvement in Public Assistance Administration.-___._--------------- 50 Improvement in Methods of Carrying Out Federal Responsibilities in Working “With: States: 225 2 se i Le Pa ee 51 Defense Welfare Services! ivi 2. @- e554 22 ee. ee ES eee 52 CHILDRENS BUREAU. 3.20 b2 S222 See ee eee 53 SomME Facts anp Fiaures ABout CHILD LIFB_______________--.------ 53 CHILDREN. WITH. SPECIAL-NEEDS 221 2 CUCL S_USs_ ToDo eee 55 FEDERAL INTERDEPARTMENTAL COMMITTEE ON CHILDREN AND YOUTH-_-_- 56 PROGRAMS..OF THE BUREAU. 22. 050 oe ese oe ee ee ee aye Research in Child Lite. te ee 57 Maternal and Child Health Services—__ = --____ = _ 2 58 Crippled Children’s Services.c. Jics244- ces caer ae ~~ 2 oe ua 60 Child Welfare Services: -.0 oo. ou Soe eS Se eee 61 Juvenile Delinquency Service Program. + 22.2.--224!-4-L 22 eae 63 International Cooperation. 22. fo. 04 oon Seka -- he 65 FEDERAL CREDIT’ UNIONS. 2. noe ee eee eee 66 PROGRAM ‘OPERATIONS 2 Uso ee ee ee eee 67 STRENGTHENING THE PROGRAM___. 222. eu lee ee eee 69 OTHER SOURCES OF SOCIAL SECURITY INFORMATION____________-_-___-- 70 Generals - oo oe ee ee ee ke ee Se eee 70 Old-Age and Survivors Insurance. _ W252. 220-2 0 Mt ee ee 70 Pablic Assistance. js 2c cece bet ge yh re ee 71 Child. Health and Child Welfare: 220-52 >0 2-2 eee ras TaBLE 1.—Social Security Administration: Funds available and obliga- tions Incurred, fiscal years 1955.and.1954_— _._-__ 4 se eee pl TaBLE 2,—Financing social insurance under the Social Security Act: Contributions collected and trust fund operations, fiscal years 1953—55___ 72 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 1955 and 1954_- 73 TaBLE 4.—Old-age and survivors insurance: Number and amount of monthly benefits in current-payment status at end of fiscal year 1955, “and amount of benefits paid in fiscal year 1955, by State_.___.-_____- 74 TasBLE 5.—Old-age and survivors insurance: Selected data on benefits, § ~ , employers, workers, and taxable earnings for specified periods, 1958—55__ 5 TABLE 6.—Special types of public assistance under plans approved by the . ' Social Security Administration: Number of recipients and average : payment, June 1955, and total payments to recipients, by program and Aba eiState, fiscal: year 1955._.-.2.-- 5... = ake TaBLE 7.—Special types of public assistance under plans approved by the | Social Security Administration: Federal grants to States and total ~~ expenditures and percetit is Federal nb by program and State; > oo94 Miscal-year- Lospasiaiai?. ban soosivea! so nalviewd avi ee i RR oy ba Detailed Contents 225 Page Taste 8.—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 fee And State, fiscal year 1955.2... -_.._-_ eeeeeeis bores 80 TABLE 9.—Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding Dec. 31, 1935-54__ 81 TaBLE 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1954, VT SS ut ya a tn i A eI SR 81 Cuart 1.—Estimated percent of aged persons with money income from employment, social insurance, and public assistance, December of se- Ce RG) Foe at ti es ie oe eee te eh ee Se 21 Cuart 2.—Major causes of dependency of public assistance recipients, PINDER ee et oe ee ed Be 44 CuHart 3.—Education and salary of public assistance caseworkers_-___-_-- 48 PUBLIC HEALTH SERVICE Pemmtmonne tH NATION ooo ceccee esse tol sc aee Sawin eee eee 83 meee eiiatiiages, and .Divorces..:o........0......... Fue iS 84 fees BOGCRAMS AND, RESPONSIBILITIES...._._..................-..<_.-- 84 REN ts a et ee ee ee ge 85 nem cCniiCs. - Wo tere hese vn ee ee Pe ee eee 85 MEEEECORICMMSONNED, 6) 2 oo be ee ee 87 Smee TPH NOTHODS..... 02... 0062s e eth dee ee 88 meee tiness'and Mortality. 2-0-2222 22 88 EIS hag ll Se gill dit Sle Mc Se le a RON Ss 89 (LEIS us ul Tal gig a lll Cg i Al a pcg aes 89 Pee WALL INSTITUTES OF HEALTH. ~~. vessllets muesie_vevant 90 Meeerom.OF b10L0GICS: STANDARDS. 25 2005. Leesa e Lee ede 90 DE OMNTH I Wt ol eS 91 Semeenror RNseAncH GRANPSieorcc!3-to 2 een seemed! —satuesestoce dae 91 INSTITUTE OF ARTHRITIS AND METABOLIC DISEASES______-------------- 92 DEE EO GINCNUS 2. | 0 Oo Te eee 92 MITT TOICCUN ele eek ee eee 93 MINT OTE 2 cece scccsse LFA AVAL S MOUS 94 meet nemotnerapy Program._..............cnnwurlk wisssilice 94 meenterveand Clinical Research............-..-.-.---44e2244ueus i we 94 Biostatistical and Environmental Field Studies_____________________-- 95 eeecs voported by. Grants_...........-----s 99 Peer or MENTAL HEALTH... .__...—._- ~~~ -oeee---baenn’ heen tn .99 226 Department of Health, Education, and Welfare, 1955 Page Training and, Community, Services. -6.56-<4lewt -bids-baan- deseo tee 100 Clinical, and. ‘Laboratory. Research.