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M.C. MIGEL LIBRARY —
AMERICAN PRINTING
HOUSE FOR THE BLIND
U.S. DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
For sale by the Superintendent of Documents, U. S. Government Printing Office
Washington 25, D. C. Price 75 cents
U.S. DEPARTMENT OF
HEALTH, EDUCATION, AND WELFARE
As of June 30, 1956
Marion B. Fousom, Secretary
Heroup C. Hunt, Under Secretary
OFFICE OF THE SECRETARY
Roswevt B. PERKINS...
BRADSHAW MINTENER .
LOWELL T. COGGESHALL .
Joun R. MacKenzigE.
TERENCE P. SCANTLEBURY .
Wiuuis D. GRrabtson, JR. .
CHARLES F. BARRETT .
ParkE M. Banta .
Rurvus E. Mims, JR. .
CHESTER B. LUND.
Harvey A. BusH .
FREDERICK H. ScuMIpT .
Assistant Secretary for Program Analysis.
Assistant Secretary for Federal-State Relations.
Special Assistant for Health and Medical
Affcirs.
Legislative Liaison Officer.
Executive Secretary.
Assistant to the Secretary.
Assistant to the Secretary.
General Counsel.
Director of Administration.
Director of Field Administration.
Director of Publications and Reports.
Director of Security.
SOCIAL SECURITY ADMINISTRATION
CHARLES I. SCHOTTLAND .
Wiutiam L. MircHe.y .
Vicror CHRISTGAU
JAY L. RONEY.
J. DEANE GANNON.
Marrna M. Ensor.
Commissioner of Social Security.
Deputy Commissioner of Social Security.
Director, Bureau of Old-Age and Survivors
Insurance.
Director, Bureau of Public Assistance.
Director, Bureau of Federal Credit Unions.
Chief, Children’s Bureau.
PUBLIC HEALTH SERVICE
LEONARD A. SCHEELE .
W. PALMER DEARING .
Jack Masur . ;
CuHaRLES E. BuRBRIDGE.
Oris L. ANDERSON .
JAMES A. SHANNON .
Surgeon General.
Deputy Surgeon General.
Chief, Bureau of Medical Services.
Superintendent, Freednien’s Hospttal.
Chief, Bureau of State Services.
Director, National Institutes of Health.
OFFICE OF EDUCATION
SAMUEL M. BROWNELL.
JOHN R. RackueEy .
ii
Commissioner of Education.
Deputy Commissioner of Education.
FOOD AND DRUG ADMINISTRATION
GeorGce P. Larrick. ... . . Commissioner of Food and Drugs.
JoHN L. Harvey... .. . . Deputy Commissioner of Food and Drugs.
OFFICE OF VOCATIONAL REHABILITATION
Mary E. Switzer. ... . . . Durector of Vocational Rehabilitation.
Emory E. Fmrespgr.... . . Deputy Director of Vocational Rehabilitation.
SAINT ELIZABETHS HOSPITAL
WINFRED OVERHOLSER. . . . . Superintendent.
Appison M. Duvat.... . . Assistant Superintendent.
FEDERALLY AIDED CORPORATIONS
Fints Davis. ...... . . . Superintendent, American Printing House for
the Blind.
Leonarp M. Eustap. ... . . President, Gallaudet College.
Morprscai W. JoHNson .. . . President, Howard University.
REGIONAL DIRECTORS
Lawrence J. Bresnanan . . . Region I, Boston, Mass.
JosEPH B. O’Connor... . . Region 1I, New York, N. Y.
EpmMunD W. Baxter. ... . . Region III, Charlottesville, Va.
RicHarp H. Lyre... ... . . . Region IV, Atlanta, Ga.
MELVILLE H. HoscuH ... . . Region V, Chicago, Ill.
James Wo DOARN. . .. . . » Region VI, Kansas City, Mo.
Waweeen, BOND); 20. .°. ...*. Region VII, Dallas, Tex.
AuBert H. Rospenruat. .. . . Region VIII, Denver, Colo.
Fay W. Hunter... ... . . Region IX, San Francisco, Calif,
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Letter of Transmittal
DEPARTMENT OF HnmautTH, EDUCATION, 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, 1956.
Respectfully,
Secretary.
THE PRESIDENT,
Tue Wuitr Houvuss,
Washington, D. C.
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JUVITIM ONY ‘NOUWONGS HLIW3H 30 LNIWLYVdd0 S'N
Contents
The Secretary’s Report .
Social Security Administration .
Pere Health Service wo... 666.) <.
ee Of Fdiucation 2 jet ene
Food and Drug Administration .
Office of Vocational Rehabilitation .
Saint Elizabeths Hospital .
American Printing House for the Blind .
Gallaudet College .
Howard University .
A detailed listing of the contents of this report, by |
topic headings, will be found on pages 261-268.
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The Secretary’s
Report
AMERICA IS A LAND of change, of sometimes sudden, dramatic growth.
As an example, consider what happened in one 30-year period in
our history, the years spanning 1820 to 1850:
Americans had needed 200 years to spread their civilization west-
ward across one-third of the country, to the Mississippi River. Far-
ther west were only the Indians of the Great Plains, the fur traders,
and, a thousand miles southwest, a foreign land owned by Spain and
forbidden to Americans. Then, almost explosively, the westward
rush began. The “Winning of the West”—from the Mississippi to
the Pacific Ocean, from Canada south to Mexico—required only 380
years.
Now let’s advance a century to another 30-year period in our his-
tory: the immediate past.
Tt took only 30 years, from 1926 to 1956, for our population to in-
crease by 50 million, and our gross national product to jump from
$97.8 billion to $412.4 billion. During this period, American industry
grew to vast proportions, to bring to everyday use products unheard
of in 1926. Normal life expectancy increased more than 12 years in
this time, and many illnesses that formerly beset us were conquered.
High school enrollment more than doubled, and college attendance
increased by 34 percent. Almost every employed American gained
through social security assurance of a minimum economic founda-
tion. In our social and economic development, we have reached our
highest point in history.
Today we stand at a doorway, looking into the unfamiliar rooms
of the nuclear age, unsure of what changes the next 30—or even the
next few—years will unfold. But we know that changes will come
and that we, with preparation, must meet them.
2 Depariment of Health, Education, and Welfare, (1956
ccna EE
The Department of Health, Education, and Welfare, youngest in
our Government, is itself a erodes of our changing times, born of
this spirited economic and social development. Our particular areas
of service are vital—and as changing as the human needs of 167 mil-
lion people. Human beings—Americans alive, Americans not yet
born—give direction and meaning to our statigies and planning. As
each individual finds better health, improved education, and stronger
economic security, his own life is enriched and the welfare of the
entire Nation is advanced. |
In advancing human welfare, we not only face up to today’s needs,
but we look constructively to the future. This way of thinking, this
forward look, is the essence of our future growth—as individuals,
communities, States, and Nation. This effort—this working in the
present and for the future—represents an underlying philosophy of
this Department as we strive to serve the people of our country, to
help each individual realize his potential.
As we move forward in our social and economic development, one
of the most rewarding investments for the future hes in research.
Expanded research in health, education, and welfare represents a
constructive investment in human beings. But research cannot fulfill
our. bright hopes for progress unless ‘we apply more quickly and fully
the knowledge we obtain through research.
Progress and Plans in Health
In the decade since World War II, 614 years have been added to the
average life span, a blessing born mainly from better control of child-
hood infections and communicable diseases. Deaths from tuberculosis
and pneumonia have been reduced dramatically. Surgical techniques,
undeveloped 10 years ago, are now routine, and treatment by anti-
biotics has progressed to. a point that a decade ago would have ap-
peared as visionary. A treatment and prevention program has been.
developed. which strikes hard, at. rheumatic fever. Chemotherapy
holds hope of controlling some forms of cancer and mental illness.
The scourge of polio is on the wane.
The progress we can total up this past year reflects the chialenen
planning, and action of many individuals and groups: of the Presi-
dent, the staff of this Department, and members of Congress who gave,
fresh emphasis to the enactment of important health legislation; of
the universities, hospitals, private laboratories, and. great philan-
thropic. organizations which devoted much. of. their effort to. better
health; of the scientists who labored to bring forth new. knowledge
and those in the medical profession who. worked daily. to bring the
benefits of medical knowledge to the people; of the local and State
governments which played their significant role in improving health.
The Secretary’s Report . 3
To all the people who, in one way or another, supported advances in
health, we owe these proud gains. |
HEALTH RESEARCH PROGRAM
Since World War IT, medical-research expenditures from all sources
have increased more than fourfold—from $60 million in 1945 to $270
million in’1956. This may seem an impressive figure, but it represents
only 5 percent of our total national expenditure for research and
development. Considering the potential humanitarian and economic
“gains from medical research, this proportion is small indeed.
Congress allocated $99 million to the National Institutes of Health,
principal research arm of the Public Health Service, for use in the
past fiscal year. These funds were greatly increased for the fiscal
year 1957. Most of this sum is allocated, in turn, for medical research
by scientists in hospitals, medical schools, and universities throughout
the country. )
Our major aim in medical research today is to find the basic causes
_ of those chronic diseases which kill and cripple so many of our people.
~The greatest killers—diseases of the heart and arteries—account for
almost half of all deaths. Cancer claims nearly 250,000 lives each
year.
But death alone does not define the full tragedy of chronic diseases.
We cannot begin to measure the hurt to each family represented in
these statistics: diabetes, 2 million people; epilepsy, 142 million
people; arthritis and rheumatism, 10 million people. And the trend
~ in chronic disease is upward, since older people who are most suscep-
tible account for an increasingly large proportion of our population.
Last year a number of specific and important findings were associ-
ated with our Institutes or with Institute-supported work. In the
fight against cancer, the chemotherapy program was rapidly expanded.
Qur scientists report that increasing emphasis is being given to basic
research into biochemistry of the cell. In another direction, during
the year, final data were collected on a test for the early detection of
uterine cancer. This test, conducted for 3 years as a pilot project in
Memphis, Tennessee, has been undergoing trial in.eight other cities,
with a view toward full national usage and the eventual elimination
of this form of cancer. During the coming year, the National Cancer
_Institute plans to develop application of the test to other parts of
the body.
The study of cerebral palsy has recently received increased emphasis.
Last year an intensive, nationwide research program was initiated to
seek out the causes and improve treatment of this disease that afflicts
some 300,000 of our children annually.
In the past we have perhaps given more emphasis to funds for
current medical research and have attached less importance to two
4 Department of Health, Education, and Welfare, 1956
isa Pn Oh ero areca aA RNAI RRM
other requirements for progress in health: adequate medical-research
facilities and well-trained manpower. However, we cannot afford
to neglect any one of these three factors, for each is important in our
total efforts toward better health. Last year the President recom-
mended to Congress a $250 million, 5-year program for grants to build
facilities for medical research and for medical education to train
more doctors. Congress subsequently authorized an annual grant
of $90 million for a 8-year period to medical schools and universities,
hospitals, and other nonprofit institutions to construct and modernize
their research facilities. Congress made no provision for aid to build
medical teaching facilities.
HOSPITALS
We have just completed the tenth year of operation under the local- _
_ State-Federal program of hospital construction. During this decade
more than 2,000 federally aided hospitals and health centers were
built and are now in operation, including 550 new general hospitals
in communities where people had never had a suitable hospital before.
An additional 800 projects are now planned or under construction,
including 325 approved last year. Asa result of this orderly planning
on a nationwide basis, projects completed or approved as of June 30
amounted to a grand total of more than 136,000 hospital beds and 750
health units for outpatient care.
The administration proposed an important new phase in our entire
hospital program, which was approved by Congress. ‘This was the
extension of the program in 1954 to include Federal aid for four new
categories: nursing homes, chronic-disease hospitals, diagnostic and
treatment centers, and rehabilitation facilities. By June 30, 1956,
204 such projects had been approved. They will provide 4,500 beds
and 120 units for outpatient care. To the extent of their use, they
will free our general hospitals to serve the more acutely ill. The first
construction under this new program began with Federal approval in
July 1955 of a 58-bed nursing home in Florence, Arizona.
NURSING SERVICES
Advances in surgery and medicine have increased the responsibili-
ties of our nurses and enlarged their workload. This, combined with
current shortages of trained nurses, has created a serious problem in
providing hospital care of patients. Last year a research program
was launched to improve nursing services, and, as a result of this study,
the Public Health Service has demonstrated ways in which hospitals
may make better use of their nurses and improve patient care. A|-
ready 113 hospitals in 14 States have been helped in this phase of their
work, and eventually these improvements will be of practical use to
- hospitals throughout the country.
The Secretary’s Report ions 5
To ameliorate the nursing shortage, legislation was sponsored by the
administration and enacted last year to train additional nurses in
teaching, administrative, and supervisory capacities. In addition, $2
million was made available to educational institutions and individuals
to train rehabilitation workers in such positions as nursing, physical
therapy, and occupational therapy. At the close of the fiscal year,
$2 million was also provided for the training of practical nurses,
whose work will free professional nurses for their more. responsible
duties.
POLIOMYELITIS PROGRAM
During the fiscal year 1956 the manufacture of poliomyelitis vac-
cine was greatly increased, and, under a voluntary priority apportion-
ment system, administered by the Federal Government and the States,
vaccine was used throughout the Nation on a broadening scale. The
program was aided by a congressional appropriation of $53 million to
help purchase vaccine. By the end of the year, enough vaccine had
been released to provide some protection for all children under 20 and
expectant mothers. _
Studies of the effectiveness of the vaccine were conducted in cooper-
ation with the States and Territories. As a result, scientists decided
that the vaccine may be given with good results in the summer and
during epidemics, and it is now clear that, even with only one or two
doses, the vaccine reduces the risk of paralytic poliomyelitis by about
75 percent. |
State by State allocations under the voluntary distribution plan
were discontinued in August 1956, when supplies of the vaccine be-
came more plentiful.
INDIAN HEALTH
At the beginning of the fiscal year, the Public Health Service, by
act of Congress, assumed responsibility for providing medical care
and health services to some 350,000 Indians and Alaska Natives. This
responsibility was transferred from the Bureau of Indian Affairs in
the Department of the Interior. }
Historically, our Indians and Alaska Natives have been isolated
both geographically and culturally from the mainstream of progress
that brought health rewards to each succeeding generation of Ameri-
cans. The health needs of these people are critical. Their average
age at time of death, for example, is 839—-compared with 60 for the
general population.
Most of their illnesses are tragically due to.causes than can be pre-
vented. For this reason, the Public Health Service has accelerated
its program of disease prevention. More than $4.3 million was spent
\
6 Department of Health, Education, and Welfare, 1956
—_———
in. this effort during the year, and more than 500 of the A, 150 Indian
health staff were engaged in preventive health activities.
HEALTH SURVEY
At the close of the fiscal year, the President signed a bill, proposed
in his health message, authorizing the Public Health Service to conduct.
a continuing national health survey, the first such Federal survey in
20 years. When we understand more clearly the extent of illness
and disability in the Nation, we can with more accuracy appraise
our needs, with more effectiveness use our medical manpower and
facilities. These statistics, brought up to date every year, will be
of tremendous significance to.all who work in the cause of health.
OTHER NEW AND EXPANDED PROGRAMS
Steps were taken to help States initiate or expand health services for
migratory labor and rural areas. Programs for study of the special
medical problems of older people were enlarged. Plans were com-
pleted for a special accident prevention unit which began work at the
end of the fiscal year. Civil defense training programs for sanitary
engineers and other public health officials were conducted in all parts
of the Nation. :
Air pollution and water pollution constitute community health
hazards and threaten, in varying degrees, our social and economic
well-being. New legislation materially ten rthen an and improved
the, Federal Water Pollution Control Act, providing for expanded
research and simplified measures for enforcement. Program grants to
State and interstate water-pollution agencies were authorized and
also grants to municipalities for construction of sewage-treatment
works,
Air-pollution research was considerably expanded during thes year,
following legislation enacted in 1955. _ Various aspects of this problem
are being studied by the Public Health Service’s facilities and in
cooperation with other Government agencies. In addition, during
the year a number of grants were made to private institutions, agencies,
and individuals for additional research into the problem of air pol-
lution.
Progress and Plans in Education
To each American his individual education is a matter of urgent
personal importance, a foundation stone he must stand upon to reach
his greatest potential. In our country, our free educational system is
basic to progress. We must strive constantly toward this goal—that
every child has the opportunity for learning to the full extent of his
ability.
The Secretary’s Report Z
Many deficiencies in our school system today are an inheritance
from the 20 years from 1930 to 1950. School construction ebbed dur-
ing that first decade of economic depression and low birthrate and, be-
cause of labor and material shortages, came to an almost ‘complete
halt during World War II. The problem has been aggravated in the
past 10 years by a 40-percent increase in school enrollment. Last fall
40 million full-time students from kindergartens to colleges—nearly
one-fourth of the total population—swarmed into overcrowded
schools. By 1960 we may expect to have 48 million students.
Since 1950, when States and communities spent about $1 billion to
build 36,000 new classrooms, public school construction has increased
era last year an estimated 63,000 new classrooms were built at
a cost of about $214 billion. But even as the construction rate spiraled
upward, new schools failed to meet expanding needs. While some
progress has been made toward reducing the deficit, 1t will take many
years at the current rate of construction to eliminate the classroom
shortage. ,
On the basis of reports from the States, 80,000 new classrooms were
needed in the 1955-56 school year to accommodate about-214 million
pupils enrolled in excess of the normal capacity of the public schools.
The Office of Education estimates an increase of more than 6 million
children in our public schools during the next 5 years. At 30 pupils
per room, this would require 200,000 new classrooms for the increased
enrollment alone. In addition to these needs, many thousands of
classrooms will need replacement.
To help meet the needs of our children for more schools, the Presi-
dent proposed a program of Federal aid in providing these des-
perately needed classrooms. The President had asked for authoriza-
tion of appropriations totaling $1.25 billion over a 5-year period in
Federal grants to the States to build schools in needy communities.
He had also requested authorization of $750 million for the purchase
of school bonds in districts with marginal credit. Congress failed to
act upon these, proposals.
We have just completed the sixth year of operation under the two
_ laws providing for Federal assistance to schools and school construc-
tion in areas where the public elementary and secondary school popu-
lation is especially increased by Federal activity. During this fiscal
year, $85.2 million was paid to such schools to assist in meeting annual
operating expenses on behalf of 980,000 students. To build new
schools in these areas, $43.4 million was approved. Over this 6-year
period, a total of $621 million was allocated, and this new. construc-
tion now houses some 900,000 school children. |
Recognizing the somnpler and. pressing problems facing our mee
today, the President initiated a nationwide citizens’ study of our edu-
cational system from elementary school through high school. Half
8 Department of Health, Education, and Welfare, 1956
iA a8 AS ed PLN DEMEANOR AAEM
a million people took part in 4,000 meetings all over the country.
These meetings, devoted to local school needs and problems, cul-
minated in the White House Conference on Education in the fall of
1955. The report to the President from the 34-member Committee for
the Conference contains 72 specific recommendations for improvement
in elementary and secondary education—a much-needed springboard
for the solution of school problems. The gains from a sharpened
public interest in education are immeasurable, for ultimately it is the
people who determine the quality and quantity of education in
America. ;
Many of the 40 million children now overflowing our elementary
and high schools soon will be at the doors of our colleges and universi-
ties. Action and planning are imperative now, and on a broad scale,
to meet the educational needs not only of those who complete high
school but also for those adults who need further educational oppor-
tunities in the sciences and professions and in the liberal arts. For
this reason, the President in April 1956 appointed a Committee on
Education Beyond the High School, composed of 85 prominent lay
leaders and educators. The committee will study and make recom-
mendations for action to help solve the fundamental problems that
beset higher education today—problems which will become more acute
tomorrow unless we remedy them.
_ In 1956 the administration proposed an unprecedented 100-percent
increase in funds for the Office of Education—from $314, million to
$6 million. Congress approved more than $514 million for operation
in fiscal 1957, a 65-percent increase. As a result, many services to
schools all over the country will be expanded and new services inaugu-
rated. Importantly, much-needed educational research can begin.
EDUCATIONAL RESEARCH
One of the serious defects in our educational system in the past has
been the lack of adequate research upon which to base our planning
for tomorrow and our decisons today. We spend annually some $15
billion to build and operate our schools, from kindergarten to college.
But we have spent less than a half million dollars to make our educa-
tional system, in its actual functioning, more efficient and responsive
to the needs.
In the spring of 1956 Congress appropriated a little over a million
dollars for cooperative educational research. This money, meager
as it is compared with the nationwide need, is eagerly sought. By
mid-July the Commissioner of Education had received 70 preliminary
proposals from nearly as many institutions and agencies; by the end
of August, 55 more proposals had been made. The Research Advisory
Committee will evaluate proposals throughout the year. If funds
are not available at the time a project is approved, it will be deferred
until they become available.
The Secretary’s Report nasal Ne 9
By October 1956, 29 projects had been recommended for support.
These include research into the important areas of education of the
mentally handicapped, the development of special abilities of students,
the relationship of education to juvenile delinquency, and the Hite
lem of why so many capable students drop out of high school and
college.
Progress and Plans in the Food and Drug
Administration
The food and drugs that we consume every day are vital to our
life and health. The year 1956 marked the fiftieth anniversary of our
first Federal food and drug law and brought a rededication to the
ideal of maintaining in our food and medicines the highest degree of
purity.
Time has dimmed somewhat the records of deplorable conditions
a half century ago that led to the first food and drug legislation. No
greater tribute can be paid the work in consumer protection than that
the public, generally, takes it for granted.
The past two decades brought a revolution in food and drug con-
sumption. The bulk foods of a generation or more ago have been
replaced by packaged and frozen food and prepared mixes. The aver-
age large market now stocks over 5,000 items, compared with about
1,000 items carried by the general store before World War II. The
drug industry expanded and its production methods changed as new
drugs and medicines were developed, beginning with the sulfa drugs of
the 1930’s and continuing to the antibiotics and tranquilizing drugs
of today. New drugs approved for safety since 1938 account for more
than 90 percent of all prescriptions written today.
Every year more than $60 billion worth of food and drug erect
subject to Federal inspection move in interstate commerce through
some 100,000 factories and warehouses. This has greatly increased
the responsibility of the Food and Drug Administration. Its limited
staff and facilities were unable to keep pace with the changes in food
processing or with the unparalleled progress in pharmaceutical re-
search and development.
Karly in 1955 a Citizens Advisory Committee was established to
study the needs of the Food and Drug Administration in meeting its
responsibilities. Some of the recommendations included in its report,
submitted in June 1955, are now moving toward reality. These include
congressional Ge of a new headquarters and laboratory build-
1 By the end of December 1956, 79 cooperative educational research projects had been
recommended by. the Committee for support.
408691—57——2
10 Department of Health, Education, and Welfare, 1956
ing and a 15- “percent increase in appropriations for 1957. Internal
reorganization is under way to provide maximum efficiency.
This progress will aid the Food and Drug Administration in its
effort to catch up—and keep up—Ww ith its ‘complex job. Further
expansion would mean, simply, improved service to American indus-
try and increased asta for American consumers.
An important part of the work being done to safeguard the public
health is the constant war against worthless or illegal medicines.
Curative claims of useless “remedies” lead the seriously ill to turn
away from competent medical treatment. During the year, an exten-
sive Investigation was made into the sources of sale of amphetamine
to truckdrivers, whose use of this stimulant jeopardized highway
safety. Conditions are now improved in the South Atlantic States
where the campaign was most active.
Asa part of its civil defense activities, the Food and Drug Adminis-
tration last year instructed approximately 2,000 people in the han-
dling of problems inherent in an attack employing chemical, biolog-
ical, or nuclear weapons and in procedures necessary to test products
so exposed and to restore a safe food and drug supply. This infor-
mation was provided through 53 5-day courses in 45 States.
Teams of workers stand ready to go to all critical problem areas to
assist local and State agencies. Their help was needed last August
when Hurricane Diane lashed through the New England States, caus-
ing serious damage to commercial stocks of food and drugs. During
the Christmas holiday season, northern and central California suffered
the worst flood in the State’s history. As the waters receded, Food
and Drug Administration workers were on hand to assist in protecting
the public from contaminated food and drugs.
Progress and Plans in Social Security
One of the strongest intrenchments against human distress in our
country today is the Federal system of old-age and survivors insur-
ance. Some years must still pass before the entire impact will be felt,
when the first full generation of Americans completes its oonaee Fife
under the provisions of the Social Security Act.
In the past year the social security system continued its steady
srowth toward maturity. By June 1956, nearly 8.4 million people
were receiving benefits at a rate of $5.3 pilliod a year. Nearly 80 per-
cent were over 65 years of age, representing three- fourths of) our
retired aged population. |
As the fiscal year closed, legislation was effected to widen the area of
protection even further. The amendments of 1956, signed by the
President on August 1, extended coverage to *heliitte military per-
sonnel, lawyers, dentists, osteopaths, other self-employed persons,
The Secretary’s Report HH
and more farm owners and operators. Thus, more than 9 out of 10
employed persons in the country are eligible for coverage under the
social insurance program. The broadened program includes cash
payments for totally disabled workers aged 50 and over and, in spe-
cific instances, for disabled children over 18 years of age. Widows are
now eligible for social security benefits at age 62. Other women may
receive reduced benefits at the same age.
PUBLIC ASSISTANCE—A CHANGED EMPHASIS
From Federal and State funds, public assistance is now being paid
to 5 million Americans. These are the needy aged, blind, totally dis-
abled, and dependent children. Every State now administers Fed-
eral funds under the Social Security Act to aid those in need.
The Federal-State public assistance programs, established in the
depression days of economic catastrophe, naturally and properly
placed emphasis on providing cash income to meet immediate needs.
Today we recognize that we have a deeper duty to those in need than
the mere payment of cash benefits. For many, disabled to the point
where they have little hope of supporting themselves or their families,
we should assume the responsibility of offering services leading to self-
care. Others receiving public assistance may be capable of future
independence, and the best service we can provide is to help them
build toward independence and a rich and full life.
The administration has a firm objective to develop services leading
to self-care, self-support, and the strengthening of family ties. This
latter goal becomes particularly compelling when highlighted by
statistics: 48 percent of all recipients of public assistance are in the
aid to dependent children program, and more than half of these young
people are dependent because of divorce, separation, unwed parent-
hood, or the desertion of the father. -
New legislation, proposed by the administration and directed to
these constructive objectives, was enacted by Congress during the year
and will become effective in July 1957. Authorizations include $5
million to launch a program of cooperative research into the causes
of poverty and ways of overcoming them. The legislation also in-
cludes an amendment to the Social Security Act to help States train
_more workers for the public assistance program. If full advantage is
taken of this opportunity, within 5 years an additional 5,000 to 6,000
professionally trained social workers will be available throughout the
country to help overcome the complex problems of dependency.
The medical needs of the aged, the sick, and handicapped far exceed
the facilities and services available. The new law authorizes Federal
grants to the States on a matching basis to help make up this defi-
ciency. This is, of course, apart from public assistance payments to
individuals.
2 Department of Health, Education, and Welfare, 1956
A ee UE ETN PS Ll re Nat IR NEP URE A UEIE ST
CHILD WELFARE SERVICES
Upon the administration’s request, the 84th Congress increased from
$10 million to $12 million the appropriation authorized to the States
for child welfare services. Besta ,
The regular programs of the Children’s Bureau, as in the past, made
notable contributions to the physical and ae well-being of our
children. Major current concerns are to provide social service to
children in all geographical areas and to aid children who are mentally
retarded or emotionally disturbed.
JUVENILE DELINQUENCY
Juvenile delinquency continues as a deep concern of the Department.
In the past 7 years, the increase of youngsters appearing in courts
has been 4 times greater than the increase in this population group.
Many units of the Department are at work on both the prevention
and treatment aspects of this problem. The Division of Juvenile
Delinquency Service, established in 1955 in the Children’s Bureau,
offers professional consultation to public and private agencies. The
Bureau’s programs for helping parents, professional workers, legal
authorities, and others to meet their responsibilities to youngsters are
potent pareas on the side of prevention.
The Office of Education, through its research, consultation, and
erants, assists educators in making school years a more meaningful
and constructive experience for boys and girls. Significant research
into the etiology of disturbed behavior of children and diagnostic —
techniques, conducted or financed by the Public Health Service, gives
promise of better handling of delinquent and predelinquent youth in
the future. In still another way, the Food and Drug Administration
works at this problem through its control of habit-forming and stimu-
lant drugs. The underpinning to family income provided by old-age
and survivors insurance and through the Federal-State program of
aid to dependent children is a strong factor in the prevention of
delinquency. |
To help States and communities make new or more vigorous efforts
to cope with their delinquency problems, the administration supported
bills introduced in the House and Senate which would provide a
5-year program of grants for planning and coordinating services, for
training workers, and for study. These bills failed of passage.
Progress and Plans in Vocational Rehabilitation
For several years there was a downward trend in the annual number
of handicapped people restored to productive jobs. Then, in 1954,
legislation was effected to expand the Federal grants-in-aid program
for rehabilitation.
The Secretary’s Report . 13
By 1956, $31 million became available to State rehabilitation pro-
grams, an increase of $6.5 million over the preceding year. Under
this broadened program, which created new opportunities for coopera-
tion between public agencies and private groups, the downward trend
was reversed. During the year 66,273 handicapped persons were re-
turned to useful lives, the highest total in the history of the program
which began in 1921. In the first year after their rehabilitation, these
people will earn an estimated $119 million, compared with their pre-
vious annual earnings of $17 million.
Such monetary rewards are secondary to the humanitarian aspects—
the increased self-respect gained by each handicapped individual as he
advances to the dignity of self-support. As a further gain to the
States and the Nation, during the year 3,500 rehabilitated people en-
tered the professional fields of education, medicine, and engineering,
where additional manpower. is urgently required. More than 8,000
now work in skilled trades, and 6,000 work on farms.
Aware of the value of private effort in this kind of enterprise—and
particularly at the community level—the Federal Government granted
_ $1 million to voluntary groups for the expansion of rehabilitation
facilities. Thissum represents 90 percent of total Federal funds.
During the year, $2 million was made available to educational insti-
tutions for teaching grants in the field of vocational rehabilitation, in
specific areas such as social work, counseling, and occupational and
physical therapy; and 2,000 students were aided in traineeships.
From these colleges and universities will come the professional work-
ers we need in this understaffed field.
An expanded research program, with a view toward the eventual
rehabilitation of a maximum number of people, was long overdue.
Grants totaling $1.2 million were approved for partial support of 39
special research and demonstration projects. These nationwide stud-
ies, though small compared with their urgency, are as varied as the
needs of the disabled. In charting a path for this research, the
Office of Vocational Rehabilitation is fortunate to have the benefit of
an advisory council composed of an outstanding group of national
leaders in medicine, education, rehabilitation, industry, and labor.
Every year, 250,000 persons become in need of help from rehabilita-
tion programs. Some of them are being rehabilitated through the
Federal-State program. Other handicapped persons are rehabili-
_ tated through private and voluntary efforts. Others have short-term
impairments, die, or leave the disabled group for other causes. Yet,
on a national annual average, 2 million people need the help vocational
rehabilitation should be able to offer.
14 Department of Health, Education, and Welfare, 1956
Progress and Plans for the Aged
Older people account for an increasingly larger percentage of the
American population. Today there are 14 million persons 65 years of
age or older. By 1975 the number is expected to climb to 21 million.
The social and economic implications of an aging population are many ~
and varied, and the whole subject matter is of increasing national
concern. |
Many of the problems of our aging population rise from basic
changes in our economy and our society. The movement of people
from a rural environment into cities, our greater industrialization, our
attitudes toward the value of work by older people, even the current
accent on youth in our culture—all these contribute to the complex
problems of growing older.
There must be an economic and social framework in America within
which older people can live usefully and with a sense of purpose.
Nothing less than this is required for each older person as a human
being; nothing less would be consistent with the national interest.
Among many factors, this framework must embrace employment for
those who are able and want to work, sufficient retirement income for
others, suitable housing, improved health, and satisfactory leisure.
Primary responsibility for meeting these needs rests, of course, with
the individual, his family, and his community.
The Federal Government, however, has long carried on many activi-
ties which bear directly or indirectly on the welfare of older persons.
In more recent years, the Government has been giving increasing
thought and emphasis to these activities.
Every major unit in the Department of Health, Education, and
Welfare conducts some activity relating to the welfare of older people.
The old-age and survivors insurance and old-age assistance programs
are basic to income maintenance of older people. Various programs
of the Office of Education and the Office of Vocational Rehabilitation
are of special service to older persons. Expansion of the Public
Health Service’s hospital construction program places particular
emphasis on nursing homes, geriatric clinics, and chronic-disease
hospitals. Research in the chronic diseases, which are more preva-
lent among older people, has been greatly expanded by the Public
Health Service. |
To coordinate and broaden the activities of various Federal agencies
whose responsibilities include programs relating to older persons, the
President in April 1956 created the Federal Council on Aging. The
Council is composed of 18 Federal departments and agencies—the
Departments of the Treasury; Interior; Agriculture; Commerce;
Labor; and Health, Education, and Welfare; and the Office of Defense
The Secretary’s Report 15
Mobilization; U.S. Civil Service. Commission; Veterans Adminis-
tration; Housing and Home Finance Agency; Small Business Admin-
istration; National Science Foundation; and Railroad Retirement
Board.
The Federal Council and the Council of State Governments jointly
sponsored in June 1956 the first Federal-State conference ever held
on the problems of the aging. The conference served to coordinate
and provide impetus to the work being done by the Federal and State
governments on behalf of older people. The conference provided an
opportunity for discussing the nature and impact of the problems
of an aging population and the experience gained from specific pro-
grams designed to meet the needs of older people. Thus, the States
were better equipped to develop principles for administrative, legisla-
tive, and community action to benefit older people.
The efforts of many individuals, of private organizations, and of
government at all levels—Federal, State, and community—are re-
quired to establish the climate and opportunity for older people to
live in dignity and make their contribution to the progress of the
Nation. But the efforts of all organizations and government units
must, in the end, be directed to producing such a climate and oppor-
tunity in the community. For it is in the community—his immediate
living environment—and nowhere else that the older person will find
personal satisfaction and impart the benefits of his experience, wis-
dom, and skills into the mainspring of American life.
* *K * Kk & *
All Americans owe a debt of gratitude to those who, in their chosen
fields of endeavor, have worked faithfully through the year in the
cause of human betterment. That flowing tide of Americans of the
last century who pounded across mountains and plains and won the
wilderness country were never, in their own time, accorded such a
resounding name as pioneers; they were simply “the movers.” Nor
do we today call our doctors, nurses, scientists, social workers, and
teachers—pioneers. But we may acclaim them as “movers.” Their
daily contributions and plans for the future have moved our country
one more year ahead in a steady progress toward better health, im-
proved education, and a deeper foundation for economic security.
16 Department of Health, Education, and Welfare, 1956
.—Grants to States: Total grants under all Department of Heslile
Education, and Welfare programs, fiscal year 1956
[On checks-issued basis]
Social Office of | American
States, Territories, Security Public Office of | Vocational | Printing
and possessions Total Administra- Health Education | Rehabil- House
tion Service itation for the
Blind
TotalLel ? Ae ae $1, 835, 819, 489 /$1, 488, 897, 227 |$104, 959, 947 |$208, 633, 750. /$33, 094, 565 | $234, 000
Alabamian Jee) Ja bere 50, 826, 270 42, 034, 093 3, 282, 676 4,441,564 | 1,062, 927 5, 010
PAT IZON Gee ot oe el oan 13, 066, 000 9, 735, 759 439, 019 2, 659, 106 230, 592 1, 524
Afrkansdstiti2t it 20a Joeh 27, 884, 530 23, 024, 583 1, 633, 568 2, 575, 559 645, 426 5, 444
Callformigh: 2s ye. a 202, 084, 798 162, 314, 461 6, 741, 226 | 30,958,570 | 2,054, 702 15, 8389
Coloradosti tts /°hbho- 33, 288, 377 27, 814, 440 617, 795 4, 551, 669 302, 046 2, 427
Connecticute 2c 232k. 17, 508, 205 18, 341, 470 707, 146 3, 015, 738 440, 459 3, 392
Delaware 2b) i292 tay BEY 2, 678, 636. 1, 983, 246 136, 179 373, 261 184, 861 1, 089
District of Columbia____ 5, 646, 763 4, 644, 885 507, 635 106, 999 386, 155 1, 089
Hiloridat i 22 22b2 sa ELE 48, 245, 061 39, 770, 274 2, 835, 021 4, 473, 567 | 1,161, 220 4,979
GeONCIA: ce see ee 60, 369, 378 48, 590, 425 4, 263, 980 5, 727, 555 |. 1, 780, 821 6, 597
TAT O tae geen ne treet 6, 858, 872 5, 309, 679 462, 299 1, 009, 966 75, 901 1, 027
Di Ois 222 a Gd Ds ee 74,705, 263 65, 492, 349 3, 023, 164 4, 687,295 | 1,491,315 11, 140
Tadianigelcn sae 4 emcee 23, 727, 063 19, 365, 699 1, 486, 139 2, 453, 746 417, 465 4,014
Towa 235 3 hte es 24, 307, 685 21, 433, 720 1, 160, 884 1, 175, 270 533, 847 4,014
KanSase mt see uk te 2 26, 863, 126 19, 126, 850 2, 070, 170 5, 289, 763 373, 760 2, 583
Kentucky Jisce 27a 35, 572, 244 30, 420, 708 2, 718, 979 2; 122, 618 306, 143 3, 796
Touisiana 2b Cae. 74, 546, 005 68, 935, 053 3, 443, 860, 1, 228, 429 939, 338 4, 325
ames icpael “Ue 10, 954, 095 8, 606,251 | - 926, 282° 1, 232, 956 188606). 2o202 Pad
NMarvlandne. | 2 ra eo 23, 730, 857 11, 469, 840 1,788, 824 | 10, 128, 904 338, 528 4, 761
Massachusetts_____.__._ 55, 994, 939 50, 612, 714 2, 595, 380 2, 196, 372 580, 827 9, 646
Michigan. 24 fa. UCase + 55, 698, 277 43, 810, 423 3, 336, 332 7, 292,818 | - 1, 242, 564 11, 140
Whinnesotalt bee 32, 288, 768 27, 333, 889 2, 585, 095 1615, 00) 748, 581 5, 632
Mississippi: 230i yh 29, 637, 561 25, 522, 264 2, 185, 928 1, 485, 190 440, 165 4,014
IMEISSOU Ie eek ot aes 81, 317, 654 73, 360, 958 3, 006, 991 4, 183, 467 761, 602 4, 636
Montanagiciisti wii. 8, 036, 245 5, 998, 121 347, 456 1, 582, 877 157,013 778
ING DPSS Kae ese eae ences 13, 018, 249 OT opeog 1, 064, 340 1, 954, 805 284, 378 1, 494
Nevada in. ioe as 3, 814, 267 1, 610, 218 522, 835 1, 648, 914 32,/300 (Ss _Se rte ies
New Hampshire____-___- 4, 821, 566 3, 435, 316 507, 479 777, 843 100; 928. |e Guar
New Jersey_______-___-- 21, 343, 280 16, 2838, 950 1, 636, 717 2, 690,191 724, 549 7, 873
New Mexico! 7 15, 246, 841 8, 340, 200 489, 655 6, 266, 140 148, 543 2, 303
INGW2 Ola aera ca 125, 570, 602 109, 824, 096 7, 595, 281 5, 717,475 | 2,415, 360 18, 390
North Carolina..._____- 41, 995, 690 34, 108, 765 4, 004, 351 2, 584, 204 | 1, 286, 763 11, 607
North Dakotas ests oe 6, 616, 937 5, 054, 897 830, 513 558, 882 176, 743 902
Oi ssp k se ate 69, 088, 592 57, 903, 399 2, 871, 084 7, 545, 160 753, 618 10, 331
Okighoma via t rie 62, 770, 417 52, 192, 165 1, 712, 900 8, 215, 876 646, 955 27521
Oregoned 22 ee st 14, 322, 982 11, 924, 728 801, 306 1, 178, 618 415, 348 2, 987
Pennsylvania___________ 63, 349, 638 51, 691, 646 5, 626, 832 3,477,117 | 2,539, 169 14, 874
Rhode Island______-__-- 8, 431, 464 6, 517, 833 425, 591 1, 318, 625 P74, 405 pes ane SE
South Carolina_.._____- 25, 242, 313 20, 328, 842 2, 185, 893 2, 194, 223 535, 212 3, 143
South Dakota________-- 8, 775, 437 6, 355, 725 527, 071 1, 744, 954 146, 318 1, 369
Tennessee._---_-----_-- 42, 089, 272 33, 523, 104 4, 475, 448 3, 198, 899 886, 500 5, 021
Texagitiees “Piast hei 112, 615, 158 94, 024, 135 4,499, 252 | 12,954,224 | 1,128, 274 9, 273
Wits woe oe ee ee 9, 726, 044 6, 991, 217 438, 741 2, 152, 490 142, 133 1, 463
Vermont... etary 4,772, 075 4, 052, 617 298, 765 279, 944 140: 740i | Ae pews age
Wir cinta oe Clee 2 ies 8 34, 578, 194 13, 460, 304 3, 775, 994 | 16,392, 764 943, 344 5, 788
Wiashinetom asic ey tf 43, 159, 989 33, 773, 092 870, 545 7, 937, 557 675; 372 3, 423
West Virginia... 2.213 24, 195, 683 21, 087, 007 12513) 352 808, 180 783, 877 3, 267
Waseonsin.. tana? 27, 248, 743 22, 648, 401 2, 548, 009 1, 420, 260 626, 005 6, 068
Way ORANG 8 ee wa 3, 545, 319 2, 489, 849 182, 155 784, 313 89" 002) tala
AJaSkae! i a colander wal, 6, 513, 670 2, 015, 019 397, 951 4, 018, 213 82; 4S fei eee
Hawaii: fei eating 7, 837, 671 3, 942, 956 186, 342 3, 520, 764 187, 142 467 ..
PusrtosRicO se Jo. ees 8, 842, 070 5, 213, 904 2, 590, 248 751, 456 284, 222 2, 240
Virgin Islandss.2-._-J.2 432, 231 3438, 506 50, 896 37,8291 (RES ote ta ee eee
Canal Zone. 2 Iss Ui aes 2 eae, eer rte 151) op ce Ee ee
COU aT 2 tee ce ets ee DOA ota re are oe 11,042 |. 222 po ee ee
America Samoa_____-__- 7 2S0 hy ee i 17, 280 |-2 222022 k |S eres
Social Security
Administration
Social Security in 1956
In June 1956, the programs of old-age and survivors insurance and
public assistance were serving as a major source of income for nearly
13 million people, with payments at.an annual rate of almost $8
billion. About 8.7 million of them were aged 65 and over; this group
represents three-fourths of the Nation’s retired aged population.. The
research and service programs of the Children’s Bureau were carried
forward during the year. Federal credit. unions continued to expand
throughout the country.
As the fiscal year closed, legislation was in process to effect a wide
range of changes in old-age and survivors insurance and the public
assistance programs.
The amendments extend the coverage of old-age and survivors in-
surance to. about 600,000 additional farm owners or operators and
about 200,000 self-employed lawyers, dentists, osteopaths and others.
The only groups of self-employed: professionals remaining outside
the scope of the program are doctors of medicine and Christian Science
practitioners. Under separate legislation, coverage on a contributory
basis was extended to almost 3 million members of the Armed Forces.
The old-age and survivors insurance program was amended through
the addition of disability benefits for certain permanently and totally
disabled workers aged 50 and over, and for adult. children of deceased
or retired workers if the children had been permanently and totally
disabled before reaching age 18 and remained so to the date of the
award. | ) i Be i 7
Another major change is in the provision of benefits for. women
prior to age 65.. The retirement age for women is reduced to 62, with
full benefits for widows and female dependent parents and, with an
_actuarial reduction in the benefit amount for wives and women workers.
Accompanying the provisions for payment.of cash benefits to dis-
abled workers at age 50 was a provision for an increase in the contri-
17
18 Department of Health, Education, and Welfare, 1956
re Sg Kg pp hte Ra
bution rate to finance these benefits. The additional contributions
amounting to one-fourth percent each for employees and employers,
and three-eighths percent for the self-employed, will be automatically
appropriated to a separate disability trust fund.
The amendments relating to public assistance that were recom-
mended by the Administration place new emphasis on helping needy
people to build toward greater independence. The amendments en-
courage the provision of appropriate social services ; to assist in making
trained individuals available for providing more services and in in-
creasing the effectiveness and efficiency of public assistance adminis-
tration, grants are made available to States for the training of welfare
personnel. In addition to an increase in Federal matching on main-
tenance payments, the amendments provide for separate matching
to help States pay for more adequate medical care for assistance
recipients.
The authorization for grants for child welfare services was raised
from $10 million to $12 million a year.
Another amendment provides grants and payments under contracts
or cooperative arrangements to States and to public or other non-
profit organizations to pay part or all of the cost of research or demon-
stration projects, such as those related to preventing or reducing
dependency, or for the coordination of planning between private and
public welfare agencies, or which will help improve the administration
and effectiveness of programs under the Social Security Act.
These amendments obviously have important implications for the
future as well as for the millions of people who now took to the social
security programs for economic security and for a variety of services.
As a result of steady growth throughout the year, the number of
beneficiaries of old-age and survivors insurance had reached 8.3 mil-
lion in June 1956, an increase of 11 percent during the year. Eight
out of every 10 of the beneficiaries were aged 65 and over; the 6.6 mil-
lion aged beneficiaries were about the same proportion of the total
benefit rolls as in June 1955.
While the number of aged persons receiving insurance benefits was
rising at an average rate of almost 1 percent per month, the old-age
assistance caseload was dropping slightly. The 1-percent decline over
the year brought the number of recipients to 2,524,000 in June 1956.
In relation to our growing aged population, this decline over the past
few years has been more significant. In the autumn of 1950, when
old-age assistance caseloads first began to drop, 23 out of every 100
persons aged 65 and over received assistance. At the end of fiscal year
1956, the ratio was down to 17 per 100. Over the same period, the
ratio of aged insurance beneficiaries to the total aged population has
risen from 19 per 100 to 45 per 100.
Social Security Administration 19
With declining old-age assistance caseloads and continuously in-
creasing proportions of the aged population receiving insurance bene-
fits, the supplementary role of the assistance program is becoming
more evident. By the end of fiscal year 1956, about 1 out of every
5 old-age assistance recipients was receiving assistance to supplement
his benefits under the insurance program—compared with 1 out of
every 10 in September 1950. When measured in relation to the ex-
panding old-age and survivors insurance rolls, however, there has
been a decrease in the proportion of insurance beneficiaries receiving
supplementary assistance payments. The 8 percent of aged insurance
beneficiaries who were also getting assistance in June 1956 had smaller
benefits, on the average, than all aged beneficiaries.
The number of families receiving aid to dependent children was
6,600 lower in June 1956 than in the same month of 1955, but the
number of children assisted was greater. The 614,000 families re-
ceiving assistance in June 1956 contained 1,708,000 children, an aver-
age of almost 2.8 per family in contrast to just over 2.7 for families
on the rolls in June 1955. Nevada, since 1945 the only State without
a federally aided program of aid to dependent children, established
such a program during the year. With old-age and survivors insur-
ance providing protection for children whose fathers have died, the aid
to dependent children program will be almost wholly confined in the
not too distant future to meeting need arising from causes other than
death—for example, from the disability or absence of the father from
the home.
Again this year there was a significant increase—9 percent—in the
number of recipients of aid to the permanently and totally disabled.
A total of 258,000 persons were receiving these payments at the end of
the year. The establishment of programs in three States during the
course of the year brought the number of federally aided programs for
aid to the permanently and totally disabled to 45.
Aid to the blind went to 106,000 persons in June 1956, some 2,000
more than a year earlier.
Average payments under each of the federally aided programs had
risen during the year, and the aggregate of payments made under the
four programs in June 1956 was 3.3 percent more than in June 1955.
Reflected in the higher expenditures for public assistance is the in-
creased cost of medical care paid for by the States for persons on the
rolls.
The programs of the Children’s Bureau contributed to the well-
- being of children throughout the Nation.
Appropriations of Federal funds under title V of the act were in-
creased by Congress by $4 million in the crippled children’s program
for fiscal 1956, by $2 million for maternal and child health for 1957,
20 Department of Health, Education, and Welfare, 1956
with $1 million identified for emphasis on programs for mentally re-
tarded children. The 84th Congress increased the authorization for
appropriations to the States for child welfare services from $10 mil-
lion to $12 million.
Preliminary figures from State reports indicate that a new peak
was reached in 1955 in the number of handicapped children served
under federally aided programs for crippled children. Some 278,000.
children were cared for during the year. Most of the ‘dren
(221, 000) were seen in clinics; anew 53,000 received physicians’ serv-
ices through home or office viet Children who were hospitalized
numbered approximately 48,000. Convalescent-home care was given
to the smallest group, around 3,800. Following the increase in the ap-
propriation for crippled children’s services, the Children’s Bureau
conducted a series of regional meetings to discuss new types of handi-
capping conditions that might be included in the program and to give
the States an opportunity to exchange ideas.
The Children’s Bureau administers the Federal grant-in-aid funds
for child welfare services. It also develops guides, recommendations
for practice, and informational materials in relation to the child wel-
fare program as a whole and for specialized services, such as social
services to children in their own homes, protective services, homemaker
services, services to unmarried mothers, foster family and group care
programs, and adoption services.
A major concern of the Children’s Bureau, the Bureau of Public As-
sistance, and State public welfare agencies is the provision of appro-
priate social services for all children in need of them in all geographical
areas, including, for example, mentally retarded children, emotionally
aint ied children, and financially dependent children.
Juvenile eT HMO 4 in the United States continues to be a major
social problem and the amount is ever increasing. Delinquency has
been on the upswing steadily for the past 7 years, and percentagewise
rising far faster than our juvenile population. The Division of Ju-
venile Delinquency Service was established in the Children’s Bureau
in 1955. Consultant service is now being given to States and com-
munities in relation to juvenile courts, probation, institutions, police
work, personnel training and community services for the prevention
of juvenile delinquency. |
Program research on disadvantaged children is being emphasized.
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 develop-
ing research methods, and has assisted agencies engaged in such
research. |
Certain groups of children call for special attention. Among these
are the juvenile delinquents, the children of agricultural migratory
Social Security Administration . ent ts 21
workers, mentally retarded children, and children placed for adoption
without legal, medical, and social protection, The Bureau placed
emphasis upon the Sree of these groups during the past year.
Federal credit unions registered further growth during the year
with a 12-percent increase in membership to 4.3 million. In June 1956,
there were 8,108 operating Federal credit unions, a net gain of 546 for
the year. Their assets of $1.4 billion were 22 percent greater than in
June 1955.
Program Administration in 1956
Ever-increasing workloads required that all of the Bureaus carry
forward their efforts to improve procedures and organizational struc-
ture and maintain a high level of efficiency. There was still much to
be done to implement the 1954 amendments, and the legislative plan-
ning and analysis 1 in connection with the 1956 amendments spanned
the year.
The major contribution the social security programs are making to
the economic security and welfare of aged persons received increased
attention during the year. A Social Security Administration Com-
mittee on Aging was established to provide for continuing close co-
ordination and an integrated focus, within the Social Security
Administration and in relation to the Departmental Committee on
Aging. Staff participated in the planning of the Federal-State Con-
ference on Aging, held in Washington on June 5-7, and served as
resource persons and recorders during the sessions.
Old-age and survivors insurance benefits taking into. account the
disability freeze were first payable in July 1955. From early in
calendar year 1955 through the end of fiscal year 1956, nearly a
quarter-million applications for a period of disability were processed
to allowance or denial. A program for the collection and analysis of
disability statistics, as a byproduct of the determinations, was put
into operation.
The Bureau of Old-Age and Survivors Insurance inaugurated an
intensive study of old-age and survivors insurance provisions and their
administration for the purpose of seeking a simpler, clearer, and more
rational law and program.
The Bureau’s use of automation in its repetitive. mass operations
was carried forward through installation of large-scale electronic
data-processing equipment in the earnings record operation.
The Bureau of Public Assistance placed increased emphasis during
the year on developmental work in improving the adequacy of services
_to needy people, and in planning for the strengthening of family. life
through increased capacity for self-care and self-support. Effort was
also made to advance efficient and effective State administration of
22 Department of Health, Education, and Welfare, 1956
public assistance programs and to strengthen Bureau administration
and facilitating services.
The Social Security Administration was given responsibility for
operation in an emergency of the financial assistance and clothing
programs of Defense Welfare Services. This is in addition to the
planning responsibility previously assigned. The Commissioner of
Social Security was also authorized to sign agreements with the States
regarding Defense Welfare Services operations. By the end of the
fiscal year, agreements had been signed with 12 States; by the end of
August, with 27 States.
The Children’s Bureau gave major emphasis in its technical research
to studies of the costs and effectiveness of various programs and
statistical reporting. One such study subject is the development of a
method for determining unit costs in child placement and institutional
care of children.
The fact that Federal credit unions are increasing in size as well
as number has important implications for the program administration
responsibilities of the Bureau of Federal Credit Unions. During the
year solutions to new problems were developed and trends were
studied for the purpose of anticipating the need for changes in pro-
cedures. To determine whether Bureau policies have kept pace with
changing economic conditions and the growth of Federal credit unions,
a comprehensive survey of the basic policies pertaining to chartering,
examination, and supervision was undertaken.
To carry out the operations of the growing programs, the Social
Security Administration had 18,591 employees at the end of June, the
vast majority of whom were in field, area, and regional offices. This
compares with a total of 18,514 on the payroll a year earlier.
INTERNATIONAL ACTIVITIES
The Social Security Administration continued to participate in
policy development in the international social welfare field through |
representation at United Nations meetings and those of the Organiza-
tion of American States. Meetings during the year at which staff
served as delegates or accredited observers included the United Nations
Children’s Fund, the First United Nations Congress on the Preven-
tion of Crime and Treatment of Offenders, the Directing Council of
the American International Institute for the Protection of Childhood,
and the International Social Security Association.
An important phase of the Social Security Administration’s inter-
national activities was the preparation of materials and papers for
Interdepartmental Committees on International Social Welfare
Policy, on International Labor Policy, on Human Rights, and on
Status of Women, in connection with sessions of the United Nations
Social Security Administration 23
General Assembly, Economic and Social Council, and other UN and
OAS meetings. Information was also prepared on new developments
in program administration and services, training, costs of social secu-
rity, and other subjects for international studies and reports sponsored
- during the year by the United Nations and the International Labor
Office.
Preparations were made for the Eighth International Conference
of Social Work in Munich, August 5-10, 1956, at the sessions of which
Social Security Administration staff participated in expert groups or
commissions.
The international aspects of social work and social welfare have
claimed increasing attention from the national organizations in these
fields. Social Security Administration staff has assisted this develop-
ment through the preparation of materials and through participation
at general meetings, workshops and panel discussions.
The Social Security Administration continued to cooperate with the
International Cooperation Administration in the nomination and
technical support of experts in the fields of social welfare, social in-
surance, and maternal and child health, as required by the agreements
between the two organizations. At the end of the year, 19 consultants
were assigned to overseas posts.
The growing consciousness of the social needs of people has been
reflected in the applications of trainees coming to the Social Security
Administration this past year. The requests for study make clear
that all governments, whether with new or advanced welfare pro-
grams, are anxious for the trainees to have a broad understanding of
social welfare in the United States and of the interrelationship of
social and economic needs, as well as specific knowledge in particular
fields.
In 1956, the swiftly expanding social welfare programs brought to
the Social Security Administration 698 trainees, from 45 countries,
representing all parts of the world. These included United Nations
and World Health Organization Fellows, International Cooperation
Administration participants, and many experts and students financed
through voluntary organizations or personal funds.
Old-Age and Survivors Insurance
During the fiscal year 1956 the old-age and survivors insurance
program made significant progress toward providing basic security for
the workers of the Nation. The largest single gap in coverage was
closed by the extension of protection to members of the uniformed serv-
ices. Coverage was also extended to all previously excluded self-em-
ployed professional groups (except doctors of medicine), to many
24. Department of Health, Education, and Welfare, 1956
eee ene errr reer ee ———_va=_wVwa
additional self-employed farmers, and to a number of smaller groups
of workers. With these extensions of coverage, the number of persons
covered by the program will be approximately 75 million during the
calendar year 1957. Significant strides were made in effectuating the
provision that protects the benefit rights of workers and their families
during periods when the worker is under a long-term disability; by
the end of the year this provision had been applied in the case of
134,000 disabled individuals. |
Legislatively, 1956 was a very active year. In addition to the
extensions of the coverage of the program, mentioned earlier, Congress
enacted many changes that introduced new concepts into the insurance
program. These included provision of benefits at age 50 and over
for disabled workers and a reduction to 62 in the age at which women
may qualify for benefits, with the benefits actuarially reduced where
working women and wives elect to receive them prior to age 65.
The year witnessed, too, the undertaking of several projects designed
to further program nite ectives and to improve administration. Plans
were made for a project for detailed study and analysis of the old-age
and survivors insurance program with the objective of determining.
where the program can be simplified, clarified and rationalized so that
it will be easier to administer, explain, and understand. The Bureau
of Old-Age and Survivors Insurance made a comprehensive study
of the effectiveness of the 1954 amendments in providing social security
coverage for farmers and farm workers. Based on this study and
on other experience, the Department prepared and submitted to the
Committee on Finance of the Senate and to the Committee on Ways
and Means of the House of Representatives a report on the effectiveness
of those provisions. A work group on aging reviewed the many ac-
tivities of the Bureau of Old-Age and Survivors Insurance in the field
of aging and presented recommendations for the expansion of these
activities. Automation in the record-keeping operation was advanced
through the installation of large-scale electronic data-processing equip-
ment to post. earnings records and to facilitate the computation of
benefit payments. Responsibility for preparation of the checks for
the 1 million beneficiaries served by the Bureau’s Birmingham, Ala-
bama, area office (payment center) was transferred from the Treasury
disbursing office to the Birmingham area office. The transfer per-
mitted the combining of check-writing operations with accounting
work, resulting in work simplification and savings.
The following pages spell out in more detail the year’s record of.
significant events and accomplishments.
Social Security Administration 25
What the Program Is Doing
BENEFICIARIES AND BENEFIT AMOUNTS
In June 1956, about 8.3 million individuals were getting monthly
benefits under the program. Some 6.6 million of these beneficiaries
were aged 65 or over—4.7 million of them retired workers and 1.9
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 1.7 million, some 350,000 were mothers
and 1.3 million were children.
In June 1956, the average insurance benefit paid to a retired worker
who had no dependents also receiving benefits was $60.00 a month.
When the worker and his wife both received benefits, the average for
the family was $104.80. Families consisting of a widowed mother and
two children received on the average $137.80.
The benefit awards for persons who came on the rolls for the first
time in the past fiscal year are considerably higher than those given
above for all beneficiaries. The higher amounts reflect the more liberal
computation provisions of the 1950 and 1954 amendments, under which
(1) it is possible to use only earnings after 1950 in the computation
and (2) as many as 5 years of low earnings and periods of total dis-
ability may be dropped from the computation of the average monthly
wage. Among beneficiaries on the rolls at the end of June 1956 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 $76, for an aged couple about $127, and
for a widowed mother and two children about $181.
THE DISABILITY FREEZE
The disability freeze provision of the Social Security Amendments
of 1954 became effective on July 1, 1955, although applications could
be filed at any time after the beginning of 1955. A person under an
extended total disability who has had both substantial and recent
covered work before disablement may, after a waiting period of 6
months, have his insurance rights preserved during the period in which
total disability prevents him from performing any substantial gainful
work. (This means that a period of total disability will not count
against the disabled person in determining whether he or his sur-
vivors are eligible for benefits or in calculating the amount of the
benefits.) By the end of June 1956 a period of disability had been
established for 134,000 disabled workers. About 110,000 applications
for a disability freeze were denied. About 36,100 persons who al-
ready were old-age beneficiaries had their benefits increased by the end
of June 1956; the average increase was $9.93 a month. The higher ben-
408691—57_3
26 Department of Health, Education, and Welfare, 1956
efits were attributable to the exclusion of a period of disability and
also to the dropping of as many as 5 years of lowest earnings in the
computation of the worker’s average monthly wage when eligibility
for such dropout stemmed from the disability freeze. About 13,100
monthly benefits payable to dependents of these retired workers and
to survivors of workers who had established a period of disability
before death were also increased because of the freeze. For the same
reason, lump-sum death payments based on the earnings records of
almost 4,500 deceased workers were increased by an average amount of
about $21.50 per worker.
THE PROTECTION PROVIDED
Of the population under age 65, 65.6 million were insured at the
beginning of the calendar year 1956. Some 26.3 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. The remaining 39.3 million were insured but would have to
continue in covered work for an additional period to make their in-
sured 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.
Of the almost 14.4 million people aged 65 or over in the United
States in December 1955, 54 percent were eligible for benefits under
old-age and survivors insurance. Forty-three percent were actually
receiving benefits, and 11 percent were working. The percentage of
aged persons who are eligible is expected to rise to 69 percent by 1960.
THE COVERAGE OF THE PROGRAM
Approximately 69 million workers were covered by old-age and
survivors insurance during the course of the calendar year 1956. An
additional 114 million people employed in the railroad industry
earned social insurance protection under what, in effect, amounts to
joint coverage of the railroad retirement and old-age and survivors
insurance programs. Altogether, including State and local govern-
ment and nonprofit employees for whom coverage is available on a
group election basis and members of the Armed Forces, over nine-
tenths of all persons in paid employment in the continental United
States were covered or could have been covered by old-age and sur-
vivors insurance in June 1956. (Members of the Armed Forces were
covered on the basis of gratuitous wage credits of $160 a month for
service before January 1, 1957, the effective date for regular con-
tributory coverage for them.)
Of the workers not eligible for coverage by old-age and survivors
snsurance, about one-third were covered by other public retirement
Social Security Administration 27
programs—Federal, State or local. The remaining two-thirds—6
percent of the Nation’s paid employment—were not covered by any
public retirement program. Those without retirement protection un-
der a public system consisted principally of self-employed persons
whose annual net earnings were less than $400 and of domestic and
farm workers who did not earn sufficient wages from any one em-
ployer to meet the minimum coverage requirements of the law.
INCOME AND DISBURSEMENTS
Expenditures during the fiscal year totalled $5,485 million, of which
$5,361 million was for benefit payments and $124 million for ad-
ministrative expenses. Total receipts were $6,937 million, including
$6,442 million in net contributions, $487 million in interest on in-
vestments, and $7 million in transfers from the railroad retirement
account. Receipts exceeded disbursements by $1,452 million, the
amount of the increase in the trust fund during the year. At the end
of June 1956 the fund totalled $22.6 billion.
Total assets of the trust fund, except for $550 million held in
cash, were invested in United States Government securities as required
by law; $2.6 billion were invested in public issues (identical with sim-
ilar bonds owned by private investors), and $19.5 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 2.5 percent.
Administering the Program
The composite measurable workload of the Bureau in fiscal year
1956 was about 7 percent above 1955, reflecting the continuing large
volume of work attendant upon the 1954 amendments to the program.
Funds appropriated for Bureau operations were $91,229,000;
$5,229,000 of this amount was a supplemental appropriation to cover
the pay increase provided by Public Law 94, 84th Congress. Recruit-
ment during the year was mainly to replace employees who had left
the Bureau. Personnel on duty at the beginning of the year num-
bered 17,651; at the end of the year 17,797. District offices providing
direct service to the public increased by 7, from 532 to 589. In addi-
tion to district offices, 41 resident stations and 3,538 contact stations
were in operation.
The major administrative circumstance of the year was the success-
ful follow-through in processing heavy workloads and in establish-
ing several new operations consequent to the 1954 amendments.
The issuance of new and duplicate account-number cards remained
at high levels. About 16 million employer reports of wages paid to
23 Department of Health, Education, and Welfare, 1956
.
employees were received, and about 230 million earnings items (in-
cluding self-employment income) were posted to individual earnings
records. Despite the inexperience of the farm groups with record
keeping, reports were on the whole well-prepared.
~ Applications for benefits remained high—about 2 million during the
year. The time required to process these claims, which had been in-
creased by the earlier rush of 1954 amendment work, returned to nor-
mal during the first part of the year. However, claims receipts in
the last quarter of the year peaked very steeply, mainly because self-
employed farmers were becoming eligible for benefits for the first
time, and during the last several months of the year the number of
claims in process increased substantially.
A new operation under the 1954 amendments was the receipt from
beneficiaries of annual reports of earnings in excess of the amount
permitted by the retirement test established by the 1954 amendments.
Beneficiaries were urged to report currently during the year so that
necessary withholding of benefits might be done currently and were
required to make, at the end of the calendar year, an annual report
of earnings when they earn above $1,200. Actions were taken to get
the necessary report forms into the hands of beneficiaries, to establish
controls to check nonreporting, and to process a concentrated load of
report receipts and make the necessary benefit suspensions, deductions,
and reinstatements in the space of several months.
Under the terms of the disability freeze provision of the 1954 amend-
ments—the provision which preserves the benefit rights of workers
suffering from long-term total disability—disability determinations
are made by the States except that in the case of foreign claimants
and railroad career employees determinations are made by the Bureau
of Old-Age and Survivors Insurance. In the early stages of the pro-
gram, the Bureau made determinations in certain classes of cases now
processed by the States—principally the backlog cases of applicants
who had been disabled for long periods of time. By February 1956,
agreements for this operation had been completed with agencies in all
States, the District of Columbia, Alaska, Hawaii, and Puerto Rico.
The staffs of these agencies engaged in disability freeze work were
equivalent to more than 200 positions nationwide. From the begin-
ning of the program early in calendar year 1955 through this fiscal
year, nearly a quarter-million applications for establishment of a
period of disability were processed to allowance or denial. As was
expected, during the initial year of operation, the Bureau did all of the
processing in 4 out of 5 cases. The cases processed by the Bureau
represented those not covered by State agreements and were primarily
the backlog cases. |
Total administrative costs for the old-age and survivors insurance
program in fiscal year 1956, including Treasury Department costs,
Social Security Administration meek 29
were approximately $124,300,000. ‘This total was less than 2 percent
of the contributions to the trust fund. The composite measurable
workload of the Bureau has increased by 116 percent since 1950, while
personnel has increased by only 59 percent. This record of increased
productivity is also reflected by lower salary costs in relation to work-
load and it accounts in major part for the continuing low level of ad-
ministrative costs compared to contribution receipts.
Among the more dramatic recent actions to reduce costs was the suc-
cessful installation during the year of large-scale electronic data-
processing equipment in the earnings record operation. This action
continues and advances the Bureau use of automation in its repetitive
mass operations. The electronic equipment, by carrying earnings
information in tape form, eliminated the need for setting up a second
summary punch-card file for 100 million earnings accounts. The cost
of new cards and cabinets for establishing this file in 1957 would have
been $335,000, and maintenance of the file would have cost $250,000
a year. Also, the use of electronic data-processing equipment to
handle earnings information reported incorrectly will substantially
reduce the number of items for which correct information cannot be
determined in internal operations. When the procedure has been
fully installed and experience has been obtained, savings of about $1
million a year are expected. A third operation in which the equip-
ment will be put to immediate use is the computation of benefit
amounts. These computations will be made at the rate of 16 a second,
compared to 60 a minute on the equipment previously used.
Use of electronic equipment opens up the possibility for large em-
ployers, as they make data-processing installations, to reduce costs by
reporting employee earnings for social security purposes on magnetic
tape instead of the present method of tabulating the reports on paper
forms. Arrangements were completed with one large employer to
begin this type of reporting in the last quarter of the year.
~ On July 1, 1955, the writing of the benefit checks was transferred
from the Treasury disbursing office in Birmingham to the Bureau’s
area office in that city. A reduction in processing costs is made pos-
sible through the elimination of overlapping balancing and control
operations, the use of addressograph plates for the preparation of
forms that previously had to be typed, and work simplifications in
the certification of claims and maintenance of the beneficiary rolls
that have been made possible by combining accounting and disburs-
ing functions. The Department has recommended, on the basis of
this experience, the transfer of the Treasury check-writing operations
to the other five area offices of the Bureau.
The project of erecting a new building on the outskirts of Baltimore,
to house all the Baltimore operations now scattered in ten different
buildings is proceeding. The architectural firms are expected to
30 Department of Health, Education, and Welfare, 1956
complete the final detailed working drawings in the spring of 1957.
After checking by the Public Buildings Service and assuming suf-
ficient funds are available to be spent on the building, everything will
be in readiness to solicit construction bids. It will take about 2 years
to construct the building.
Fact-Finding for Program Evaluation and Improvement
SIMPLIFICATION STUDY
At present the basic old-age and survivors insurance legislation is a
product of 7 sets of major amendments and approximately 20 other
less significant amendments. As this program expanded, complexi-
ties have been introduced, making difficult not only its administration,
but also its understanding by the public.
An intensive study of the program has been instituted to determine
how and where the program can be made simpler and more rational.
A STUDY OF FARM COVERAGE
During the last 6 months of 1955, the Bureau of Old-Age and Sur-
vivors Insurance made an extensive study to evaluate the effectiveness
of the agricultural coverage provisions of the Social Security Amend-
ments of 1954. These provisions extended old-age and survivors in-
surance coverage to self-employed farm operators for the first time and
broadened the coverage of agricultural workers to include all who were
paid at least $100 in cash wages during a year by a farm employer.
Considerable interest in the experience under these provisions had been
expressed not only in the Congress but also among many farm groups.
The Bureau’s study was designed to obtain and analyze informa-
tion on how the agricultural coverage provisions were working out,
and on the prospects for complete and accurate reporting of covered
farm earnings. Special reports were obtained from all of the district
social security offices; farmers in 24 States were consulted about their
coverage and the coverage of their farm workers; and contacts were
made with crew leaders, hired farm workers, and leaders in farm
organizations and in rural communities. The results of this special
study, together with information drawn from the Bureau’s adminis-
trative experience with the provisions for coverage of farmers, were
evaluated in a special report submitted to the Committee on Finance
of the Senate and to the Committee on Ways and Means of the House
of Representatives.
About 3 million farmers had sufficient self-employment income to
be covered by old-age and survivors insurance under the 1954 amend-
ments. In spite of the previous lack of understanding of old-age and
survivors insurance among farm people, it was clear by the end of
Social Security Administration 31
1955 that the provisions for coverage of farm operators were working
out satisfactorily and that only relatively minor improvements in
the coverage provisions were needed.
Of a total of slightly more than 4 million persons employed at paid
farm work during the course of a year, about 2.2 million were covered
by social security. Those still excluded from coverage are mainly
people who are not normally in the labor market—such as students,
housewives, and children—although they do some farm work at one
time or another during the year. About half a million farmers em-
ployed covered workers. The study showed that the great majority
of these employers had experienced ne serious problems in fulfilling
their social security responsibilities. About 5 out of every 6 em-
ployers apparently needed to make only minor adjustments in their
record-keeping system and were using practicable and workable pro-
cedures to facilitate compliance with the farm-worker coverage provi-
sions. The remaining employers encountered difficulties of varying
degree in obtaining and recording the information necessary to de-
termine which of their workers were covered.
WORK GROUP ON AGING
During the year the Bureau set up a work group to review its ac-
tivities in the area of aging and to develop recommendations as to
further activities that might be undertaken in this area. The work
group’s report, designed to aid administrative planning, includes a
brief description of the numerous ways in which the Bureau’s field
organization has provided leadership and services and otherwise has
participated in community affairs related to aging. The report also
summarizes the Bureau’s research and program-planning activities
that have dealt with various aspects of the aging problem.
Areas considered include: (1) Increased participation by the Bureau
in community and regional programs relating to the problems of older
people, particularly through a more uniform level of activity in all
district offices; (2) continued emphasis on the Bureau’s public in-
formation activities that relate to the interests of the aged; (8) expan-
sion of the Bureau’s research on aging through field surveys, studies
based on the Bureau’s records, and studies of the social and economic
aspects of old age in cooperation with other governmental and non-
governmental agencies; and (4) increased participation by the Bureau
staff in conferences and meetings dealing with the problems of the
aging.
REFERRAL PRACTICES OF DISTRICT OFFICES
The Bureau has, from the beginning of the program, assumed a
responsibility for referring to the appropriate public or private agency
32 Department of Health, Education, and Welfare, 1956
people who come to district offices and ask where they can get help
with problems not directly related to old-age and survivors insurance.
This year there has been completed the second of two studies in differ-
ent parts of the country of the referral service provided by district
offices. From these studies it appears that many people come to the
local offices for this kind of service even when they have no problems
immediately related to old-age and survivors insurance to discuss.
Referrals are made to a wide range of agencies with the largest pro-
portion being made to related programs concerned with income
maintenance—unemployment compensation, public assistance, and the
employment services. The findings derived from these studies will
serve as the basis for planning ways in which the Bureau offices can
more effectively help people by referral service.
Legislative Developments During the Year
The fiscal year 1956 was one of intense legislative activity. The
most important measure affecting old-age and survivors insurance was
H. R. 7225, a bill that was passed by the House in July 1955 and
passed by the Senate early in fiscal 1957. The bill—known as “The
Social Security Amendments of 1956” (P. L. 880)—was signed by
the President on August 1.
MAJOR PROVISIONS OF THE 1956 AMENDMENTS
Katension of coverage.—More than 600,000 additional persons who
have self-employment income from farming were afforded coverage
under old-age and survivors insurance through changes made by the
1956 legislation. One change extended coverage to certain income,
previously excluded as rental income, derived by owners or holders of
farm land who participate materially in the farm production under
an arrangement with the tenant or share farmer who produces the
commodities on the land. This provision extended coverage to about
400,000 persons. Another change, the extension of the optional
method of computing farm self-employment income for social security
purposes, made coverage available to about 200,000 farm operators.
This option is designed to preclude the need for small farmers to keep
special records for social security purposes, and also to enable both
large and small farmers to maintain their old-age and survivors
insurance protection during years of low farm earnings. The new
provision permits farm operators whose gross farm income in a year is
at least $600 and not more than $1,800 to deem their farm net earnings
to be two-thirds of their gross farm income; if gross income exceeds
$1,800 and net earnings are less than $1,200, net earnings may be
deemed to be $1,200. The provision previously in effect was restricted
to farmers whose gross farm income was at least $800, with half, rather
Social Security Administration 33
than two-thirds, of the gross farm income (up to $1,800) the maximum
that could be reported for old-age and survivors insurance purposes
under the option. The use of the option, which formerly was limited to
individual farmers who reported their income on a cash basis for
income-tax purposes, was extended to members of farm partnerships
and to farmers who report on an accrual basis. The 1956 amendments
also provided that share farmers are, generally speaking, self-employed
persons for social security purposes, thus confirming an interpretation
which had been given to previous law.
The amendments extended coverage to more than 200,000 self-
employed professional people, including self-employed lawyers,
dentists, osteopaths, chiropractors, veterinarians, naturopaths, and
optometrists. The amendments continued the exclusion of doctors
of medicine from old-age and survivors insurance coverage.
A number of changes in the law resulted in making coverage possible
for several relatively small groups of employees. These groups
include: additional employees of State and local governments and
of nonprofit organizations, additional clergymen in foreign countries,
and American employees of a foreign company in which an American
corporation holds 20 percent or more (rather than 50 percent as in
previous law) of the voting stock. Coverage was also made available
to employees covered by the retirement systems of the Tennessee Val-
ley Authority and the Federal Home Loan Banks. For both groups,
coverage would be subject to approval by the Secretary of Health,
Education, and Welfare of a plan for equitable coordination of their
special statf retirement systems with old-age and survivors insurance.
Changes in coverage of farm workers.—The 1956 amendments made
three changes in the provisions for coverage of farm workers. Under
the new coverage test, a farm worker is covered under old-age and
survivors insurance with respect to his work for a farm employer if
his cash pay from the employer in a year is $150 or more, or if the
worker performs agricultural labor for the employer on 20 or more
days during the year for cash wages computed on a time (rather than
on a piece-rate) basis. Under the law previously in effect, a farm
worker was covered for his work for a farm employer if his cash pay
from the employer amounted to at least $100 a year. The amendments
specifically designate “crew leaders” as the employers of the crews or
workers they furnish to perform agricultural labor for other persons,
provided the crew leader pays the workers and there is no written
agreement specifying that the crew leader is an employee of the person
for whom the agricultural labor is performed. A person who is a
crew leader under this provision is deemed to be self-employed with
respect to his services in furnishing the crew members and any work
he performs as a member of the crew. The amendments broaden the
34 Department of Health, Education, and Welfare, 1956
previous exclusion from coverage of certain agricultural workers from
Mexico and the British West Indies so that the exclusion now applies
to the services of workers temporarily admitted from any foreign
country to perform agricultural labor. The farm-worker coverage
provisions as modified by these three amendments afford coverage to
roughly the same number of farm workers as were covered under
previous law.
Disability insurance benefits—The 1956 amendments to the Act
provide a new type of benefit—payable in certain cases of disability.
Totally disabled workers between the ages of 50 and 65 who meet
specified work and disability standards can receive monthly benefits
under the old-age and survivors insurance program beginning with
July 1957. It is estimated that about 400,000 people will be eligible
to receive benefits for that month and that about 900,000 people will be
receiving benefits by 1970.
To be “disabled” under the new law a worker must be unable to en-
gage in any substantial gainful activity by reason of a medically de-
terminable physical or mental impairment which can be expected to
result in death or to be of long-continued and indefinite duration. A
waiting period of 6 consecutive months of disability is required before
benefits may be payable. In order to qualify for disability benefits
a worker must be both fully and currently insured and also must have
had 20 quarters of coverage during the 40-quarter period ending with
the quarter in which the disability begins. These requirements are
intended to limit the payment of disability insurance benefits to per-
sons who have had a, sufficiently long period of coverage under the
program to indicate that they were dependent upon their covered
earnings over an extended period before they became disabled and who
have had sufficient recent coverage to indicate that their withdrawal
from covered work was probably due to their disability.
The disability benefits program will be administered in close re-
lationship with the vocational rehabilitation program. Applicants
for disability insurance benefits will be referred to the vocational re-
habilitation agency. The law contains special provisions designed to
keep the disability benefits consistent with the objective of rehabilita-
tion. A beneficiary who engages in remunerative work pursuant to a
program for his rehabilitation carried on under a State-approved vo-
cational rehabilitation plan will, up to a year after he engages in such —
a program, not be considered as able to engage in substantial gainful
activity solely by reason of the services rendered under this rehabili- .
tation program. A rehabilitant will thus have a year to test his earn-
ing capacity without losing his disability benefits. On the other hand,
disability benefits will not be paid to anyone who, without good cause,
refuses rehabilitation services which have been made available to him
under a State-approved vocational rehabilitation plan. For the pur-
Social Security Administration 35
pose of guarding against a pyramiding of certain benefits that may be
payable to an individual under various public programs on account
of disability, the disability benefit under old-age and survivors insur-
ance is reduced by the amount of any other Federal benefit or work-
men’s compensation benefit that is based on the individual’s disability.
A distinctive feature of the disability provision is the separate
financing system. Beginnng with 1957, an additional tax of 14 of
1 percent on wages (14 each from employee and employer) and %&% of
1 percent on self-employment income is imposed to finance the dis-
ability insurance program. This additional tax will be deposited in
the newly created Federal disability insurance trust fund. Disability
benefits and the costs of administering the disability benefits program
will be paid from this fund.
Benefits for adult children who are disabled before attaining age
18.—The 1956 amendments made an important change in the eligibil-
ity requirements for child’s insurance benefits. Until now, child’s
benefits could not be paid after the child attained age 18. Under the
new law, child’s insurance benefits are payable, beginning in January
1957, to dependent children age 18 and over who become totally dis-
abled before age 18. Also, mothers of children entitled to benefits
under the new provision can receive mother’s benefits on the same
basis as mothers of children under 18.
It is estimated that about 20,000 children age 18 or over will be
added to the benefit rolls in the first year; after the first year, annually
about 2,500 disabled children will be either currently reaching age
18 and continued on the benefit rolls or added to the rolls when the
insured parent cies or becomes entitled to old-age insurance benefits.
To qualify for these benefits a child must meet the same definition
of disability as a disabled worker. The child’s disability must have
become total before he reached age 18 and must have continued un-
interruptedly after age 18. The child must have been or, upon filing
application, would have been entitled to child’s benefits before he
reached age 18 or it must be proved that the child was receiving at least.
half of his support from the worker when the child applied for bene-
fits or when the worker died. Like benefits for disabled workers, dis-
abled child’s benefits will be adjusted if any other Federal benefit or
workmen’s compensation payment is made on the basis of the child’s
disability. A disabled adult child will be referred to the vocational
rehabilitation agency and his benefits will be suspended if he refuses,
without good cause, to accept offered rehabilitation services. Bene-
fits for disabled adult dependent children and the costs of adminis-
tering the provision for these benefits will be paid from the old-age
and survivors insurance trust fund.
Benefits for women at age 62.—The 1956 amendments reduced to
62 the age at which women may qualify for benefits. As a result, ap
36 Department of Health, Education, and Welfare, 1956
estimated 860,000 additional women could, if they filed a claim, draw
benefits for November 1956, the effective date of this provision.
Widows and dependent mothers of deceased workers may receive
full benefits at 62. Working women and wives, on the other hand,
may draw benefits prior to 65 if they elect to receive actuarially re-
duced benefits (in such cases the reduced benefit is payable both before
and after age 65). As under present law, wives with child bene-
ficiaries in their care can draw full benefits regardless of age.
The old-age insurance benefit of a woman—that is, the retirement
benefit payable to her on the basis of her own earnings record—is
reduced by 5% of 1 percent for each month before age 65 for which she
draws the benefit. A woman who elects to receive an old-age insur-
ance benefit for the month in which she attains age 62 will thus have
her benefit reduced by 20 percent. A wife’s benefit is reduced by 253,
of 1 percent for each month before attainment of age 65 for which she
draws the benefit; if the benefit starts at age 62 it will thus be reduced
by 25 percent.
If provision had been made for paying full-rate benefits to all
women at age 62, the cost of the program would have been significantly
increased. Since benefits to wives and women workers are payable
on an actuarially reduced basis there was little increase in the cost
of the program.
Suspension of benefits of certain aliens —Under the 1956 legislation
benefit payments to certain aliens not eligible for benefits for Decem-
ber 1956 who are outside the United States for more than 6 consecutive
months will be suspended. Benefit payments will not be suspended if
the alien is a citizen of a country that has a social insurance or pension
system which is of general application in the country and which pro-
vides for the payment of periodic benefits or their actuarial equivalent
to otherwise eligible American citizens who leave that country. They
will not be suspended if the individual upon whose earnings record
the alien is receiving benefits has at least 10 years of employment under
social security or has lived in the United States for at least 10 years,
or if suspension would violate an existing treaty between the United
States and another country. ‘Time spent outside the country in the
active military or naval service of the United States will not cause
suspension of an alien’s benefit. If an alien whose benefit is suspended
dies outside the United States, no lump-sum death payment will be
made. | |
Conviction for subversive activities —The amendments provide
that courts may, at their discretion, as an additional penalty, ter-
minate an individual’s benefit rights based on earnings prior to his
conviction for certain Federal crimes, such as espionage, sabotage,
treason, sedition, and other subversive activities. Any wages and self-
employment income reported after the individual’s conviction will be
Social Security Administration 37
treated as a new earnings record, on which, if he meets all conditions
of eligibility, he can establish new benefit rights. Benefit rights of
other members of the individual’s family who are otherwise eligible
will not be affected by his conviction. The provision applies only to
convictions for crimes committed after August 1, 1956, the enactment
date of the Social Security Amendments of 1956.
Removal of certain employment from coverage—The new law ex-
cludes from coverage after June 30, 1956, any service in the employ
of any organization registered (or required to register) under the
Internal Security Act of 1950 as a Communist-action, Communist-
front, or Communist-infiltrated organization.
Interest rate on trust fund investments—The interest rate on trust
fund investments will be changed to reflect the essentially long-term
character of the investments. The interest rate will be equal to the
average rate of interest borne by all marketable interest-bearing obli-
gations of the United States not due or callable until after the expira-
tion of 5 years from the date of original issue. Under the previous
law, the rate of interest for trust fund investments is equal to the
average rate borne by all interest-bearing obligations of the United
States without regard to maturities or marketability. To make it
clear that bonds purchased by the trust fund are as much a part of the
public debt as any other obligations of the Federal Government, they
are designated as “public debt obligations for purchase by the Trust
Fund” in place of the designation under the old law, “special obliga-
tions issued exclusively to the Trust Fund.”
Advisory Council on Social Security Financing.—Provision is
made for the establishment periodically of Advisory Councils on So-
cial Security Financing to review the status of the Federal old-age
and survivors insurance and disability insurance trust funds in rela-
tion to the long-term commitments of the program. The first Coun-
cil will be appointed after February 1957 and before January 1958.
The Secretary of Health, Education, and Welfare will appoint its
members. They are to represent employers and employees (as far as
possible, in equal numbers) and self-employed persons and the public.
The Commissioner of Social Security is to serve as Chairman of the
Council. The Council’s report will be included in the annual report
submitted to the Congress by the Board of Trustees.
A new Council, similarly composed and with the same functions,
will be appointed by the Secretary not later than 2 years before each
scheduled increase in the social security tax rate. Each Council will
report its findings and recommendations not later than January 1 of
the year preceding the one in which the tax increase is scheduled.
Coverage of the uniformed services—The major extension of cover-
age approved by the 84th Congress resulted not from Public Law 880
338 Department of Health, Education, and Welfare, 1956
but rather from Public Law 881, a law designed primarily to revamp
survivor benefit programs for members of the uniformed services.
Members of the services, numbering nearly 3 million, were brought
under regular contributory old-age and survivors insurance coy-
erage for the first time by the new law, and the social security
protection thus provided was made the base for a simplified and
improved structure of military survivor benefits. Although the old-
age and survivors insurance coverage of servicemen is restricted to
their basic pay and does not apply to wages in kind, in other respects
the new provisions follow the recommendations made earlier by the
Committee on Retirement Policy for Federal Personnel and endorsed
by President Eisenhower. Under legislation previously enacted as
a stop-gap measure, gratuitous old-age and survivors insurance wage
credits of $160 a month were provided, under certain conditions, for
service in the Armed Forces performed after September 15, 1940, and
before April 1, 1956. Public Law 881, 84th Congress, extended the
period for granting the gratuitous $160 wage credits to include mili-
tary service after March 1956 and before January 1957, thus bridging
the gap between the expiration date of the earlier provisions and the
beginning date of contributory coverage. ‘The new law also provided
for reimbursement of the Federal old-age and survivors insurance
trust fund for expenditures resulting from the gratuitous wage credit
provisions. ‘These expenditures include approximately $200 million
already paid out of the trust fund by the close of the fiscal year anc
more than $600 million in expected future disbursements.
Proposals to cover Federal civilian employees—Early in 1956,
Administration-sponsored bills were introduced in the Congress which
would have extended old-age and survivors insurance to Federal
employees covered by the civil service retirement system. At public
hearings before the Post Office and Civil Service Committees of
the Senate and the House of Rrepresentatives, the Department
and the Civil Service Commission both recommended that social
security protection be extended to the civilian employees of the
Federal Government. The Administration’s spokesmen pointed out
that the retirement and survivor protection of Federal employees
would be considerably improved if they, like 18 million or more
employees in private industry, had old-age and survivors insur-
ance coverage in addition to their staff retirement system. They
also emphasized that this coverage would provide more equitable
benefits to employees who shift between Federal employment and
private industry. The measure passed by the Senate, however, liberal-
ized the civil service retirement system without extending old-age and
survivors insurance to employees covered under the system. The
House of Representatives later passed a bill similar to that approvec
by the Senate, and the legislation eventually approved (Public Law
Social Security Administration 39
854) contained no provisions for extending old-age and survivors
insurance to Federal employees. The more than 2 million Federal
civilian employees now constitute the largest group without old-age
and survivors insurance coverage. Thus, Federal employment is
now the only major type of employment in which a worker does not
acquire social security coverage and may lose his previously acquired
protection. Until an equitable plan for coordination of old-age and
survivors insurance and Federal retirement systems is put into
effect, many Federal employees will have less adequate retire-
ment and survivor protection than employees in private industry who
are covered by both social security and staff retirement systems.
Status of the plan for combined reporting of social security and
withholding taxes —The Department of Health, Education, and Wel-
fare and the Treasury Department submitted to the Congress a pro-
posal that would make possible integrating old-age and survivors
insurance wage reporting with annual reporting of income taxes with-
held. Under this proposal the report of each employee’s wages made
annually on the withholding-tax form (Form W-2) would provide the
information needed for the social security earnings records, thus mak-
ing it possible to eliminate the present detailed quarterly wage reports
filed by employers for old-age and survivors insurance. In 1951, the
Hoover Commission estimated that as a result employers would save
about $22 million a year. The workload of wage report items to be
processed by the Government would also be reduced. Recent esti-
mates indicate that in fiscal year 1959, the number of wage items that
would have to be processed under the present quarterly reporting pro-
visions by the Social Security Administration for wage record pur-
poses would amount to about 245 million. A change to annual report-
ing would eliminate the need for processing at least one-half this
number of wage items. The reduction would be three-fourths if it
were not for the fact that a substantial number of employees work
for more than one employer in the course of a year.
Under the proposed plan, the Bureau of Old-Age and Survivors -
Insurance would mechanically match the reports made by employers
on Forms W-2 with those copies filed by employees with their indi-
vidual tax returns. The purpose of this matching operation would be
to discover errors in reporting wages under old-age and survivors
insurance and income-tax withholding. The Government would bene-
fit through improved tax administration. Also, employees would
benefit because the plan would provide a comprehensive mechanical
check each year on the accuracy of the amounts of earnings reported
for their social security records. The employees’ receipts on Form
W-2 would be an exact copy of the employers’ social security report.
The employee could check this information against his own records
40 Department of Health, Education, and Welfare, 1956
5 eT Ae OE De AL cS iM i a cS LE te NR ao A
and obtain a corrected copy of the Form W-2 to attach to his income-
tax report; automatic reconciliation of discrepancies would result.
The plan requires that the definition of insured status and related
provisions of old-age and survivors insurance be put on an annual
rather than a quarterly basis. The necessary changes were included
in the draft bill submitted to the Congress.
Financing the Program
With the amendments to the old-age and survivors insurance pro-
gram which became law on August 1, 1956, Congress modified the
schedule of contribution rates so as to continue to reflect its intent
that the system be self-supporting from the contributions of covered
workers and employers. The revision in the contribution schedule
was arrived at after careful review of long-range actuarial cost esti-
mates prepared for use by the congressional committees in their legis-
lative considerations. As indicated, previously, separate arrange-
ments have been established for the financing of old-age and survivors
insurance benefits and of disability insurance benefits.
OLD-AGE AND SURVIVORS INSURANCE BENEFITS
Since enactment of the Social Security Amendments of 1954, three
important changes have taken place which will result in higher in-
come to the system than was expected according to the long-range
actuarial cost estimates on which the 1954 contribution schedule was
based. First, the present cost estimates are based on earnings levels
in 1955, which are about 15 percent higher than the 1951-52 earnings
levels on which the earlier estimates were based. As earnings levels
rise, relatively more is collected in contributions than is paid out in
higher benefits: This is due to the fact that the benefit formula
is weighted in favor of those with low average wages. As a result
of this weighting, benefit amounts, expressed as a percent of a worker’s
wage, decline as his average wage increases. As earnings levels
rise, there is a corresponding rise in contribution income and some,
but proportionately smaller, increase in benefit outgo.
Second, the change made in the method of determining the inter-
est rate of securities purchased for investment by the trust funds
will result in higher interest earnings. Accordingly, the present
cost estimates are based on a yield of 2.6-percent interest as compared
with the 2.4-percent rate on which the earlier estimates were based.
Third, the extension of coverage, including that of the uniformed
services under P. L. 881, will result in relatively more being collected
in contributions than is paid out in benefits. This occurs because
under limited coverage those who move in and out of covered employ-
ment have low average monthly wages in covered employment and re-
Social Security Administration 41
ceive the advantage of the weighted benefit formula. Under extended
caverage, their wages in covered employment will be greater with a
corresponding increase in contribution income. There will be some,
but proportionately smaller, increase in benefit outgo. Over a period
of time the contribution income will increase more than benefit outgo.
Expressed. as a level premium percent of payroll, this additional
income will be somewhat more than is needed to meet the larger outlays
for old-age and survivors insurance benefits resulting from the amend-
ments. Accordingly, the schedule of contributions that was estab-
lished in 1954 has been retained without change.
The level premium cost of these benefits on an intermediate basis
is 7.48 percent of payroll. Contributions income is equivalent to 7.23
percent of payroll on a level basis. This leaves an actuarial insufh-
ciency of 0.20 percent of payroll. (There was an actuarial insuffi-
ciency of 0.38 percent of payroll when the 1954 amendments were
adopted. )
DISABILITY INSURANCE BENEFITS
The level premium cost of the disability insurance benefits on an
intermediate basis is 0.42 percent of payroll. Contribution income
has been specifically allocated to finance these benefits; this income
is equivalent to 0.49 percent of payroll, thereby producing an actuarial
surplus of 0.07 percent of payroll.
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,
disability, 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 De-
partment will continue to prepare new cost estimates reflecting the
latest information available.
Public Assistance
The 1956 amendments to the Social Security Act provide for far-
reaching and significant changes in the public assistance programs.
The objectives of the programs have been broadened by encouraging
the States to provide more adequate medical care and appropriate
social services to help needy persons achieve more independent living,
and in general, to strengthen family life. The use of Federal funds
has been authorized to assist States in making grants to schools for
training in order to increase the skill of public assistance personnel.
The amount of Federal funds available to the States for public as-
sistance programs has also been increased. In addition, an amend-
408691—57—_4
42 Department of Health, Education, and Welfare, 1956
ment to another title, which has great significance for all the social
security programs, provides for the study of the causes of dependency
and the development of constructive methods of dealing with it.
Legislative Developments
THE 1956 AMENDMENTS
Amendments relating to public assistance include the following:
1, An increase in Federal funds in each program. (a) The Federal
share in State assistance payments for old-age assistance, aid to the
blind, and aid to the permanently and totally disabled was increased
to 44 of the first $30 (raised from $25) of a State’s average monthly
payment plus half of the balance up to the new maximum of $60
(raised from $55). Hffective October 1, 1956, through Jume 30, 1959.
(b) The Federal share in State assistance payments for aid to depend-
ent children was increased to 1447 of the first $17 (raised from 4 of
the first $15) of a State’s average monthly payment plus half of the
balance up to the new maximums of $82 for the first child and the same
amount for the needy relative with whom the child is living (raised
from $380) and $23 for each additional child (raised from $21).
Effective October 1, 1956, through June 30, 1959. (c) The ceiling
on Federal matching for Puerto Rico and the Virgin Islands was
raised 25 percent. LH ffective July 1,1956. No change was made in the
present special matching formula for individual payments in these
jurisdictions. See 4 (c) below.
2. A new provision in each program for separate Federal sharing
in State medical care costs paid directly to supplers of medical serv-
ices. Hffective July 1,1957. In old-age assistance, aid to the blind,
and aid to the permanently and totally disabled, a Federal share (on
a 50-50 basis) of a State’s expenditures for medical care in behalf of
recipients was authorized up to a monthly maximum determined by
multiplying $6 by the total number of recipients of cash or medical care
under the program for the month. In aid to dependent children, the
Federal share is one-half of such expenditures up to a monthly maxi-
mum of $6 times the total number of needy relatives, plus $3 times
the total number of children receiving aid for the month. This new
provision, recommended by the Administration, is in addition to the
one for sharing in money payments to assistance recipients.
3. Inclusion in the statement of purpose in each of the four public
assistance titles of the objective of furnishing appropriate public
welfare services to help assistance recipients toward more independent
living. (a) In aid to dependent children, the emphasis is on helping
to maintain and strengthen family life and on assisting the needy
relative caring for the child to attain maximum self-support or self-
Social Security Administration 43
care consistent with the parental role; in old-age assistance, on achiev-
ing increased self-care; and in aid to the blind and aid to the perma-
ently and totally disabled, on assisting individuals toward self-support
or self-care. Effective August 1, 1956. (b) The authority of the
Federal Government to participate in a State’s costs in providing
agency staff services to help needy people achieve increased self-care
or self-support was clarified. Hffective August 1, 1956. (c) The
States are required to outline the services, if any, provided toward
these objectives under each of the assistance programs and, except
in old-age assistance, the steps taken to assure maximum use of other
agencies providing similar or related services. HL ffective July 1, 1957. —
4. The aid to dependent children program was broadened through:
(a) Inclusion of additional relatives (first cousins, nephews, and
nieces) with whom the needy child may live and receive federally aided
assistance. Effective July 1, 1957. (b) Deletion of the limitation of
Federal sharing in assistance expenditures for children between the
ages of 16 and 18 to those who are regularly attending school. “’ffec-
tive July 1,1957. (c) Extension to Puerto Rico and the Virgin Islands
of provisions for Federal sharing in aid to dependent children pay-
ments with respect to the needy relative with whom the dependent
childisliving. Effective July 1, 1956.
5. A new provision for Federal funds to train personnel for public
assistance programs which (a) provides for allotments to States on
the basis of population, need for trained personnel, and financial need,
and (b) authorizes payment from the allotments of 80 percent of
expenditures for State grants to public or other nonprofit institutions
of higher learning for training of personnel employed or preparing
for employment in public assistance programs, for establishing fel-
Jowships or traineeships (directly or through grants), and for provid-
ing special short-term courses of study. Hffective July 1, 1957, for
d years.
STATE LEGISLATIVE CHANGES
While most of the State legislatures met during the year, the meas-
ures enacted affecting the public assistance programs were few in
comparison with those passed in recent years. However, some of
this year’s measures were important.
For example, several States expanded the scope of their assistance
programs. The establishment of a federally aided program of aid
to dependent children in Nevada extended this potent force for
strengthening family life into every jurisdiction in the Nation. Two
States, Florida and Nebraska, began programs of aid to the perma-
nently and totally disabled during the year, and Federal aid was
approved on a retroactive basis for the Maine program which began
in April 1955. The number of States now administering this program
44. Department of Health, Education, and Welfare, 1956
is 45. Kentucky also developed a plan for a new program of aid to
the permanently and totally disabled, and Texas prepared a consti-
tutional amendment that would empower the legislature to establish
such a program.
A bill to open public assistance lists to limited public inspection
passed by the West Virginia Legislature was vetoed by the Governor.
No additional States adopted legislation permitting similar action,
and the previous total—31 States—still remains. Several States
amended their earlier provisions.
Financing of medical care for public assistance recipients was also
the subject of legislation in several States. Many States have already
begun planning for legislative changes necessary to participate in the
new provisions of the 1956 amendments to the Social Security Act.
Trends in Caseload and Expenditures’
About 5.7 million persons—8.4 percent of the total civilian popula-
tion or approximately 1 in 19—received some form of public assistance
in June 1956. There was a decline of 69,000 in the total caseload from
that of a year earlier even though the aid to the blind and aid to the
permanently and totally disabled programs showed increases. Sea-
sonal influences were reflected during the winter months by increases
in the aid to dependent children and general assistance programs. The
year’s peak of 5.9 million persons reached in March was nearly 200,000
below the total in the peak month in the preceding year.
Expenditures for assistance payments from Federal, State, and vay
funds during fiscal 1956 amounted to $2.8 billion, répecsiin aim about
nine-tenths of one percent of personal income payments in the Nation
during 1955. The Federal share of this expenditure was $1.4 billion.
The 2.5 percent increase in total expenditures reflected increases in
average payments in each of the assistance programs except general
assistance, due in part to increasing expenditures for medical care
through vendor payments and higher standards of assistance in some
States.
OLD-AGE ASSISTANCE
Old-age assistance was received by 2,524,000 persons in June 1956,
a decrease of about 25,000 persons, or 1.0 percent, from the number
receiving aid in the previous June. The caseload rose slowly through
November 1955, largely as a result: of an expanded program in Ala-
bama, and then declined throughout the remainder of the year. Only
six States had higher caseloads at the end of the year than at the
1 Caseloads, averages, and total expenditures in all programs except general assistance
are based on data which include vendor payments for medical care and cases receiving
only medical care.
Social Security Administration 45
beginning. The national average monthly payment for old-age
assistance was $54.29 in June 1956 as compared with $52.30 a year
~earlier. Payments ranged from a low of $28.45 in West Virginia to
a high of $90.18 in Connecticut.
AID TO DEPENDENT CHILDREN
Aid to dependent children was received by 614,000 families in June
1956. Although the number of children receiving aid rose slightly,
there was a decrease of about 6,600 families, or 1.1 percent from the
preceding June. A seasonal rise began in December 1955, but the
year’s peak of 617,000 families, reached in May 1956, was 9,000 below
the peak in fiscal 1955. More than half the States had lower caseloads
at the end of the year than at the beginning. The national average
payment in June 1956 was $89.27 per family ($24.35 per person) as
compared with $86.78 per family ($24.04 per person) in June 1955.
Average payments per family ranged from $27.69 in Mississippi to
$144.96 in Wisconsin.
AID TO THE BLIND
Aid to the blind was received by 105,800 persons in June 1956, an
increase of about 2,000 or 1.8 percent during the year. The caseload
increased slowly but rather steadily, and at the end of the year only
22 States had fewer recipients than in June 1955. The national aver-
age assistance payment in June 1956 was $60.42 as compared with
$57.41 in the previous June. Average payments ranged from $32.44
in West Virginia to $103.27 in Massachusetts.
AID TO THE PERMANENTLY AND TOTALLY DISABLED
Aid to the permanently and totally disabled was received by 258,000
persons in June 1956. The increase of 21,000 persons, or 9.1 percent,
was due in part to the initiation of new programs in a few States,
liberalization in policy provisions in some States, and the continuing
growth of a relatively new program. The national average monthly
payment was $56.72 in June 1956, as compared with $54.98 a year
earlier. Average payments ranged from $24.59 in Mississippi to
$118.42 in Connecticut.
GENERAL ASSISTANCE
About 290,000 cases received State and/or locally financed general
assistance in June 1956, a decrease of 20,000 cases or 6.5 percent from
the preceding June. A seasonal rise in the caseload began in November
1955 and reached a peak of 336,000 cases in February; this, however,
was 45,000 cases lower than the peak reached in the preceding year.
There was a decrease in the national average payment per case from
$53.78 in June 1955 to $51.94 in June 1956, even though the average
46 Department of Health, Education, and Welfare, 1956
shy oun CIPU NET 2S EP TRE Se
per person increased slightly. Average payments per case ranged
from $13.95 in Arkansas to $76.20 in New York.
OASI BENEFICIARIES RECEIVING SUPPLEMENTARY ASSISTANCE
PAYMENTS
About 516,000 beneficiaries of old-age and survivors insurance also
received old-age assistance in February 1956 to supplement insurance
benefits insufficient for their basic needs or to meet special needs. They
represented a little more than a fifth (20.4 percent) of all old-age
assistance recipients in February 1956, as compared with 489,000 or
19.2 percent a year earlier. The national average old-age assistance
payment for recipients receiving both insurance and assistance pay-
ments was less than for those receiving only old-age assistance—$44.74
compared with $56.39.
In addition, about 32,600 families received both benefits under the
old-age and survivors insurance program and assistance payments
under the aid to dependent children program in February 1956—9.3
percent compared with 5.2 percent a year earlier. About 80 percent
of these families were receiving insurance benefits based on the wage
record of a father who had died, 17 percent on an aged retired father’s
work record, and 3 percent on the wage record of a deceased mother.
The national average assistance payment in February to families
receiving both types of payments was $68.98 per family compared
with $90.75 for families receiving only assistance. The average family
receiving both assistance and insurance benefits included more children
than the average family receiving only assistance payments.
Program and Administrative Developments
The basic objective of the Bureau of Public Assistance is to assist
the States in the development and maintenance of a sound and efficient
public welfare service for the people of the country. This involves
assuring that Federal public assistance grants to States are adminis-
tered in accordance with the provisions and intent of the Social Secu-
rity Act; assisting States in the application of Federal requirements
and working with them toward improving their programs; securing
information on a nationwide basis about program operations for re-
porting and for use in advising officials of the Department, the Con-
gress, and others on various aspects of the public assistance programs;
and cooperating with national, public, and voluntary agencies and
other organizations in planning for the development of needed welfare
Services.
Within this framework of responsibility, special interest during
the year was focused on planning for the strengthening of individual
and family life through provision of financial assistance, including
Social Security Administration 47
costs of medical care, and through needed social services directed
toward increased capacity for self-care and self-support, and preven-
tion of needless physical deterioration or further personal and eco-
nomic dependency. Special attention was given also to improving
welfare services for the aging. In addition, activities were directed
toward advancing efficient and effective State and local administration
of public assistance programs and strengthening Bureau administra-
tion and facilitating services.
STRENGTHENING OF INDIVIDUAL AND FAMILY LIFE
While similar problems and disabilities are found among people in
all income groups, those of needy people are often compounded by
their inadequate financial resources. The experience of State public
assistance agencies has shown that, although financial help is all that
some needy people require in order to plan and live independently, for
many others, the provision of money alone, without other types of
help, can be expensive both in terms of dollars and cents and in human
frustration and misery. Without additional help, some will remain
wholly dependent on public assistance when they might be able to
achieve improved self-care or increased self-support. Others will con-
tinue unnecessarily in deteriorating situations which are detrimental
and costly not only to the individuals but to the community.
In most instances, the need for help beyond financial assistance
grows out of the circumstances that lead people to apply for public
assistance, and the kinds of problems they bring with them to the
public welfare office. For example, more than two and a half million
people who receive assistance are over age 65. These persons, almost
half of whom are at least 75 years of age, have a high incidence of
chronic illness, and frequently suffer from the loss of family and
friends and from general exclusion from employment opportunities
irrespective of their skills or physical vigor. In addition, about
614,000 families (including 1,708,000 children under 18) are receiv-
ing aid to dependent children because of family breakdown, or because
one or both parents have died, disappeared, or are disabled. Another
258,000 persons, many of them heads of families, are permanently and
totally disabled; about a third of these persons are under 50 years of
age and nearly half are under 55. Approximately 106,000 persons are
receiving assistance because they are blind; of this number more than
half are less than 65.
The additional help these people need is mainly of three types. The
first involves a review and evaluation of their situation to determine
the extent of their financial need and the nature of other help needed:
how much they can do for themselves, and how much they require from
the public assistance agency or from other community resources. In
this, the welfare agency seeks answers to such questions as: Can a
48 Department of Health, Education, and Welfare, 1956
ee
parent be helped to carry his parental responsibilities so that family
life will be strengthened and the children have the opportunity for
healthy growth and development? Can the physical disability which
occasioned financial need be cured or alleviated with adequate medical
care? Can vocational training be provided to develop new skills?
What resources are available for improved housing? Can the aid of
friends and relatives be enlisted to provide care at home so that an
old person need not go to an institution ?
The second type of help needed is assistance in locating and using
other available resources suited to the applicant’s needs. Some may be
found in community programs or facilities and others in the person’s
own circumstances.
The third major type of help needed is with emotional problems.
Some people cannot make effective use of either money or other re-
sources until they receive help in dealing with problems that have
prevented them from using the personal and community resources
available to them. These are often the people whose behavior both
occasions the most community concern and requires the most skillful
help. Frequently these problems are particularly destructive to
family life and to the normal growth and development of the children.
The extent to which public welfare agencies can provide the help
needed will depend largely on the extent to which they have qualified
social work staff, and on the availability of services from mental
health clinics and other psychiatric and casework services in the
community.
Public assistance laws of most States provide statutory assumption
of responsibility for both financial assistance and accompanying social
services, and many State welfare programs include the provision for
some services to public assistance applicants and recipients. The
Bureau has long held that the availability of welfare services to
needy neople is essential to the achievement of the purposes of the
public assistance programs and, therefore, to their proper and efficient
administration. ‘The public assistance amendments of 1956 relating
to strengthening family life, self-support, and self-care clearly indi-
cate Federal support of the State’s efforts to make available the help
people need to achieve the maximum independence of which they are
capable.
In furthering this objective, work is under way within the Bureau
on clarifying the scope and content of the social services needed by
persons seeking or receiving public assistance, the role of the public
welfare agency in providing these services, and criteria for Federal
financial participation in the State’s costs of such services. For ex-
ample, interpretative materials are being developed on social services
for the aging, including counseling, environmental adjustment, pro-
Social Security Administration — 49
tective services, and services leading toward increased self-care.
Effort is also being made to clarify policy and standards in relation to
the use of homemaker services. 3
Much of this work involves the participation of other agencies. For
example, the Bureau is working with the Children’s Bureau in the
further development of homemaker services for the needy aged and
families with children, as well as in the maximum use of both the aid
to dependent children and the child welfare services programs in
providing other services for needy children. In the latter, the docu-
ment on services in the aid to dependent children program, prepared
jointly by the Bureau of Public Assistance and the Children’s Bureau,
was discussed at several joint regional meetings held during the year;
the progress made by States in implementing the concepts in this
document is being evaluated.
The continuing emphasis on the need for a wide range of welfare
services has pointed up the necessity for adequately qualified social
work staff. The 1956 amendment authorizing the use of Federal funds
to assist States in meeting the cost of training personnel for public
assistance programs will undoubtedly increase the number of ade-
quately qualified persons available for work in public assistance
agencies. Increasing emphasis is also being placed on the role that
volunteers can play in extending and strengthening public welfare
services. To encourage this participation, a new publication, “Citizen
Participation in Public Welfare Programs, Supplementary Services
by Volunteers,” discusses the purposes of supplementary services and
offers suggestions for developing volunteer services and for the orien-
tation, training and supervision of volunteers.
IMPROVING WELFARE SERVICES FOR THE AGING
The federally aided public assistance programs are an important
income-maintenance and social service resource of the Nation’s aging
population. About a sixth of the aged (65 years of age and over) are
currently receiving old-age assistance. Other public assistance pro-
grams include a large number of persons in the 55-65 age range; nearly
half the recipients of aid to the blind are 65 or over, most of the
recipients of aid to the disabled are in late middle life—approximately
a third of them at least 60 years of age—and in 7 percent of the
families receiving assistance under the aid to dependent children pro-
gram a grandparent is the relative caring for the child.
Old-age assistance is available to the needy aged through State or
local departments of public welfare in every community in the United
States and the Territories. This program also presents significant
pioneering opportunities in providing other needed social services,
since the majority of the needy aged live in small communities or rural
50 Department of Health, Education, and Welfare, 1956
areas where almost no other organized community welfare services are
available.
Increasing attention and activity are being directed toward meeting
needs of the aging at Federal, State, and local levels.
At the national level——The Bureau has been working with other
Federal agencies in planning for and stimulating the development of
needed services for the aging. It has been participating in planning
and in joint activities carried on by a variety of national voluntary
organizations such as the Family Service Association of America, the
American Public Welfare Association’s Committees on Aging and
Medical Care, and the National Social Welfare Assembly’s Committee
on Aging, as well as by sectarian groups and national professional
social work organizations.
The Bureau also has been developing technical materials relating
toaging. For example, material on homemaker services, with specific
emphasis on its use for aged persons who are sick, is being prepared
with the help and advice of other public and voluntary agencies to
assist States in developing this important home-care resource. Con-
sideration is being given also to other services involved in helping
aged persons remain in their homes. For example, the possibility
of the broader use of surplus commodities for “meals on wheels” is
being explored jointly by the Bureau and the Department of
Agriculture.
Attention is being directed also to the problems of some aged persons
requiring protection because of varying degrees of difficulty in han-
dling their own affairs. An interbureau committee on guardianship
within the Social Security Administration studied problems of guard-
ianship in both the public assistance and old-age and survivors
insurance programs. In addition, the Bureau gave special attention
to State practice in helping aged persons secure the kind of protection
needed, and explored difficulties experienced by States in the use of
guardianship procedures. Also, representatives of 11 State public
assistance agencies at a meeting in April shared their experience in
operating under the money payment provisions of the Social Security
Act in relation to aged persons of marginal competency. The discus-
sion focused on effective methods of handling problems of individuals
needing social and legal protection, and on identification of areas
requiring further attention.
Work undertaken or under consideration in other subject areas
having implications for serving the aging include: developing in-
terpretative materials on social services for the aging; helping State
mental health services and public welfare departments expand and
improve their teamwork in arranging for those no longer in need of
institutional care to return to the community; determining the types
of institutional care needed by individual aged persons and the amount
Social Security Administration 51
of public assistance to be paid for such care; and exploring ways in
which public assistance agencies can help toward the improvement
and extension of institutional facilities under public, voluntary, and
proprietary auspices. The report issued by the Bureau in June 1955
on “Recipients of Old-Age Assistance in Early 1953,” containing State
data on the social, economic, and health characteristics of the needy
aged, has been used by both Federal and State agencies in legislative
and program planning. Additional materials are being prepared on
specific aspects of these data which describe the personal character-
istics of recipients, the total costs of their requirements, the amount
and types of their resources, and the responsibility that adult children
are carrying in providing support for their aged needy parents.
At the State and local level—Many State and local public welfare
agencies also are planning for and, in most instances, are providing
some services to enable the needy aging to remain in their own homes
as long as their health permits. For example, efforts are being made
to provide various home-care services, such as homemaker services for
older people living alone. Some local public welfare agencies also
provide the aging and their relatives with counseling services directed
toward helping them with problems of social adjustment and intra-
family relationships. In some instances, where appropriate, referral
is made to voluntary family service counseling agencies or other com-
munity resources for additional help in working out these and other
problems around health, employment, living arrangements, recreation,
and housing. In some communities, volunteers provide supplementary
services, such as assisting the aging in participating in community
recreational and creative activities.
Several States are making substitute family arrangements such as
foster home care for those aged who though no longer able to main-
tain their own homes, do not yet require institutional care; also for
those who are well enough to be released from mental hospitals or
other institutions but who have no source of support and no families
or homes to return to. There has also been increased cooperative
planning with institutional facilities in helping older persons return
from sheltered care as soon as possible. An example of this is the
North Carolina State agency’s special unit providing services for the
aged; it is preparing some persons for return to normal life outside
the institution, and is working through local welfare offices to choose
the community placement best suited to the needs and interests of
the aged individual. Between 1952 and 1954 about 500 patients were
released from State mental hospitals and placed in private living
arrangements, with prospects of continuing success in the placement.
State mental health programs, too, are beginning to give special atten-
tion to the needs of older persons for a range of community services
52 Department of Health, Education, and Welfare, 1956
including alternatives to placement of nonpsychotic patients in State
hospitals.
Many public welfare agencies are becoming the focal point for social
services for other aged persons in addition to the needy. For example,
some State departments of public welfare are providing social services
to the non-needy person, and others are providing leadership in or-
ganizing State commissions to do broad planning for all older people.
There is also increasing public welfare representation on State and
local commissions for the aging, community welfare councils and study
groups. These place major emphasis on the aging by enlisting citizen
participation, developing programs and services needed, and coordi-
nating the activities of public and voluntary agencies. Many citizen
boards of State and local public welfare departments are taking in-
creasing interest in community planning for the aging, and are in-
terpreting the needs of the group to State legislators and to others
in the community.
ADVANCING EFFICIENT ADMINISTRATION OF PUBLIC ASSISTANCE
PROGRAMS
Regional and departmental staffs have been working together in
advancing more efficient and effective administration of public assist-
ance programs at Federal, State, and local levels. Much of this is
done through providing technical assistance and consultation on re-
quest to the States, through continuing review of State and local
administration and special study of various aspects of the program,
and by assisting States in strengthening the administrative under-
structure of their public assistance programs.
For example, the Bureau provided consultation to 9 States on vari-
ous aspects of the aid to the permanently and totally disabled program,
to 11 States on specific phases of medical care, to 7 States on need
and standards of assistance, and to several additional States in other
areas such as welfare services, incapacity, disability, and legislative
planning. Consultation was also provided to 14 States on various
aspects of staff development and training, such as the planning for
long-term staff development in anticipation of the 1956 amendments
to the Social Security Act relating to public assistance, the initiation
of Statewide staff development plans, and the strengthening of the
skills of the field representative and other supervisory positions. The
increasing recognition by States of the significance of staff training
in improving the quality of services to public assistance recipients was
reflected in more requests for consultation in this area than could be
met because of limitations on staff time. Numerous requests were also
received for participation of Bureau consultants in national and State
social welfare conferences and other types of professional meetings.
Social Security Administration 53
In addition to the help given to States with specific problems in
program areas, much of which is revealed through the continuing
review of State and local administration and study of specific program
areas, a variety of steps were also taken to assist States in the study
and control of the cost and efficiency of their administration. For
example, at the request of State agencies, the Bureau conducted sur-
veys in 10 States designed to provide a basis for improving organiza-
tion, streamlining procedures, and using staff and administrative ex-
penditures more efficiently. Following the conference on adminis-
trative management of large urban agencies, held in Washington in
June 1955, attention was given to problems arising in large local of-
fices, such as State direction and supervision of large local agencies
and the proper size of caseloads and workloads. Work is being done
also on the analysis of administrative costs of public assistance, in-
cluding the costs of certain broad functions in State and local agencies.
Developmental work is continuing on the application of principles
of statistical quality-quantity control in public assistance administra-
tion. During the year, materials developed cooperatively by the
Bureau and the State of Maine were presented at several regional
meetings and at the national round-table meeting of the American
Public Welfare Association. In addition, with case recording consti-
tuting a major and time-consuming function of local agency visitor
staff, a Bureau committee is developing criteria and principles to guide
States in more efficient and effective performance in this area.
Pertinent experience of some State and local agencies in specific
areas of staff development and administrative and fiscal management
was made available for the use of other States through publication of
certain of their materials. Among the reports processed for distribu-
tion were Washington’s material describing methods developed for
induction and training of social service supervisors; Missouri’s ex-
perience in identifying staff training needs as the basis for Statewide
planning for group meetings as a part of the on-going training pro-
gram; California’s guide for analyzing a staff training program
within the day-by-day function of the agency; and the experience of
Louisiana, Missouri, Pennsylvania, and Washington in establishing
caseload standards in local offices. The Bureau also issued a kit con-
taining materials on the preparation of manuals and other written
instructions for staff use.
Work also continued in other areas in developing solutions to new
complexities or in identifying constructive approaches to some older
problems. For example, a “new look” was taken at some of the
component elements of Federal-State relations, including the State
plan, and the administrative review of State and local public assist-
ance administration. Consideration was given to the program devel-
opment role of the Bureau, including the establishment of a research
54 Department of Health, Education, and Welfare, 1956
hia ER 9 EL) BARA ORM Le i
development committee to provide a continuing mechanism for con-
sideration and evaluation of proposals for research in relation to the
development and appraisal of program policies. Effort was made to
devise methods for reducing Bureau work in assuring that Federal
requirements for plan and practice are being met. A program of
manpower utilization audits was initiated to aid in assuring that the
Bureau’s activities are being administered as efficiently and econom-
ically as possible, and plans were made for the General Accounting
Office to begin a comprehensive audit of Bureau operations. Many of
the recommendations growing out of earlier consideration of questions
raised about Federal requirements and the streamlining of operations
resulting from the decentralization of certain functions to the regional
offices were implemented in whole or in part. In an effort to further
improve Bureau administration, a series of study sessions was held
with an expert in this area.
Several ad hoc committees of State and regional staff and other
persons met with the Bureau during the year to advise on specific
subject areas, for example, with a selected group of State people to
discuss ways of dealing with the problems that arise in making money
payments to aged persons who have difficulty in managing their affairs,
and securing qualified and interested guardians where this appears
necessary ; with the national family service agency in a series of meet-
ings to discuss common interests in the development of social welfare
services for public assistance recipients; with selected physicians and
State agency staff to consider the medical and social needs of the dis-
abled, especially the group termed “completely helpless” under the
State’s program; and with State public welfare staff and representa-
tives of voluntary agencies to consider proposals for changes in public
assistance legislation.
Bureau staff have also been working with the Council on Social
Work Education on the planning of curriculum in public social serv-
ices; on the development of knowledges, skills, and attitudes needed
by those administering the public assistance programs; on the develop-
ment of teaching materials and criteria for teaching grants and
traineeships; and on devising ways of strengthening recruitment to
the field of social work. Similarly, medical social workers and assist-
ance standards specialists in the Bureau have been working with the
American Public Welfare Association on provisions for medical care
services and adequate housing for the needy.
In addition, the first meeting of the regional public assistance techni-
clans was held in Washington in January to consider needed changes
in technical materials for use in the administrative review and the
development of materials on case recording. Also, the first national
meeting since the late thirties of State research and statistics personnel
was held in March to discuss the functions of research and statistics
Social: Security Administration 55
units in State public assistance agencies. An interim committee was
established with representation from each region to plan future meet-
ings. The first meeting of State welfare department consultants on
standards of assistance was also held in July; these are home econo-
mists who work on the formulation and pricing of items, such as food,
clothing, fuel, and utilities, which make up the standard by which need
is determined.
Other publications issued during the year include: a preliminary
release of data obtained from the recent study of support given by
absent fathers to children receiving aid to dependent children; a trend
report consisting of a graphic presentation of data reflecting the 1m-
pact on the assistance programs of social, economic, and legislative
factors during varying periods in the past 20 years (a similar chart
book will be issued in October of each year) ; a pamphlet describing the
public assistance programs and explaining in general terms the respon-
sibilities of the Federal agency and State governments under the public
assistance titles of the Social Security Act; and a reissue of the earlier
publications on the characteristics of State public assistance plans,
and the characteristics of staff development provisions in State public
assistance plans.
DEFENSE WELFARE SERVICES
In advancing the delegated defense welfare programs of emergency
financial assistance and emergency clothing, the Bureau pursued the
objective of preparedness for a civil defense emergency built into the
Nation’s established public welfare organization—Federal, State, and
local. ‘Thus, the experience and skill in helping people, in administra-
tion, and in organization of community resources, which have de-
veloped in public welfare programs, can be made immediately available
and effective in a time of national emergency.
To clarify the broad, general terms of the welfare delegations, a
memorandum of understanding was signed by the Secretary of Health,
Education, and Welfare and the Administrator of Federal Civil De-
fense, specifying the nature and scope of the delegated program, the
extent of authority delegated, and the basic operating and fiscal prin-
ciples applicable to the two programs. “Emergency financial assist-
ance” is defined as assistance in cash or in kind, including essential
services, and “emergency clothing” as distribution in kind. The
Federal responsibility in providing emergency financial assistance
and clothing will be met with 100 percent Federal funds. Delegated
responsibilities will be discharged through established State agencies
administering public assistance.
In March 1956, an “Interim Statement on Emergency Financial
Assistance and Emergency Clothing” was issued to State public assist-
ance agencies. ‘This material is being incorporated into a manual for
56 Department of Health, Education, and Welfare, 1956
Federal, State, and local use in planning, organizing, and developing
the programs, in test exercises and training activities, and in civil
defense emergencies. Negotiations have been in process to formalize
through written agreements the relationship between State agencies
and the Social Security Administration in the planning, organization,
and operation of the delegated welfare programs. Florida was the
first State to take formal action to enter into such an agreement, and
Connecticut and Montana next. By the end of June, 16 States had
signed agreements; by August the total had risen to 27. These agree-
ments have the concurrence of the State civil defense directors and,
in some instances, of State governors.
The interest and participation of various groups and organizations
have been maintained in a number of ways. A regional meeting was
held in Dallas in June with representatives of State welfare depart-
ments and of Federal and State civil defense organizations. National
private welfare agencies have been consulted regarding their part in
the programs, and plans are under way to establish an advisory com-
mittee in that area. ‘Two meetings were held with clothing industry
representatives and clothing specialists in other Government depart-
ments and private organizations to consider the most efficient and
effective means of meeting clothing needs in a civil defense emergency.
State and local public welfare administrators and defense welfare staff
in 22 States met in June to take stock of developments to date and to
advise the Bureau regarding the future course of defense welfare
planning.
A substantial amount of instructional material was prepared for
Operation Alert, including a formula for estimating clothing re-
sources. This formula was supplied to FCDA for application in the
Milwaukee survival project. 3, 139 38, 225 37, 550 675 31 410 662,000} 1,610
California 22 sex. 676. 0 36, 469 444, 523 435, 233 9, 290 321 4,820} 11,487,000} 2,380
@olorado: 2-3-4 == WOnt 3, 560 43, 347 42, 510 837 40 510} 1,044,000} 2,050
Connecticut. -~---- 142.0 8, 437 102, 715 100, 579 2, 136 63 1, 040 2, 648,000} 2, 550
Delaware. --------- NOS 1, 040 12, 759 12, 418 341 a 180 420,000) 2,330
Dist. of Col__--- 31.5 1, 627 19, 883 19, 424 459 30 430 941, 000 2,190
Bloridase=eesa5 228.0} 11,966} 145,216) 142,805) 2,411 100} 1,180] 1,949,000} 1,720
Georgigicck ares 12585 5, 269 64, 880 63,149) 1,731 80} 1,120] 1,951,000} 1,740
Hawaii: =. 18.6 879 10. 830 10, 622 208 10 170 362,000} 2,130
Ldahos oer 28.1 1, 356 16, 562 16, 207 355 14 180 345,000} 1,920
Mlinois =e ees 502.2} 28,163) 344,085) 336,024) 8, 061 234} 4,090] 9,928,000} 2, 430
Indignas-ssseeees = 240.2} 12,596) 153,585) 150,360) 3,225 91} 1,700} 3,823,000} 2,250
lowa-- eee 131.5 6, 542 79, 572 78,058} 1,514 70 770| 1,573,000} 2,040
Kansaseece ae 94.8 4, 649 56, 576 55, 498} 1,078 49 670} 1,407,000; 2,100
Kentucky = + 22e25- 134. 6 6, 058 74, 137 72,496} 1,641 50 760} 1,520,000} 2,000
Rouwisiana se 97.0 4, 276 52, 459 51,208} 1,251 59 820} 1,568,000} 1,910
Maine: tec. a Fae. 68. 7 3, 421 41, 593 40, 821 772 25 350 640,000} 1,830
Marylandjas cee 116.6 6, 075 74, 545 72, 565} 1,980 66 950} 2,075,000} 2,180
Massachusetts. ---- 346.5] 19,691] 239,512) 234,769) 4,743 121} 2,110) 4,792,000} 2,270
Viichigan <2 sae = 358. 7 20, 321 248, 130 242, 620 5, 510 140} 3,010 7, 755,000] 2, 580
Minnesota--------- 151.3 7, 877 95, 751 94,013} 1,738 74) 1,020] 2,181,000} 2,140
Mississippi-------- 63.1 2,475 30, 363 29, 654 709 33 470 722, 000 1, 540
IMMsSOUriaeeee eee 218.3} 11,212} 136,602) 133,774) 2,828 99} 1,580} 3,416,000} 2,160
Montanase tenes -= 29.6 1, 487 18, 202 17, 767 435 16 200 402,000} 2,010
Nebraska-_ 45 Wit =. 61.0 2, 989 36, 377 35, 671 706 33 430 830,000) 1,930
Nevada 2. se ee 8.6 455 5, 584 5, 444 140 7 80} 184,000} 2,300
New Hampshire --- 42.0 2, 205 26, 834 26, 296 538 16 220 430, 000 1, 950
New Jersey-------- 321.3] 18,648} 227.812) 222,417| 5,395 143} 2,190] 5,373,000} 2,450
New Mexico-_------ 22.6 947 11, 621 11, 358 262 16 200 376, 000 1, 880
NewYork: 2o2 b= 938. 2 52, 839 644, 577 630,154] 14, 423 493 7,360} 17,607,000} 2,390
North Carolina_.__| 139.6 5, 918 (PATO 70,931; 1,781 81) 1,290} 2,262,000} 1,750
North Dakota. -_-_- 16.9 758 9, 209 9, 056 153 13 130 226, 000 1, 740
Ohio! 24 sees ere 487.6 27,109 330, 621 323, 497 7, 124 193 3, 700 9,151,000} 2,470
Oklahoma lo2--2 22 93.1 4, 317 52, 768 51, 620 1, 148 47 670 1, 334, 000 1, 990
OrecOneeae sas 105.5 5, 624 68, 450 67,103] 1,347 45 620} 1,425,000} 2,300
Pennsylvania_____- 672.3] 37,488] 456,577; 446,773] 9,804 247| 4,560] 10,950,000} 2,400
PitertoyRicoss=22-2 33.4 1,001 11, 446 11, 247 199 17 340 259, 000 760
Rhode Island__--_- 58.1 3, 241 39, 424 38, 638 786 20 360 787,000} 2,190
South Carolina_--- 71.8 2, 923 36, 011 35, 080 931 42 650 1, 150, 000 1,770
South Dakota _-_-_-- 24.3 1,144 13, 899 13, 658 241 16 170 312, 000 1, 840
Tennessee___------ 125.0 5, 407 66, 334 64, 737| 1,597 66 990} 1,826,000) 1,840
OX AS se ak eke Bee a 288.3) 18,195} 161,826) 157,953) 3,873 211} 2,840} 5,597,000} 1,970
(ita Wtvscay eee 31.6 1, 594 19, 434 19, 067 367 15 260 557, 000 2,140
Vermontie e222. 24.0 1, 207 14, 662 14, 397 265 11 130 249, 000 1, 920
Virgin Islands- ---- 0.4 14 165 160 5 (5) 10 6, 000 600
Mirginian =03 .25-eue 141.3 6, 510 79, 902 77, 891 2,011 76 1,150} 2,202,000 1, 910
Washington __-_-_--- 154.0 8, 321 101, 337 99, 270 2, 067 62 870 2,012,000} 2,310
West Virginia__-_-_- 112.1 5, 404 65. 867 64, 700 1, 167 35 560 1, 231,000] 2,200
Wisconsin. --_----- 204.3} 11,023] 184,077; 131,525] 2,552 89} 1,320} 3,081,000} 2,330
Wiyonmingese see 11.9 608 7,405 7, 267 138 8 110 224,000} 2,040
Gel oT Cees ee 52.9 2, 767 33, 139 32, 819}. 320 |228-22e— 60 187,000} 3,120
Maritiin ese. eho aes Sook ss See eee soe ee (en een ee alee Ano lero 100 340,000; 3,400
1 State of residence estimated.
2 State data represent number of employers reporting taxable wages by the State of their reporting head-
quarters. An employer is a legal entity such as a corporation, partnership, or single ownership, for which
a single tax return is filed. Excludes agricultural employers.
3 Preliminary estimate. Workers are shown in the State of major job—that is, the State in which the
greatest amount of taxable wages or self-employment net earnings was received.
4 Preliminary estimate. Total annual taxable earnings are shown in the worker’s State of major job.
Averages are rounded to nearest $10.
5 Fewer than 500 employers.
6 Benefit data relate to persons in foreign countries receiving old-age and survivors insurance benefits.
Employment and earnings data relate to citizens of the United States employed by American employers.
7 Relates to employment of officers and crews of American vessels.
Social Security Administration 79
Table 5.—Old-age and survivors insurance: Selected data on benefits, employers,
workers, and taxable earnings for specified periods, 1954-56
{In thousands, except for average monthly benefit and average taxable earnings; corrected to Nov. 9, 1956]
Item 1956 | 1955 1954
Fiscal year
Benefits in current-payment status (end of period):
TCT Cen ee fe PS he hs Selo a Mek ee et 8, 374. 5 7, 563. 5 6, 468. 8
(DUCES 2 2 oe eS ea tee A 4, 731.9 4, 214.8 3, 519.4
mere en EIS UOMO S 2.60 ooo ke eee 5 Sen ep 2k 1, 255. 0 1,131.3 959.1
Gini enn. a et Sie eel Se eee ck 1, 316. 7 1, 220.9 1,111.9
WHOLONESIORWICOWCP S25 -5-- 82555 e201 so ese 8 747.8 689. 8 586. 3
IMATE" Se ln ol 297. 3 281. 2 267.7
OIE Sn ae he ee le 25. 7 25. 6 24. 4
MOUMMMOMEMveaIMOUNb= - 20-5 2.08 nee o ee nec aae $439, 424 $384, 025 $278, 702
VOR GYEG). S27 a eS ENS te a ie $296, 976 $257, 230 $182, 334
NPOIMOTRISMaAmCes st ae oor St sae ee et $41, 968 $37, 011 $26, 302
GONG 2 ea a a ea a GaSe $48, 662 $43, 730 $34, 770
DenemunmormisOWOr S22. 28 denne ae $36, 648 $32, 150 $24, 016
IIR OUS) UE So eae I a rd $13, 876 $12, 677 $10, 249
[PUREST Sk Se ra ey et Ua i ee eee $1, 293 $1, 226 $1, 030
Average monthly amount:
BED). Sb no oat A ee eR ee $62. 76 $61. 03 $51. 81
\EPRE DOSS GHP | SUP IST OVE (6 EAS es a en a pe $33. 44 $32. 72 $27. 42
RO a amen re eS Se a og Se eee ete $36. 96 $35. 82 $31. 27
IWAGOweSlOrwiGOWCr S22 22.2.0 02 sie 22s e Senn $49. 01 $46. 61 $40. 96
lo Se ie ee $46. 67 $45. 08 $38. 28
[OBR Oo ee i ee ee a $50. 31 $47. 86 $42. 26
Benefit payments during period:
DRO mnys DENCH Satna oe BS Sse tt 2k le eed eek $5, 245, 473 $4, 232, 609 $3, 185, 282
Olden Smt aerate me tems ee Pee eee oe ee See t| & $3532;:910 $2, 802, 967 ' $2, 068, 404
DP ICIIEDD Se ee oe ake le oe Ht $531, 831 $428, 847 $318, 614
Senta inane ee remem e wel oS) ll eden n ack $1, 180, 732 $1, 000, 795 $798, 264
LDAUUDOY A UHa OfeNya BOC Ole ae ee eae $115, 340 $100, 539 $90, 175
Estimated number of living workers with wage credits (mid-
point of period—Jan. 1):1
CL oo i ee a gs I ne ed ee a 99, 800 95, 200 93, 600
TENCSE oo SESS G 2 ga ie Fae Ee ne ea 6 Sa ae 70, 100 70, 300 71, 000
Curmently-put.not fully insured....2.-.-.....-..2.22-- <.-- 1, 200 600 2
OSSD SULTAN Lo. 5 Sta i tone ee Ee ee ag le Oe ee 28, 600 24, 300 22, 500
Estimated number of employers reporting taxable wages, 1st |
Re oe icral year... _ 0. - ns ae hecce kent susec.-2ek 3 3, 910 3, 715 | 3, 654
Calendar year
Estimated number of workers with taxable earnings. _-___.__- 4) 66, 000 59, 700
Estimated amount of taxable earnings_.-.-.__.---.__---_____-- (4) $159, 000, 000 | $134, 000, 000
PALVieravoma xaplevearmings §._ 02 [2b le ers ks ele ito (4) $2, 410 $2, 240
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. The effect of such duplicationis
substantially less significant for insured workers than for uninsured workers.
2 Not possible under the 1950 amendinents until July 1, 1954.
3 Excludes agricultural employers.
4 Not available.
5 Rounded to nearest $10.
Department of Health, Education, and Welfare, 1956
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84. Department of Health, Education, and Welfare, 1956
Table 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 program and State, fiscal
year 1956
[In thousands}
Maternal Crippled
State and child children’s | Child welfare
health services services
services
United. States® 3 <0 e 2k ae a ee ee a $11, 921.3 $14, 804. 0 $6, 897. 3
Alabamaes = - 220 Seu ee ee Re bee se eee 426. 1 518.1 218.1
PAT aS Kae be Ee aa ON EAs eS ete ee essa ee 84. 4 169. 7 39.4
ATIZON GS SS uae ee ee eee enh cee as ae 85:9. | 23 Sa 66. 3
PACK RINGS RRL hohe SNe ct eee 201. 3 309. 9 160. 8
Califor lass See ie Se Re EAI ee eee en ee ah 607. 9 622.1 239. 7
COlOTAA OL. eee es a ae cere eae 209. 7 148. 2 76. 2
Connecticut? 22S = ee eS a en 144.8 211.6 68. 4
DD GlA WaT. les Se ae te ee ee kD ener ee eee ne ee 85. 5 93. 2 40. 9
District, of Columpbia== 22th ee eee 150. 6 252. 0 28.9
Mlorida: 32.68 922 soe i ae ee ee eee 286. 5 392. 5 141.2
\
Georgia ts 2.9522 Se et ee ree eae 360. 1 554. 5 22501
ELA wiles ee ee a pe ee ee 141.6 162. 6 33. 0
T dahon: 82 eer Re Re a ee eer ee 92. 6 150. 7 29. 3
Tim O1SR 2 eRe ee ee Se i Se ae aes en 309. 7 458. 4 194. 7
Trid tang. f 2 oa a ae a re ea pe eiegeee em arene 233. 6 151.5 98. 7
Loh \ife apie eee Gy Gag, Pree ate er A i Ue pel tN eM os fhe sn 177.1 291. 2 150. 7
Kiansas2.¢o. eat eee GC a ee ere ee ree 136. 3 177.5 110.9
KOM GU CK 20 ei ae eres oc a oe ee Oe ee 291.4 494.1 221.3
Louisian sg. 2 oe ot oa Ne ee eee 300. 0 372. 4 173.1
6s UW 0 Cos sep VO eR De ap age EE ah Ea Bae ns ee Bs Take 87.6 114.7 69. 3
Mhary land 22 os os eee ees ee 328. 8 308. 7 100. 8
Massachusetts:-2 22.2.) 22) See bee a es ee 350. 8 212. 4 80. 0
IMGichigam 22 52 ele aE hee On ee Be ee ee oe ee ne ee 331. 4 461.7 2205 1
VEIT CSO ES as SS oe Se Rd ke a ee ee 223.9 265. 3 163. 3
WMGISSISSIP DIS es ee oe ee Si a etc a a 307. 7 S2t.4 202. 0
MESSOUTIEE so ho ORS NS Sear ee Oe eee eee 255. 4 410.6 170.8
Montane 2. 222. oe ate ee ee ee eee 84. 2 131.0 64. 0
INebraskac. oo. eo A SE Oe eee ee ee 99. 2 130. 6 Sl 2
Nevada: Sos ee Oe ee ee ee eee ee 73. 2 86.9 PEE
INew*Hampshire se = aie eee eas eee eo 65. 2 28. 2 47.9
INOW. FOTSOY ote. ee ee eee eee 157.4 213.8 81.1
New Mexico: Ss oe ee! 5 ie ee eee 123. 5 122. 5 71.6
ING We OR oS ee ee ae ee ae ee 453. 8 444.9 217.5
North: Caroling. 2.2 Se es ce ee ee ee ee 547.8 S57 319.0
SING UTNE) Eh 0 G5 Pe te ee a a ten 85.1 106. 2 61.8
ONiO2s2 oho es ne See 2 a ee Rae ee eee 374. 9 463. 2 260. 5
Ollahom gos. oe os Pe De Oe ae ee eS oer eee 156. 1 322. 0 135. 0
Orecon 32> SS 2 SS ee ee ee ee eee ee eee 105.9 139. 2 51.0
Pennsylvania vss: <8 ot SS ae oe ee eet a 482.4 561. 6 294. 3
PUPeLtO RECON aie aes eee eked ee ala Sa te eee eee eI 308. 0 451.6 204. 3
Rhodédsland. 2-21.) 2 Be A eee eee ee 84.9 126. 7 39.1
South:Carolina) = 2 2.23 so Se ee ee ee ee eee 259. 7 390. 3 185. 2
South Dakotas... 2s re Te ee ee ee ee ee 86. 1 106. 3 70.6
MPennessee. 263 a a e E ee eee ee 379. 8 424.6 217.6
GOXHS ie ee ue edge sot eae A 7 ie ee ee ee 543. 7 701. 5 332. 6
MU pal ee a d e h eceR c ee Se ee e 128. 0 197.6 58. 5
ViOTTMNONG 2c 23.2.8 cs a ae ee ee es ed er 77.0 97.6 51.1
Vircinislandss= 25. 2-20 222s 2s Uae eee een ee ae 68. 1 87.1 30. 0
DTG br salt.a rs We peer eh ae i eI ed eat ee 32ie2 395. 7 214.0
Washing tor. tat ee See eee es ery ee ee oo cee 182. 8 215. 3 112.6
WiesteVilroinia 2.2 ee 2 oe Si Ee ere eek en ae eee nee 185. 5 287.7 163. 9
W.hASCOnSIT eee see ee ee ee oe Ce ae 201. 5 Sle 170. 2
Way ONIN ete ee an eS ee De ee eee 75.6 71.4 41.0
in a
1 Based on checks issued less refunds.
Social Security Administration
85
Table 9.—Federal credit unions: Number of members, amount of assets, amount
of shares, and amount of loans outstanding, Dec. 31, 1935-55
|
Number of
Year reporting Number of | Amount of | Amount of | Amount of
credit members assets shares loans
unions !
OBR. 3 cade 762 118, 665 $2, 368, 521 $2, 224, 608 $1, 830, 489
ICR. oc boolean 1, 725 307, 651 9, 142, 943 8, 496, 526 7, 330, 248
WB ony caceee eel 2, 296 482, 441 19, 249, 738 17, 636, 414 15, 683, 676
TORS. . wo saben 2, 753 631, 436 29, 621, 501 26, 869, 367 23, 824, 703
MEO soso oe 3,172 849, 806 47, 796, 278 43, 314, 433 37, 663, 782
HOS 0 MepnnN ime CS ee 3, 739 1, 126, 222 72, 500, 539 65, 780, 063 55, 801, 026
NO we ee ee 4,144 1, 396,696 | 105, 656, 839 96, 816, 948 69, 249, 487
WE). nee 4,070 1, 347, 519 119, 232,893 | 109, 498, 801 42, 886, 750
TOES oo oe pee ae er 3, 859 1, 302, 363 | 126,948,085 | 116, 988, 974 35, 228, 153
Cle a ota ee 3, 795 1, 303, 801 144, 266, 156 | 133, 586, 147 34, 403, 467
LOA ee ek 5), 50 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414
OA Gnesi 8S 3, 761 1, 302,132 | 173,166,459 | 159, 718, 040 56, 800, 937
OA eee Ri Roe Nt 3, 845 1, 445, 915 210, 375, 571 192, 410, 043 91, 372, 197
11 OS nremnb pC raire 4,058 1, 628, 339 | 258, 411,736 | 235, 008, 368 137, 642, 327
4.0 ee ck 4,495 1,819, 606 | 316, 362,504 | 285, 000, 934 186, 218, 022
Hs () Pa nes 4, 984 2,126,823 | 405,834,976 | 361, 924, 778 263, 735, 838
OR oe occas ee 5, 398 2,463,898 | 504,714,580 | 457, 402, 124 299, 755, 775
ORR. oe See 5, 925 2, 853, 241 | 662,408,869 | 597, 374, 117 415, 062, 315
TYG VS Oe SS 6, 578 3, 255, 422 | 854, 232,007 | 767,571, 092 573, 973, 529
OM on dado es ieee 1 PPM 3, 598, 790 |1, 033, 179,042 | 981, 407, 456 681, 970, 336
WOiGe Sete 7, 806 4, 032, 220 |1, 267, 427,045 |1, 135, 164, 876 863, 042, 049
1 In the period 1945 through 1955, the number of operating and reporting credit unions was the same. In
other years, the number of credit unions which reported was less than the number in operation.
Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1955, and
Dec. 31, 1954
Amount Percentage
distribution
Assets and liabilities —
Dee. 31, 1955 | Dec. 31, 1954 Change Dec. 31, | Dec: 31,
during year 1955 1954
Number of operating Federal credit
MOM CMe a ok Le ee = 7, 806 1, 227 LY AS) lt legeapsp can | Pe ee ce A
MNOUAIEISSCLS= as oe cone eect $1, 267, 427, 045/$1, 033, 179, 042/$ 234, 248, 003 100.0 100.0
Loans to members.--_-.-__-------- errs 863, 042,049] 681, 970,336) 181,071, 713 68. 1 66.0
Cias ee oe S 105, 361, 383 97, 740, 682 7, 620, 701 3 9.5
United States bonds_.___._.---------.--- 83, 896, 302 84, 313, 214 — 416, 912 a6 8.2
Savings and loan shares...._------------ 181, 956, 756} 143, 974, 932 37, 981, 824 14.4 13.9
Loans to other credit unions_----_------- 24, 019, 882 17, 737, 716 6, 282, 166 9 ik
OPC ASSO tS eeeee a Jee kd 9, 150, 673 7, 442, 162 1, 708, 511 ea oil
MOP abilities: .-< 9.222220. .225- 1, 267, 427, 045} 1, 033, 179, 042 234, 248, 003 100. 0 100. 0
INOtessavabless a edule bes 29, 098, 259 19, 729, 224 9, 369, 035 2eo 1.9
Accounts payable and other liabilities. -__ 3, 642, 212 2, 772, 413 869, 799 5c} .3
GUOGINES). bs Se ea a 1, 135, 164, 876 931, 407, 456 203, 757, 420 89.5 90. 2
Mepularireserve--..- 385.02 0.02_Lk-.ee 39, 042, 931 31, 134, 017 7, 908, 914 nal 3.0
Special reserve for delinquent loans--__-_- 2, 468, 400 2, 273, 804 194, 596 ne, =
Wnedividedi earnings. -J2.20.-.0 2 222. 58, 010, 367 45, 862, 128 12, 148, 239 . 6 4.4
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Public Heat Service
Health of the Nation
| THe PAST YEAR was one of significant progress in American health.
_ Advances were made in many fields, and the Nation’s health status—
as revealed in national death rates and the continued decline of the
- acute, communicable diseases—continued to improve.
Research scientists probed deeper into the causes and cures
of today’s major diseases. The national network of hospitals and
medical facilities continued to expand. Important forward steps
_ were taken to increase the numbers of professional health workers.
Many State and local health services were intensified or broadened.
In addition, a substantial number of significant new health measures
were requested by the President and enacted into law by the Congress.
This included legislation to aid research, to strengthen health services
and increase health knowledge, and to augment medical manpower.
_ Although some of these measures did not become law until after the
close of the fiscal year, the legislation was drafted, studied, and con-
sidered during the period covered by this report.
Among the notable developments of the year was the appropriation
by the Congress of the largest dollar increase for medical research in
the history of the Public Health Service. The National Institutes of
Health, principal research arm of the Public Health Service, began
fiscal year 1957 with a total appropriation of $183 million. This fig-
ure compares with a total appropriation for 1956 of $99 million and
for 1940 of less than one million dollars. Most of the additional funds
are being used to support research projects by scientists in hospitals,
medical schools, health agencies, and private laboratories throughout
the Nation.
87
88 Department of Health, Education, and Welfare, 1956
LEGISLATIVE HIGHLIGHTS
The President also recommended—and the Congress enacted—a
new program of Federal aid for the construction of medical research
facilities. The program authorizes the expenditure of $90 million over
a 3-year period, to be matched on a 50-50 basis, by medical schools in
keeping with the principle of partnership among those engaged in
forwarding health.
Better health for the American people depends upon a sufficient
number of well-trained professional personnel. During recent years,
the shortages in nursing and in trained public health workers have been
especially serious. In his special message, the President recommended
several measures to aid in stretching the supply of nurses and public
health personnel. Asa result, the Congress authorized, in Public Law
911, a program of traineeships and advanced study for various types of
professional personnel needed in State and local health agencies, and
for professional nurses to qualify them for supervisory, administra-
tive, and teaching positions. In addition, a program of grants to the
States for vocational training of practical nurses was authorized, to be
administered by the Office of Education. These steps, combined with
the augumented program of assistance to students and teaching scien-
tists, should enable the Nation to make substantial inroads on the
health manpower shortage.
Public Law 911 also included provisions to increase the number of
hospital and medical care facilities and to improve the care and treat-
ment of the mentally ill. Both of these measures were enacted at
the request of the President. Title 4 of P. L. 911 extended, for a
2-year period, the successful local-State-Federal program of hospital
and medical facilities construction (see p. 119) and authorized an in-
crease in funds for the program. Title 5 authorized a program, of
Federal grants for special studies of the institutional care of the men-
tally ill. The projects are designed to develop better methods of care
of the mentally ill, and to improve administration and services in
mental hospitals.
The President also recommended several other steps to improve pub-
lic health services and to increase knowledge of health needs and
problems. One of the important measures enacted by the 84th Con-
gress was authorization for the Public Health Service to conduct a
continuing national survey of sickness and disability in the United
State (P. L. 652). This will help provide up-to-date and compre-
hensive information on the extent, nature, and severity of the major
diseases and impairments in this country. By the end of the fiscal
year, plans were already under way by the Public Health Service ta
set up the survey mechanism (see p. 92).
SEE > oe
|
Public Health Service 39
To help clean up our Nation’s streams and rivers, the Congress
enacted Public Law 660, which extends and strengthens the Federal-
State water pollution control program (see p. 142).
This year, too, the Congress created a National Library of Medicine
within the Public Health Service. ‘The law (P. L. 981) provided for
the transfer of the Armed Forces Medical Library from the Depart-
ment of Defense and authorized the erection of a new building to re-
place the present obsolescent structure. This Library houses the
world’s greatest collection of medical literature and is of inestimable
value to the medical profession and the Nation. A 17-member Board
of Regents, authorized by the legislation, will advise on a site for the
new library building. Plans for effecting the transfer of the library
from the Department of Defense to the Public Health Service were
completed shortly after the end of the fiscal year.
Other health measures enacted during the year or on which
substantial progress was made toward enactment were: P. L. 411,
which extended the duration of financial assistance to the States for
the purchase of poliomyelitis vaccine (see p. 131); P. L. 732, which
authorized $4 million for a new building to house the laboratories of
the National Institute of Dental Research; P. L. 880, which authorized
the construction of mental health facilities for the Territory of
Alaska; P. L. 832, which authorized a Congressional appropriation of
$400,000 to defray the costs of holding the 11th Assembly of the World
Health Organization in the United States in 1958; and P. L. 854,
which provided salary increases for the Surgeon General and other
top officials and for medical and biological scientists in the Public
Health Service and other Federal agencies.
Taken together, all these measures represent a broad and compre-
hensive approach toward meeting many of the Nation’s leading health
needs. They reflect the deep desires of the American people for a
healthier and happier life and the expressed wish of the President to
work unceasingly toward that goal. This, then, has been a year of
unusual activity in the field of health—by professional and voluntary
groups and at all levels of government. America’s multipartnership
in the health cause has been strengthened and fortified, and should
yield even greater dividends in the years to come.
HEALTH RECORD
As already noted, the Nation continued to enjoy good health during
the past year. The death rate for 1955* was 9.3 per 1,000 population,
compared with the 1954 record low of 9.2 and the previous low of 9.6
in 1950, 1952, and 1953. This was the eighth consecutive year that
the death rate has been below 10 per 1,000.
1 All vital statistics are given for the calendar year.
408691—57——_7
90 Department of Health, Education, and Welfare, 1956
a
~The infant mortality rate, 26.4 deaths per 1,000 live births, remained
practically unchanged from 1954. The maternal mortality rate con-
tinued its descent in 1955, with 4.7 maternal deaths per 10,000 live
births.
The average length of life was 69.5 years for the entire population
in 1955, the most recently published life tables for the United States.
The average life expectancy was 67.3 years for white males, 73.6 for
white females, 61.2 for nonwhite males, and 65.9 for nonwhite females.
An increasing proportion of all deaths was caused by the major
cardiovascular-renal diseases. This group accounted for 54 percent
of the deaths in the United States during 1955, with a death rate of
506.0 per 100,000 population. Cancer caused 16 percent of all deaths
in 1955. The death rate was 146.5 per 100,000 population.
The mortality trend for accidents has been generally downward
since 1936. In 1955, the death rate was 56.9 per 100,000 population.
In the last 10 years, there has been no definite trend in the rate for
motor-vehicle accidents. But the rate for all other accidents dropped
nearly a third—to 33.5 in 1955.
Deaths from most communicable diseases continued to decrease.
The tuberculosis death rate dropped from 10.2 per 100,000 population
in 1954 to 9.1 in 1955. The principal diseases of childhood—scarlet
fever and streptococcal sore throat, diphtheria, whooping cough, and
measles—which caused about 10 deaths per 100,000 children in 1945,
were responsible for about 1 death per 100,000 in 1955. Since 1987,
when the sulfa drugs were introduced, the influenza-pneumonia death
rate has been cut three-fourths, from 114.9 in 1987 to 27.1 in 1955.
Many infectious diseases also decreased in incidence. Reduc-
tions of 20 percent or more were reported for infectious hepatitis,
poliomyelitis, malaria, and typhoid fever. In 1955 the total number
of reported cases of infectious hepatitis was 31,961, as compared with
50,093 in 1954. ‘The incidence of poliomyelitis decreased from 38,476
in 1954 to 28,985 in 1955. Although the incidence of diphtheria has
been decreasing for many years, there was an increase in the number
of cases during the latter part of 1955.
BIRTHS, MARRIAGES, AND DIVORCES
About 4,047,300 live births occurred in 1955, slightly more than
the total in the preceding year (4,017,362). However, since the popu-
lation increased nearly 2 percent between 1954 and 1955, the birth rate
declined slightly—from 24.9 to 24.6 per 1,000 population. There was
a continued rise in the proportion of registered births occurring in
hospitals—94.4 percent—and in the proportion attended by physi-
clans—96.8 percent.
Public Health Service 91
The number of marriages increased slightly. There were 1,531,000
marriages in 1955, for a marriage rate of 9.3 per 1,000 population,
compared with 1,490,000 marriages in 1954, and a rate of 9.2 per 1,000
population. Figures for 1955 indicate a slight decrease in the num-
ber of divorces. In 1954 there were 379,000 divorces, for a rate of
2.4 per 1,000 population.
Change in Leadership
In April 1956, Dr. Leonard A. Scheele was reappointed Surgeon
General of the Public Health Service for a third four-year term.
Shortly after the close of the fiscal year, Surgeon General Scheele an-
nounced his retirement from the Service, effective August 1. President
Eisenhower appointed Dr. Leroy E. Burney as the eighth Surgeon
General of the Public Health Service on August 3, 1956. A career
officer of the Public Health Service, Dr. Burney served as Chief Deputy
of the Bureau of State Services from 1954 to 1956 and was Commis-
sioner of Health for the State of Indiana for 9 years.
Funds and Personnel
_ For its various programs and activities, there was a total of $485.7
million in funds available to the Public Health Service in 1956 (see
table 1, page 153). About $395 million of this sum was in appro-
-priations and authorizations, with the balance made up of reim-
bursements for services rendered to other agencies and in unobligated
balances from previous years.
Grants to the States for health programs and for construction of
health facilities amounted to 39.7 percent of the total funds obligated.
Research and training grants to medical, dental, and research insti-
tutions represented 16.2 percent of the total.
At the close of 1956, there were 21,268 full-time employees in the
Public Health Service (see table 2, p. 155). This number included
1,266 members of the regular Commissioned Corps of the Service,
1,698 members of the Reserve Corps on active duty, and 18,304 full-
time Civil Service employees.
‘Public Health Methods
|
_ The Division of Public Health Methods evaluates national health
“needs and resources in a staff capacity for the Surgeon General. It
conducts special studies, develops and applies methods for measur-
: ing the extent and nature of disability and illness, and participates
in special cooperative projects with public and private agencies. The
Division also edits and publishes Public Health Reports and the Pub-
92 Department of Health, Education, and Welfare, 1956
lic Health Monographs, media for disseminating information about
public health research, practice, and administration.
ANALYSIS OF ILLNESS AND MORTALITY
Legislation enacted during the year authorized the Public Health
Service to conduct a continuing national survey and special studies of
sickness and disability. The National Health Survey Program, lo-
cated in the Division of Public Health Methods, will consist of a con-
tinuing sampling of the population by means of household interviews
designed to secure data on sickness, disabilities, and the medical care
received for these conditions. It will also include special studies to
collect detailed morbidity information, for example, physical exam-
inations and clinical tests of a subsample of persons interviewed during
the household survey. The purpose of the program is to provide
statistical information that will define more clearly the extent of illness
and disability in the Nation.
The direction of a special survey of Indian health was made the
responsibility of the Division in July. Requested by the Committee on
Appropriations of the House of Representatives, its purpose is to de-
termine measures needed to bring Indian health to an accepted level.
Statistics on the Indian population were assembled and analyzed, and
a. house-to-house morbidity survey was made at selected reservations.
Information on public health services was collected by means of a
questionnaire, supplemented by data routinely reported to the Pub-
lic Health Service. Information on health services provided by the
Division of Indian Health was obtained from that Division and by
special field studies. A study of economic and social resources avail-
able for Indian health was carried on by contract arrangements with
universities. A preliminary report was made to Congress at the end
of October; a comprehensive report will be submitted later.
A study of surgical experience in selected areas of the United States
was completed. In it these observations are reported: Fewer surgical
removals of tonsils and the appendix have taken place in small cities
and rural areas than in large cities, in nonwhite than in the white
population, in eastern cities than in those of the far west, and in
families with low incomes than in those with higher incomes.
HEALTH PERSONNEL STUDIES
Part one of a manual, Cost Analysis for Collegiate Programs in
Nursing, has been completed. Prepared with the assistance of the
Division of Nursing Resources, and published by the National League
for Nursing, it presents a method for analysis of expenditures. The
preparation of part two of the manual continued during the year.
A pilot study that applies cost analysis methods to medical edu-
cation, in which the Division is cooperating with Emory University,
|
.
Public Health Service 93
is nearing completion. This has required detailed study of the finan-
cial relationships between the school of medicine and the parent uni-
versity, the hospital, and other professional schools. The dividing
of expenditures according to the primary functions of teaching, re-
search, and service, and the technical problems of allocating indirect
expenditures added to the complexities of the study.
Another study nearing completion is that being made in collabora-
tion with the American Hospital Association and the National Asso-
ciation of Social Workers. This study represents the first compre-
hensive survey in 25 years to determine the extent to which medical
social service is a part of hospital care.
In cooperation with the Division of Dental Resources, a report on a
special study of original tabulations of dentists made for the Health
Manpower Source Book series was published this year in an article on
the location of dentists. The location of dentists graduated in recent
years was contrasted with the distribution by residence of students
attending dental school within the past 12 academic years. Members
of the Division made extensive contribution to a publication of the
Office of Defense Mobilization released during the fiscal year that
reviews for each category of paramedical personnel such characteris-
tics as these: functions, education, supply, demand, aids for teaching
and training, and recommendations for overcoming shortages. The
Division also provided consultative service to many groups, including
representatives from abroad, on problems associated with health and
medical personnel.
STUDIES OF HEALTH SERVICES
Among the important studies completed by the Division during the
year was one jointly sponsored by the Division of Special Health
Services and the Commission on Chronic Illness. This was a study of
selected home care programs, undertaken because of the interest in
the provision of care to patients at home. Among the findings of the
study is the observation that patients of all economic groups, espe-
cially those with long-term illness, need coordinated services at home
during some phase of illness; yet comparatively few communities have
recognized the potential of organized home care.
During the fiscal year, the Commission on Chronic Illness began
to terminate its activities, preparatory to eventual deactivation and to
the transfer of its functions to other agencies and groups. Among
the final tasks, in which the Division is participating, is the
preparation of the report of the Commission in a four-volume series
entitled “Chronic Illness in the United States.” Volume I, Pre-
vention of Chronic Illness, will present the Commission’s recom-
mendations and will include a revision of 16 technical statements on
preventing chronic disease.
94 Department of Health, Education, and Welfare, 1956 _
a fe ee a a ae,
National Institutes of Health
The National Institutes of Health, the main research bureau of the —
Public Health Service, continued to dune and support research and ~
research training in the major diseases of our time. In 1956 its lab- ©
oratory and clinical investigations at Bethesda, Md., as well as its
extensive program of research grants, represented about a quarter ©
of the medical research in this country. Approximately two-thirds of ©
the NIH appropriation was awarded to scientists in medical schools,
hospitals, and other non-Federal institutions (see table 3, page 157).
Today’s medical scientist, in order to make maximum progress, re- ~
quires highly skilled teams of auxiliary personnel. In December 1955 ~
centralized services at NIH were reorganized and expanded to form ~
two new Divisions—the Division of Research Services and the Divi- ~
sion of Business Operations. The research services are performed by
branches concerned with biometrics, laboratory aids, plant engineer-
ing, research facilities planning, sanitary enginering, and scientific re-
ports. The business operations are the responsibility of branches on
financial management, management analysis, offices services, personnel,
plant safety, supply management, and a Board of United States Civil
Service Examiners.
Another program change was an expansion of activities in the Na-
tional Microbiological Institute, with a change of name to National
Institute of Allergy and Infectious Diseases. NIH now comprises
seven institutes and five divisions, including the Clinical Center.
Clinical Center
A total of 443 beds had been activated in the Clinical Center by the
end of fiscal year 1956, an increase of 70 over the previous year. Pa- —
tients hospitalized for study totaled 2,112, and their average stay was —
44.5 days. ‘The average daily census was 281. All of these figures
represent substantial increases over the preceding year.
One handicap to the clinical program is the continuing nation-
wide shortages of essential professional workers, particularly gradu-
ate nurses. In an effort to attain maximum use of the clinical
facilities, an intensive nationwide program of nurse recruitment was ~
begun, in cooperation with other parts of the Public Health Service.
Despite this handicap, a varied and vigorous program of clin- ©
ical study, closely meshed with NIH’s laboratory research, is now ~
firmly established. It has already made numerous contributions,
many of which are mentioned elsewhere in this report.
Less tangible, but in the long run not the least of these contribu- —
tions, is the progression of young physicians who go out each year
Public Health Service 95
from the Clinical Center to the faculties of medical schools, to
_ hospitals and other institutions, and to private practice. These physi-
- cians—designated as clinical associates—come to NIH directly from
the first or second year of residency in leading general and special hos-
_ pitals. Under the direction of senior clinical investigators, they pro-
vide necessary medical and surgical care for the research patients
_ while also taking part in the research studies.
Many young physicians use their NIH service as qualifying exper1-
ence toward their chosen medical specialty, and all have an oppor-
tunity to learn the techniques and traditions of research medicine.
This program is thus enhancing the ability of hundreds of physicians
throughout the country to do independent research and to approach
the teaching and practice of medicine with the inquiring mind and
sharpened skills of the research worker.
Large numbers of physicians, nurses, dietitians, science teachers,
and hospital administrators from every part of the Nation and many
foreign countries continued to visit NIH, attracted by the new clinical
program. The schedule of lectures, seminars, symposia, and clinical
staff conferences also attracted many physicians and scientists.
Division of Biologics Standards
The past year has been one of substantial accomplishment for the
Division of Biologics Standards, which was created a year ago.
The intensified developmental research and testing required for
poliomyelitis vaccine, as well as the background research for the
entire program, necessitated an increase in staff from 45 to 188
during the year. The need for additional space led to Congressional
authority for the construction of a $3,500,000 building, planned for
occupancy by January 1959. Meanwhile, temporary space was made
available for immediate expansion of the Division’s four programs—
viral products, bacterial products, blood and blood products, and
control activities.
During the year, the Division strengthened the program concerned
with testing the poliomyelitis vaccine. More than 80 million cubic
centimeters of vaccine were released—57 million cc.’s of this amount
since January 1.
The close cooperation of the manufacturers, the Technical Com-
mittee on Poliomyelitis Vaccine, and Division scientists has made
possible the development of improved measures for dealing with a
number of technical problems affecting consistent and safe vaccine
production. ‘These measures involve: (1) suitably spaced filtration
procedures to remove aggregates in which virus may be protected
from inactivation by formaldehyde, (2) improved sampling methods
in the tissue culture tests, and (3) increased sensitivity of the monkey
96 Department of Health, Education, and Welfare, 1956
safety test. This has required an intensified testing program, close
observation of manufacturing processes, and a revision of the origi-
nal requirements for manufacture and testing.
Division scientists are studying human cell lines in tissue culture,
with a view to finding one that will be even more sensitive to polio-
myelitis virus than the monkey kidney cells now in use. Other work-
ers are studying the possible emergence of resistant mutants or vari-
ants to formaldehyde, ultraviolet light, and other inactivating agents;
and methods for improving the potency test of the vaccine.
The Division is also concerned with such problems as the purifica-
tion of rabies vaccine, the classification and isolation of influenza
virus, the control of serum hepatitis, and methods for extending the
storage period of blood for transfusion. A complete panel of red
cells of known antigenic makeup has been prepared for identifica-
tion of antibodies of unknown bloods. In addition, complete geno-
typing of families with hereditary abnormalities is being done in
a search for red cells of unusual types.
Division of Research Grants
Because the conquest of many diseases depends to a large extent
on a vastly increased understanding of fundamental biological struc-
tures and processes, the Division of Research Grants placed particular
stress on the support of basic medical research during the fiscal year.
These biological structures and processes contain the ultimate sig-
nals of any abnormality preceding a disease process. Many of these
signals, however, remain so delicate and subtle that we have not yet
been able to develop the necessary skills, apparatus, or methods
required to establish valid criteria or baselines.
In order to aid the numerous scientists attempting to furnish these
criteria, the Division of Research Grants, through its recognized
authorities composing the National Advisory Health Council and
the various Study Sections, instituted new programs specifically
designed to increase the number and special training of research
scientists in the fields of biophysics, instrumentation, and pathology.
Reward from this support was evident in the degree of progress
made in these fields, as well as in biochemistry, histochemistry, meta-
bolism, reproduction, endocrinology, physiology, and radiation.
Especially conspicuous was the advance made in obtaining more
highly purified ribonucleic compounds for study. These compounds,
predominant in the genes, control the development of the individual as
well as the heredity of unborn generations. Hence, the effects of radi-
ation and numerous deleterious chemical substances have been in-
tensively explored.
Public Health Service 97
Significant progress was also made in understanding how certain
metals, serving as part of an enzymé system, react within the body as
a “claw” that reaches out and fastens itself to certain proteins. The
year was further marked by a more widespread use of techniques pri-
marily designed for the physical sciences. On one grant-supported
project, the emission spectroscope revealed previously unidentified
inorganic material in the biological sample.
Institute of Allergy and Infectious Diseases
A major development at NIH during the year was the delegation
to the National Microbiological Institute of responsibility for a broad
program of fundamental research on allergy. Authorization was
made by the Surgeon General and became effective December 29, 1955.
It was also decided io change the Institute’s name to the National
Institute of Allergy and Infectious Diseases. The new name not only
reflects the importance attached to the program; it also emphasizes the
close relation of allergy to the study of infectious diseases, particularly
those concerned with immunology.
The decision to initiate an expanded research program in allergy
was the outgrowth of a series of conferences at the National Institutes
of Health, attended by some of the Nation’s leading authorities in
allergy and immunology. It was decided that major emphasis should
be placed on grant-supported studies to encourage scientists in schools
and hospitals to investigate problems in this long-neglected field.
An estimated 10 percent of the population in this country suffers
from some form of allergy, with asthma victims alone numbering be-
tween one and two million. Despite the widespread prevalence of
these disorders, present knowledge of allergy is meager. This is par-
ticularly true concerning the underlying mechanisms of the allergic
response. :
One of the most notable areas of progress in infectious disease re-
search in the past year was the field of common respiratory diseases.
An experimental vaccine developed by scientists of the Institute
against one type of APC virus was tried out in prisoner volunteers
and was shown to provide substantial protection against induced in-
fection. On the basis of these results, a field trial in cooperation with
the Navy was initiated in January 1956 to evaluate an APC vaccine
made from three strains of virus which are an important cause of res-
piratory disease in military recruits. This group of viruses, recently
renamed adenoviruses, produce grippe-like illnesses. ‘They are not
the cause of nonfeverish illnesses commonly termed colds. The
vaccine effected a significant reduction in the occurrence of acute
respiratory disease due to the APC virus prevalent during the period of
observation.
98 Department of Health, Education, and Welfare, 1956
Institute scientists succeeded in crystallizing Coxsackie virus for
the first time. Isolation of a human virus in crystal form was first
achieved in 1955 by University of California scientists working with
poliomyelitis virus grown in tissue culture. The NIAID studies repre-
sent the first time any virus has been obtained in pure crystal form
directly from animals. Purification of viruses opens new opportuni-
ties to study their chemical makeup and immunological reactions.
New advances were reported in tissue culture studies aimed at de-
fining the minimal nutritional requirements of various cell lines. —Thus
far, Institute scientists have shown 27 factors to be essential for survi-
val and growth of cells in the test tube. Among these are 13 amino
acids and 8 vitamins, including inositol, one of the least understood
of the vitamins and one for which there is no evidence of a require-
ment in man.
In studies of the nutritional requirements of certain parasitic
worms, Institute scientists have succeeded in cultivating in the test
tube for the first time a nematode parasite of a vertebrate through
its entire life cycle. Asa result, studies can now be made with para-
sites exposed to a predetermined environment uncomplicated by the
bacteria normally found in the intestinal tract of laboratory animals.
During the past year, scientists of this Institute reported isolation of
type 1 poliomyelitis virus from an infant born at the time his mother
was in a respirator suffering from acute poliomyelitis. This 1s be-
lieved to be the first time a subclinical infection with poliomyelitis has
been demonstrated in a newborn infant. The child’s growth and de-
velopment have been normal.
RESEARCH GRANT STUDIES
Grant-supported studies in the Nation’s universities and other re-
search institutions produced a number of significant results. A
University of Chicago scientist, for example, demonstrated that an
outbreak of the pulmonary fungus disease, histoplasmosis, was caused
by inhalation of spores while spreading infectious chicken manure
compost on garden soil. Another study at Iowa State College showed
a marked reduction in the number of trichinae, the microscopic para-
sites causing trichinosis, in bulk and untreated-link sausage over the
number found 10 years earlier. This reduction is probably due to
sterilization of the garbage fed to hogs or to elimination of garbage
feeding. ‘Tests carried out on smoked and heat-treated link sausage
yielded no trichinae.
Institute of Arthritis and Metabolic Diseases
Research conducted and supported by this Institute during the
year yielded a number of important developments. Progress has
Public Health Service 99
been notable both in basic studies directed toward development of
fundamental knowledge of the complex metabolic processes and in
clinical investigations seeking improved methods of treatment.
PROGRESS IN RESEARCH
Highlighted in this report last year was the fact that NIAMD had
conducted the first clinical trials of two new steroid compounds,
prednisone and prednisolone. ‘These chemical cousins of cortisone
were reported to be several times as potent as the older steroid in the
treatment of rheumatoid arthritis, yet safer to use because they did
not cause certain untoward side effects. During the past year these
new drugs have, in everyday use, borne out the preliminary findings
of the scientists. They are now rapidly replacing cortisone and
hydrocortisone in the treatment of rheumatoid arthritis and several
other diseases. Meanwhile, the search for even better antirheumatic
drugs continues.
Research in the field of metabolism yielded a discovery which can
result in saving the lives of many children suffering from a usually
fatal hereditary disease of infants—galactosemia. Institute scien-
tists found in the blood of normal persons a new enzyme which makes
it possible for the body to convert one of the sugars in milk, galactose,
into glucose (blood sugar), which produces energy. Searching
further, they found that children suffering from galactosemia lacked
this enzyme. Now that the basic cause is known, a relatively simple
diagnostic test is made possible. This is important because early diag-
nosis and treatment are vital. Treatment of the disease, when diag-
nosed, is simple: removal of milk from the diet.
Another promising compound, 9-alpha-flourohydrocortisone, was
studied intensively last year as a part of the Institute’s continuing
search for improved antiarthritis drugs. It was found to be 20 to
40 times more potent than cortisone in its antirheumatic action, but
unfortunately, it caused serious side effects which will prevent its use
in the treatment of arthritis.
It is a noteworthy event when pain-relieving power similar to that
of morphine is demonstrated in a new chemical type. Chemists at
the Institute have produced such a compound. Preliminary tests in-
dicate that the new drug has low addiction lability.
Institute scientists have found that a well-known chemical steri-
lizer, ethylene oxide, destroys essential vitamins in food products,
even though thoroughly removed from the products before marketing.
It is employed in industry to sterilize food items when steam or other
conventional methods cannot be used.
One of the principal hormones secreted by the pituitary gland con-
trols the activity of the thyroid gland. NIAMD investigators have
developed a sensitive, accurate, and rapid method by which this hor-
100 Department of Health, Education, and Welfare, 1956
mone may be assayed. The method is being used to guide efforts to
isolate and purify the hormone in the laboratory.
Searching for new raw material sources for the synthesis of anti-
arthritis drugs, chemists at the Institute have extracted from the
dried leaves of a shrub which grows wild in Paraguay the sweetest
natural product yet known, a substance called stevioside, which is
300 times sweeter than table sugar (sucrose).
During episodes of acidosis, which lead to coma and death, dia-
betics often are unresponsive to insulin. Institute scientists have
shown that the plasma of patients with diabetic acidosis contains a
material which suppresses or abolishes the effect of insulin. Search
for the source of this insulin inhibitor is continuing.
PROGRESS IN GRANTS
Through its extramural programs, NIAMD supports research pro-
jects in non-Federal institutions throughout the country, provides
grants to medical schools for graduate training programs, provides
research fellowships for medical students, and awards training sti-
pends which enable physicians to develop specialized skills in the rheu-
matic and metabolic diseases. Research grants recommended by the
National Advisory Arthritis and Metabolic Diseases Council yielded
such results as the following.
Although degenerative joint disease (osteoarthritis) is considered
to be largely due to wear, tear, and irritation of the joints, grantees at
Washington University, St. Louis, have found that laboratory ani-
mals fed a high-calorie, high-fat diet are more likely to develop this
disorder than animals that are underfed.
At Yale University, grantees have developed a technique by which
high-frequency sound waves are used to break up urinary caleuli—
stones found in the kidney, bladder, and ureter.
At the Boston Children’s Hospital, grantees have developed a new
diagnostic test for mucoviscidosis, also known as fibrocystic disease of
the pancreas, which is nearly always fatal if not found at an early
stage. The new test, 98 percent accurate, is based upon analysis of
sweat and is much more simple than the test previously used.
At Johns Hopkins University grantees have found that one of the
complications of diabetes, diabetic retinopathy, a disease of the retina
of the eye, is inked to an apparent inability of the affected individuals
to utilize vitamin By».
Cancer Institute
The age-adjusted cancer mortality rate for women continued to
decline slowly, following a trend which began about 1935. By 1954,
the rate dropped to the level which prevailed in 1910. In contrast to
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Public Health Service 101
this trend, the age-adjusted death rate for males is steadily increasing,
and there is no indication of a slackening in the immediate future.
Between 1950 and 1954, the respiratory system accounted for two-
thirds of the rise in male mortality rates for all sites.
The Third National Cancer Conference was held under joint spon-
sorship of the Institute and the American Cancer Society. Arrange-
ments were completed for the Journal of the National Cancer Institute
_ to be issued monthly, beginning July 1, 1956, after 16 years as a
bimonthly publication.
NATIONAL CHEMOTHERAPY PROGRAM
The Cancer Chemotherapy National Service Center, headquarters
for the national voluntary program of cooperative research and
development in chemotherapy of cancer, completed its first year of
operation. Under the guidance of advisory groups, steps were taken
to stimulate, support, and assist research in cancer chemotherapy.
Approximately 6,800 chemical compounds were procured for the
screening program. These came principally from educational insti-
tutions, government installations, and industrial firms. Financial
support was given for the synthesis of new chemical agents and for
the procurement of relatively large amounts of chemical agents that
warrant extended investigation. Contracts for screening chemicals
were let to five laboratories, providing a total capacity for annual
evaluation of between 5,000 and 10,000.compounds against three mouse-
tumor systems.
Preclinical pharmacological testing on five drugs was begun at the
Food and Drug Administration under an arrangement whereby the
FDA will provide the Center with a rather complete preclinical
workup of compounds, at the rate of one or two a month.
LABORATORY AND CLINICAL STUDIES
The wide range of research activities at the Institute produced
significant accomplishments in both laboratory and clinical studies.
New advances in cancer knowledge were reported by Institute scien-
tists working in the fields of biology, biochemistry, chemical phar-
macology, physiology, endocrinology, radiation, and surgery.
Studies at the cellular level were assisted by the development of
techniques for growing massive, long-term tissue cultures outside the
body. Cells were grown freely suspended in a rapidly shaking nu-
trient fluid. By this method cultures can be grown weighing as much
as 21 grams, whereas conventional methods permitted the growth of
cultures weighing only 20-50 mgs.
The remarkable power of the amino acid arginine to reduce lethal
toxicity of amino acid mixtures such as those used for intravenous
feedings was reported by Institute scientists. It was later found that
102 Department of Health, Education, and Welfare, 1956
administration of arginine at the appropriate time will permit sur-
vival of all rats receiving a lethal dose of ammonium ion. This ob-
servation emphasizes the need for studying metabolism of ammonia,
or ammonium compounds formed by molecular rearrangements within
the body, as a practical problem in feeding by vein the patient who
cannot eat.
A new synthetic, water-soluble, complete diet has been developed
and used successfully by Institute scientists in growing rats from the
weanling stage through maturity.
A new drug, Amphenone, developed by Institute scientists, was used
successfully to suppress the functions of the adrenal glands. Hor-
mones produced by the adrenals apparently play a role in the growth
and development of some cancers. Drugs like Amphenone may be-
come effective substitutes for surgical removal of the adrenal glands
in patients with breast cancer for whom adrenal surgery has a pallia-
tive effect. It has also brought adrenal overactivity under control in
other patients who suffer from cancer of the adrenal glands or adrenal
overgrowth.
Studies in radiation therapy have shown that both tumor response
and normal-tissue tolerance may be improved if effective doses of
ionizing radiations are administered over prolonged periods of time
rather than in shorter periods as generally practiced.
Institute scientists have reported that the cause of hypoalbuminemia ~
in cancer patients appears to be a defect in the rate of production of
albumin in the body. Hypoalbuminemia is a decreased concentration
of circulating albumin, a blood plasma protein. This observation was
made in the course of a study of the distribution and metabolism of
blood proteins of cancer patients.
STUDIES SUPPORTED BY GRANTS
Activity of scientists working under grants covered all phases of
research on the cancer problem: the cancer-producing process, im-
provements in diagnostic and therapeutic procedures, and host-tumor
relationships. In the search for drugs to block certain chemical path-
ways necessary for the growth of cancer, grant-supported scientists
found that selenium cystine produced temporary remissions in a few
leukemia patients. In one patient this drug appeared to neutralize
the resistance that he had acquired to another drug, 6-mercaptopurine.
The occurrence of disagreeable side effects indicates the need for
further study.
A grantee has observed that bile may carry a substance that Bich tite
cancer specifically in the biliary system. Subcutaneous injection of
bile from individuals with cancer of the bile duct into hamsters and
mice produced cancer of the bile duct in some of the animals and
cancer of the liver in others. In sharp contrast, hamsters tested with
Public Health Service 103
bile from normal individuals and from those suffering from benign
biliary tract disease showed only sloughing of the skin at injection sites.
Some light was shed on duplicating biologic systems by a study in
which living virus was separated into its major components—a protein
and a nucleic acid—and was then caused to reconstitute itself through
proper mixing. The reconstituted virus regained the attributes of
life: it infects other cells and reproduces. This study has an impor-
tant potential for extending knowledge of viruses that cause cancers
or destroy them and of the growth and multiplication of cancer cells.
BIOSTATISTICAL AND FIELD INVESTIGATION STUDIES
“Morbidity from Cancer in the United States, Part I,” a definitive
~ work on the occurrence of cancer in 10 metropolitan areas, was pub-
lished. Results of a survey on the distribution of smoking patterns in
the country, taken by the Bureau of the Census for the Institute, were
tested on the relation between smoking and lung cancer. The study
indicated that the risk of lung cancer for the total population of the
United States appears to correspond to that found in earlier studies
of selected groups of smokers and nonsmokers.
Analysis of recorded mortality among Navajo Indians has confirmed
the presumed deficit of cancer and cardiovascular-renal disease in this
population group.
Studies of the cell examination techniques for early detection of
uterine cancer, initiated 3 years ago in Memphis, Tenn., were widened
by establishment of field projects in eight different areas of the coun-
try. The new centers will provide comparative data for the estab-
lishment of true incidence rates and more information on the natural
history of carcinoma in situ. One objective is to demonstrate that
eventual widespread application of this screening technique will help
eradicate cervical cancer.
The results on 75,000 patients with cancer during a 17-year experi-
ence were analyzed in a collaborative study with the Connecticut State
Department of Health. There has been a significant improvement
in survival rates, not attributable to earlier diagnosis, and referable
particularly to specific sites of the rectum, colon, and uterus.
CANCER CONTROL AND RESEARCH TRAINING
_ Grants in the amount of $2,250,000 were made to health agencies
in 47 States and 4 Territories for the support of cancer programs.
- These are directed toward expansion and wider use of cancer diagnos-
tic and treatment services.
Manpower resources in the cancer field were augmented under the
Institute’s three specialized training programs: teaching grants to
medical, dental, and osteopathic schools; support of physicians in
clinical traineeships; and support of research fellowships to promis-
104. Department of Health, Education, and Welfare, 1956
ing young scientists. The latter two programs have been in opera-
tion for 18 years.
Institute of Mental Health
The challenge of the national mental health problem resulted in
important forward strides in 1956. These included measures of Fed-
eral and State legislatures, development of more effective research
tools and treatment techniques, increasing numbers of trained scien-
tific and professional personnel, and greater interest and participa-
tion in mental health activities by citizens and private organizations.
Early in the fiscal year, Congress enacted the Mental Health Study
Act (P. L. 182), which provided for a thorough review and evaluation
of current knowledge concerning resources, methods, and practices for
dealing with mental illness. The study is expected to produce rec-
ommendations on how to extend psychiatric knowledge and how to
make more effective use of professional personnel and facilities, both in
short supply. Under the terms of the act, the National Institute of
Mental Health awarded a grant to the Joint Commission on Mental
Illness and Health, Inc., to conduct a nationwide analysis and evalua-
tion of the human and economic aspects of mental illness. The Com-
mission’s membership includes representatives of the American Med-
ical Association, the American Psychiatric Association, and 19 other
national organizations having a major interest in the social, legal,
scientific, clinical, and psychological aspects of mental illness.
In every State during 1956, there was an accelerated effort to meet
mental health needs. There were increasing requests for technical
and consultative services in State hospitals and institutions, in pro-
fessional and community education programs, and in clinic and re-
habilitative services. Consultants in special areas such as drug addic-
tion were added, and work was extended on alcoholism, school mental
health, and inpatient services for emotionally disturbed children.
The Institute also worked with the States on two other major mental
health problems—juvenile delinquency and mental retardation.
Grants to support a wide range of basic and applied research were in-
creased in both of these areas. In addition to expanded research, the
Institute made available the services of specialized staff to State and
private organizations and to other Federal agencies planning and
evaluating remedial action.
The States also focused attention on extending community
mental health services. Such services contribute to mental health gen-
erally, help prevent admissions to hospitals, and increase the num-
bers of persons who can be discharged from mental hospitals. Sev-
eral States enacted legislation providing for matching local community
mental health expenditures on a 50-50 basis.
Public Health Service 105
Regional cooperation by States in the field of mental health con-
- tinued to grow. Pooling of mental health resources has enabled each
participating State to benefit from the facilities of a total area, rather
than from its own facilities alone. The most recent of these inter-
_ State compacts for mental health—and the second to be supported by
an Institute grant—was undertaken by the Western Interstate Com-
mission for Higher Education.
_ ADVANCES IN TRAINING
During the past year, Institute grants supported graduate training
in clinical psychology, psychiatric nursing, psychiatric social work,
public mental health, and psychiatry. Other grants were awarded
to medical schools to improve psychiatric instruction. _
In addition to extending the training opportunities for personnel
associated with the mental health professions, grants were made to
support various pilot projects in evaluating teaching methods and
training procedures. A grant awarded to the College of Nursing at
Wayne University has among its objectives the determination of the
value of an investment in preservice education for psychiatric aides.
Scheduled for intensive study are the effects of such training on
patient care, the proper content and teaching methods for a preservice
program, and the identification of those areas of supervision and
administration which can be safely assumed by the trained aide in
caring for the psychiatric patient.
Attention was also given to providing mental health training courses
for lawyers, teachers, ministers, and others who deal with human
problems. One current grant to the Law School of the University of
Pennsylvania is to develop the curriculum content and methods for
training law students in the behavioral sciences. Nine grants were
awarded in support of institutes for general practitioners, pediatric-
ians, psychologists, and other professional personnel to acquaint them
with recent advances in research on mental retardation and techniques
for counseling parents of retarded children.
DEVELOPMENTS IN MENTAL HEALTH RESEARCH
Both the intramural and extramural research programs of the
Institute benefited from the intensified application of techniques de-
rived from a wide range of scientific disciplines. A strong stimulus
to research came from statistical studies. The collection and eval-
uation of data from mental health clinics and hospitals and the devel-
opment of unified reporting systems on a nationwide basis have raised
a host of questions concerning etiology, treatment, and types of com-
munity services that can and should be provided.
In the research grants program of the Institute, increased research
potential has made possible a growth in large, multidisciplined, pro-
408691—57—_8
106 Department of Health, Education, and Welfare, 1956
cine dal
gram-type projects as well as expanded efforts in clinical psychology
and psychiatry and basic physiological, psychological, and sociologi-
cal investigations.
The several grants made to finance conferences were an indication
of the Institute’s concern for certain special areas of research. Grant
support was given to the American Psychological Association’s Na-
tional Conference for Planning Research on the Psychological Aspects
of Aging. Another was made for the Symposium on Interdisciplhi-
nary Research in the Behavioral, Biological, and Biochemical Sciences
held at the University of Wisconsin. In such conferences, leaders in
relevant research fields met to synthesize their collective knowledge
and to determine the direction of their future efforts.
A psychopharmacological conference, cosponsored with the Nee
tional Research Council and planned fait the fall of 1956, has aroused
much interest because of the widespread use of trantaiieae drugs in
the treatment of mental disorders. It is expected that the conference
will take up the many ways that drugs act upon mental state and
mental disease. The relation observed between certain drugs and
normal body substances poses the challenging possibility that chem-
ical imbalances may be a factor in the development of some mental
diseases. The identification made this year of the chemical disturb-
ance in phenylpyruvic oligophrenia. (a disorder associated with mental
retardation) has led to its prevention and treatment.
Institute of Dental Research
The National Institute of Dental Research continued its search for
further evidence of the cause of tooth decay and disease of the oral
tissues. The Institute continued to demonstrate the inhibitory effects
of fluoridated drinking water on dental caries.
Greater emphasis was placed on the study of periodontal diseases,
which are often seen among older persons. Preliminary findings sug-
gest that, to be effective, efforts at prevention of periodontal disease
must begin early in life.
There is continuing evidence that the heat processing of certain
protein foods may bring about nutritive changes which become a
factor in dental caries. Proteins are thus being seriously considered
in nutritional studies on dental disease.
In continuing research on dental metabolism, the evidence sug-
gests that the physiological activity of the dental enamel may be of
major importance in determining susceptibility to dental caries.
A histochemical technique has been developed for diagnosing tissue
disease through detection of the proteolytic enzyme peptidase. In a
study of tumor tissue, the technique reveals changes that cannot be
Public Health Service 107
seen with routine staining methods. The investigation may, there-
fore, prove of value in fields other than dental research.
Hereditary defects in tooth structure were studied in 63,000 school
children in Michigan. Part of the study involves a comparison with
a group of about 4,500 isolated people, found along the Atlantic sea-
board. ‘Two dental conditions were identified.
Studies on the etiology of dental caries and periodontal disease
in laboratory animals are going on. Bacteriological studies in-
clude the effects of various antibiotics and their relation to prevention
of decay. The periodontal tissues and the salivary secretions are
being studied for biochemical and enzymatic properties related to
oral diseases.
New and improved techniques for preparation of specimens for
electron microscopy and diffraction are being developed. Research
in the biologic effects of ultrasound on human tissues other than teeth
are also under way. Particularly to be determined is the kind of
radiation set up by ultrasonic equipment.
Institute of Neurological Diseases and Blindness
The Institute’s expanded research program in neurological and
sensory disorders has resulted in several advances in the diagnosis,
treatment, and prevention of many chronic and crippling conditions.
Intramural investigations were coordinated with research grant proj-
ects on the development, activity, and function of the brain and
nervous system.
Studies on the embryology, pathology, cytology, histochemistry,
and biochemistry of nerve cells and fibers of the brain and spinal cord
are under way. Other studies concern the experimental production
of cerebral palsy by means of anoxia, birth injury, anesthesia, and
cerebral vascular damage.
Investigation of the microstructure of nerve cells, fibers, junctions,
and terminals with the electron microscope and micrograph, and
studies on the nerve impulse and rapid ion movements, have provided
new leads in nerve-muscle research.
Experimental studies of thermoregulatory mechanisms of the auto-
nomic nervous system and research on the effects of drugs and irradia-
tion on the brain centers that regulate body heat, water balance,
sleep, visceral activities, and endocrine secretions have resulted in
better understanding of many neurologic disorders.
Studies on the development, regeneration, vascular supply, and
functional restitution in the central nervous system have led to further
investigations of the fever-producing mechanisms which facilitate
nerve regeneration.
108 Department of Health, Education, and Welfare, 1956 g
een tee es Eee ieee AE
Valuable information on sensory disorders has been found in studies
of the auditory and vestibular tracts, the sensory mechanism of the
inner ear, taste bud degeneration and regeneration, and effects of
anesthetic agents in relief of pain and toxic change.
Other projects included investigation of cerebral hemodynamics;
studies on nutritional, metabolic, enzymatic, and endocrinal aspects
of neurological disorders; and production of Parkinsonism in mon-
keys by reserpine and other drugs.
CLINICAL PROGRESS
Significant progress was made in the field of neuromuscular dis-
orders. New drugs and electronic techniques provided valuable
knowledge of the biochemistry and electrophysiology of muscle and
neuromuscular function. Biochemical studies of blood and urine,
using radioactive tracer techniques, and protein metabolism studies
in patients with muscular dystrophy and related diseases, have yielded
important data.
A new approach to the causes and course of multiple sclerosis in-
volves the production of experimental demyelination. Electro-
phoretic studies and biochemical analysis of gamma globulin in
multiple sclerosis patients provided new leads to differential diagnosis
and prognosis.
Experimental studies on control of respiration and blood flow by
the central nervous system show that the anterior spinal artery may
carry enough blood to sustain medullary respiratory and vasomotor
center function. Studies on effects of temperature on the myoneural
junction show that relatively low frequencies of electrical stimulation
initiate tetanus in the hamster at low temperatures.
Neurosurgery studies contributed to the knowledge of focal epilepsy,
localization of motor and perceptual functions, speech, memory and
consciousness; and surgical relief from pain has been progres-
sively successful.
In collaboration with NIAID, the therapeutic effects of pyrime-
thamine on patients with toxoplasmic uveitis and of metacortin and
other drugs on inflammatory eye diseases were evaluated. Studies
of adenopharyngeal conjunctivitis have determined the viral cause
and course of the disease. Tissue culture studies have shown that the
APC virus, type 8, is immunologically similar to the virus causing
epidemic keratoconjunctivitis.
Studies on glaucoma show that eye pressure changes elicited by
central stimulation are secondary to coexisting changes in the systemic
blood pressure and independent of striate muscular activity in the
orbit. Other investigations show that ionizing radiation, nutritional
deficiencies, metabolic agents, and drugs can produce cataractous
changes. Electroretinographic studies have resulted in evaluation of
PB aS ROT 5 OO OI, — CNL LTTE TD
Public Health Service 109
photopic and scotopic responses in patients with hereditary retinal
degeneration. Because histological and serological studies indicate
that 20-25 percent of all granulomatous uveitis may be due to infection
with Toxoplasma gondii, a more accurate diagnostic test for presump-
tive ocular toxoplasmosis, an agar-diffusion technique, has been devised
to replace the so-called toxoplasma dye test.
Radioisotope studies with malignant tissue of the eye indicate that
the beta-emitting P*? uptake of ocular melanomas is often too slight
to assure detection by external counting.
The glutamine-asparagine studies have led to greater emphasis on
the investigation of gamma amino butyric acid, which is of vital im-
portance in the metabolic processes of the brain. A dramatic corol-
lary of this work has been the relief from seizures in cases of total or
partial removal of the temporal lobe.
RESEARCH GRANT ACCOMPLISHMENTS
Several compounds called hydroxylamine derivatives, which seem
to act as true antidotes for the nerve gases, have been synthesized.
Preliminary studies suggest that migraine headaches may be
promptly terminated by intravenous injection of norepinephrine, a
blood vessel constrictor.
Studies on barbiturate poisoning and insulin coma show that elec-
trical stimulation to the head provides a beneficial restorative effect.
Peripheral electrical stimulation was found to be as effective as
cranial stimulation.
Studies on the origin of childhood convulsions show that Nissl stain
may provide a histochemical means of assessing protein metabolism
in the brain.
In the studies on epilepsy, scientists found that the anticonvulsant
action of Diamox is unrelated to its inhibitory effect on enzymes con-
trolling kidney excretion and the resultant acidosis, and that ammo-
nium chloride influences the anticonvulsant action of Diamox, inde-
pendently of enzyme inhibition.
The final report on retrolental fibroplasia reaffirms that oxygen in
high concentrations given routinely to premature infants is a major
contributing factor of this disease. The report also validates earlier
findings that the use of oxygen can be limited to clinical emergencies
without affecting the survival rate of premature babies.
Heart Institute
More than half of the Nation’s deaths and much of the physical
disability of its population are attributable to heart disease. ‘The
problem is complex, embracing over a score of cardiovascular dis-
orders. To meet it, new knowledge must be gained through research
110 Department of Health, Education, and Welfare, 1956
bani: seo UO OEE SE RE LE aR MRL
and applied widely. The programs of the National Heart Institute
are focused on these goals.
Substantial progress was achieved in 1956. In research conducted
by the Institute, important findings increased fundamental and clini-
cal knowledge of the underlying disease processes affecting the heart
and circulatory system. Significant advances also resulted from grant-
supported research in universities and hospitals. ‘Training activities
aimed at increasing the supply of persons qualified in research and
clinical aspects of cardiovascular disease were extended. In coopera-
tion with the Bureau of State Services, the control of heart disease
was fostered, and States and localities were assisted in developing com-
munity heart programs.
PROGRESS IN HEART RESEARCH
The process which underlies atherosclerosis, the most common form
of hardening of the arteries, is an accumulation of fatty materials in
the lining of blood vesels. Because this may be due to an abnormal
handling of fatty substances in the body, a major part of NHI research.
is concerned with the study of mechanisms involved in the absorption,
distribution, and utilization of fats and fatty substances. Just as
detergents are required to make fatty substances soluble in water,
special chemical entities are necessary for transporting fat in the
watery fluid of the blood. In the blood plasma the fats are carried
attached, in complex arrangements, to the plasma proteins. The
attachment of fat to protein does not, in general, occur spontaneously,
but requires the mediation of certain enzyme systems. The operation
of those systems has been under intensive study, and some of their
components have been clarified by Institute investigators.
One facet of the problem, previously puzzling, is now open to solu-
tion. It has been known for some time that injection of the anticlotting
drug, heparin, causes the enzyme system to appear in the circulating
blood. This system can break down large fatty aggregates believed
to be directly related to atherosclerosis, but whether the heparin merely
causes activation of the enzyme system or is an integral part of it has
not been known. A definitive answer to this question will be made
possible through the Institute’s recent development of a strain of
bacteria by which heparin is specifically destroyed.
The drug, reserpine, derived from Indian snake root and now used
widely in the treatment of hypertension and mental disorders, con-
tinued to be the subject of investigation. NHI studies have shown that
the effect of reserpine is due to its property of causing the release of
serotonin, a substance previously thought to play a role in the regula-
tion of the blood pressure through a direct effect on blood vessels. It
now appears that the pertinent effect of serotonin is probably in the
central nervous system, where it may be involved in the transmission
NE Se tpt Mm Hm
Public Health Service lll
of nerve impulses within the brain centers. Particular interest lies
in that center concerned with the control of blood pressure. The
implications of this finding and its various facets—relevant not only
to heart problems but to nervous and mental functions as well—are
being extensively explored.
The essential discovery in this area and the entire present exploration
have been made possible by a new analytical instrument, the spectro-
photofluorometer. This instrument, devised in NHI laboratories,
makes possible the identification and quantitative measurement of
minute amounts of a wide variety of substances by means of the
characteristics of the light they emit when excited with ultraviolet
light of particular wave lengths. The notable and unforeseen applica-
tions of the instrument are an excellent example of the way in which
fundamental developments contribute to scientific progress in
directions which cannot be anticipated.
When the heart muscle can no longer carry the load imposed
upon it, a characteristic complex of derangements and symptoms
ensues. Breathlessness and swelling of the ankles and legs are the
most commonly observed features. These symptoms are those of con-
gestive heart failure and, in general, are directly attributable to reten-
tion in the body of excessive amounts of salt and water. The secretion
by the adrenal gland of excessive amounts of the hormone aldosterone
has been shown in previous Institute work to be the immediate cause
of most of this retention. Studies aimed at determining the normal
stimulus for secretion of this hormone are progressing and may provide
the key to identification of the source of abnormal stimuli in cardiac
failure.
Studies are also in progress in evaluating the various factors which
make up the workload of the heart muscle and determine its require-
ments for oxygen and oxidizable foodstuffs. It has been found that
the oxygen used by the heart muscle of the experimental animal is
directly proportional to the pressure against which the heart must
pump the blood and to the frequency of the heart beat. Surprisingly,
there appears to be no relation of oxygen requirements to the volume
of blood expelled with each beat. If these findings are confirmed in
more extensive experiments, they will have an important bearing on
the handling of patients, since it is when the demands of heart muscle
for oxygen exceed supply that angina pectoris results. It is probable
that the significant workload leading to enlargement of the heart and
congestive failure is that which increases the demand for oxygen.
In surgical studies, the further development and evaluation of
diagnostic techniques is continuing, and the application of low tem-
peratures to surgical approaches to the interior of the heart has been
furthered. Considerable effort has been devoted to the problem of
artificial heart and lung devices for the maintenance of vital circula-
112 Department of Health, Education, and Welfare, 1956
tion during open heart surgery. Studies of the use of plastics to
substitute for blood vessel segments and for the possible replacement
of damaged valves are also being pursued. Of particular interest is a
procedure and device for the complete bypass of aortic heart valves
by rerouting the main course of outflow from the heart at the end
of the left ventricle opposite from the normal egress through a
valve-containing plastic tube directly into the aorta, the body’s main
arterial trunk. The flaws in this procedure have now been virtually
eliminated, and animals so treated have shown remarkable health
and exercise-tolerance.
ACCOMPLISHMENTS THROUGH RESEARCH GRANTS
Grants made by the Institute resulted in notable advances in many
areas of research. In arteriosclerosis, a number of projects dealt
with the possible influences of dietary factors in producing condi-
tions favorable for the increase of the fatty substance, cholesterol,
in the blood and in the walls of arteries. One investigator reported
studies of high and low cholesterol diets in several groups of men
in the United States and in two groups on the Island of Sardinia,
where the type of diet differs considerably from that in this country.
The results, in all groups, indicated that the serum level of cholesterol
is essentially independent of cholesterol intake in the diet. Other
researchers produced findings showing that the amounts of fats con-
sumed influenced cholesterol levels and that different types of fats
apparently produce varying effects.
Important contributions to understanding the causes and mecha-
nisms of blood clotting were made. One team of investigators pre-
pared a purified prothrombin, one of the substances involved in the
early stages of clot formation, and was thus able to determine more
exactly its characteristics and how it becomes converted to thrombin
in the development of a blood clot. Another group succeeded in puri-
fying accelerator globulin, a substance in blood which is recognized
as the agent that facilitates the conversion of prothrombin to throm-
bin. Use of these purified substances should clarify much that is
yet unknown concerning the process of clot formation.
Progress continued to be made in heart and blood vessel surgery.
A difficulty encountered in grafts for the repair of blood vessel
injuries is incompatibility between the transplanted and host tissues
and the consequent failure of incorporation of the graft. An investi-
gation completed in 1956 indicates that controlled chemical treatment
(with ethylene carbonate) of blood vessel segments to be used as
grafts may offer a solution to this problem.
A remarkable surgical development reported during the year was
the origination of a simple, inexpensive oxygenator-pump, composed
chiefly of plastic tubing, which can substitute temporarily for the
Public Health Service 113
heart and lungs of patients undergoing heart surgery. The apparatus
has been used successfully in many operations on the interior of the
heart.
Bureau of Medical Services
The Bureau of Medical Services administers the programs of the
Public Health Service which relate to care and protection of the in-
dividual; the health program for American Indians; aid in the con-
struction of community hospitals and health facilities; development
of the Nation’s nursing and dental resources; and foreign quarantine.
It operates the hospital and outpatient facilities of the Service and
gives professional supervision to members of the Service staff assigned
to other Federal agencies to direct their health programs.
Hospitals and Outpatient Facilities
The Division of Hospitals conducts the medical care program for
American seamen and other legal beneficiaries of the Public Health
Service. Beneficiaries include officers and enlisted men of the U. S.
Coast Guard, commissioned officers of the Public Health Service,
Civil Service employees of the Federal Government injured or taken
ill in the course of their work, and several smaller groups. Patients
with leprosy and persons addicted to narcotic drugs as defined by
statute are treated in special hospitals.
The Division also administers the Federal employee health pro-
gram. Federal departments, at their request, receive consultative
help in establishing or improving health activities for their employees ;
22 health units are conducted on a reimbursable basis.
In 1956, the Division maintained 16 hospitals, 25 outpatient. clinics,
and 96 outpatient offices; in addition, 58 physicians served active
Coast Guard and Coast and Goedetic Survey personnel. Of the hos-
pitals, 12 provide general medical and surgical services, 1 is ex-
clusively for patients with tuberculosis, 2 treat narcotic addiction and
_ neuropsychiatric disorders, and the combination hospital-community
at Carville, La., cares for persons with leprosy. Most of the hospitals
are in major port cities, including Boston, New York, Baltimore, New
Orleans, San Francisco, and Seattle. The outpatient clinics are
staffed by full-time personnel and provide a range of medical, dental,
and allied health services. The outpatient offices are conducted by
local physicians in their private offices on a part-time basis, as needed.
During the year, action was taken to integrate more of the out-
patient clinics with hospitals in the same geographic areas. The
outpatient clinic in Portland, Maine, became a unit of the Boston
hospital; the clinic in St. Louis, Mo., was merged with the Chicago
114 Department of Health, Education, and Welfare, 1956
hospital; and the outpatient clinic in New York City was made a
section of the outpatient service of the hospital on Staten Island.
VOLUME OF SERVICES
Inpatient admissions in all the hospitals rose 6 percent—from 45,-
852 in 1955 to 48,627 in 1956. The average daily census remained
approximately the same, at 5,412. The average length of stay per
patient dropped 214 days. The number of outpatient visits went up
4 percent to a total of 1,042,000.
The general hospitals admitted 43,399 patients in 1956, compared
with 41,379 in 1955. The daily number of patients averaged 2,765,
about the same as the previous year.
Tuberculosis —The tuberculosis hospital, at Manhena Bence
Brooklyn, N. Y., operated at its 325-bed capacity, a decrease of 14
patients from 1955. All the accepted newer drugs for treating pul-
monary tuberculosis are used, as indicated, and the staff keeps abreast
of the status of experimental drugs and therapeutic procedures
for other chest diseases. Cardiopulmonary function facilities were
expanded to include cardiac catheterization. procedures on patients in
need of them. A special education program for patients nearing dis-
charge was begun, and training conferences for tuberculosis patients
who also have diabetes were continued.
Leprosy.—tThe Public Health Service Hospital at Carville, La., is
devoted entirely to care and treatment of persons with leprosy.
Patients receive complete medical care and full maintenance. Serv-
ices include not only the special medical, surgical, and dental therapy
necessary to treat the disease, but also general medical care. Since
the course of treatment at Carville usually spans a period of years,
the hospital conducts social service and community activities pro-
grams with diversified recreational and educational opportunities.
The sulfone drugs still constitute the “treatment of choice” at
Carville. All workers in the field of leprosy agree that these drugs
offer a comparatively effective form of therapy. Most sulfone-treat-
ed patients enjoy greatly improved general health. In the majority
of cases, the irreparable ravages of long-standing leprosy can be
avoided if treatment is begun early. Like the onset of the disease, the
sulfone drugs work slowly. Therefore, the search for more efficient
and quicker-acting specific therapy for leprosy continues.
Admissions to the Carville hospital totaled 59 in 1956, compared
with 57 the year before. The average daily census declined from 319
to 313 as patients with “closed” cases left the hospital. Leprosy
parallels tuberculosis in that a stage of apparent arrest may be
reached, and the patient may enjoy long periods relatively free from
disease activity.
Public Health Service L115
Narcotic Addiction.—The hospitals in Lexington, Ky., and Fort
Worth, Tex., treat narcotic addicts as defined by Federal law. They
also receive mentally ill patients entitled to care as beneficiaries of the
Federal Government.
In 1956, the two hospitals admitted 4,767 patients, an increase of
18.5 percent; the average daily census remained virtually changed at
2,010. Most of the patients admitted were narcotic addicts who en-
tered voluntarily. The stability of the average daily census while
admissions increased indicates the addicts’ weakened capacity for self-
control in relationship to narcotics. About 25 percent of voluntary
addicts who enter the hospital leave within a week after admission;
by the end of a fortnight, 50 percent are gone. This period of hospi-
talization is hardly long enough for recovery from the acute absti-
nence syndrome. On the other hand, addict patients sentenced by
Federal courts usually stay a year or more. The need persists for a
way to require addicts to remain in the hospital until they achieve
reasonable recovery from physical dependence on narcotic drugs.
TRAINING MEDICAL CARE PERSONNEL
More than 250 physicians, dentists, pharmacists, and dietitians
served internships and residencies in Public Health Service hospitals
during the year. Eight of the hospitals had approval for the post-
graduate training of physicians granted by the American Medical
Association. The American Dental Association approved eight hos-
pitals for dental internships.
Through affiliation with colleges and technical schools, about 100
undergraduates received practical’ experience and hospital instruc-
tion in physical therapy, occupational therapy, vocational therapy,
social service, practical nursing, and medical laboratory technology.
The Baltimore hospital trained 10 new medical record librarians.
The hospital on Staten Island provided the clinical nursing portion
of the hospital corpsmen course offered by the U. S. Coast Guard.
CLINICAL INVESTIGATIONS
Twenty formal clinical investigation projects were started under
the auspices of a new clinical investigations committee in the Division.
In cooperation with a pharmaceutical firm, one hospital began a cost-
accounting study of expenses of administering frequently used in-
jectables by the conventional method; this will be followed by an
investigation of those costs using the single-dose closed system. In
collaboration with the Food and Drug Administration and the Ameri-
can Association of Medical Record Librarians, the Division partici-
pated in a study of methods of recording and reporting adverse re-
action to drugs.
116 Department of Health, Education, and Welfare, 1956
ce ah a a a i I ce
At Carville, the first conference on leprosy investigations was
held to discuss leprosy studies from the standpoints of bacteriology,
pathology, immunology, biochemistry, metabolism and nutrition,
chemotherapy, epidemiology, and clinical management. Conducted
by a Public Health Service interbureau committee, the meeting
brought to Louisiana nearly all scientists in the United States en-
gaged in research on leprosy.
FREEDMEN’S HOSPITAL
Freedmen’s Hospital, Washington, D. C., is a general hospital with
provision fcr chronic chest diseases. It serves as the clinical teaching
arm of the College of Medicine of Howard University. ‘The hospital
has a capacity of 320 general medical and surgical beds, 50 bassinets,
and 150 beds in the annex for chronic chest diseases.
In 1956, the hospital admitted 11,638 inpatients, an Increase over
1955; daily average census was 366, compared with 378 in 1955. The
outpatient service, consisting of 36 organized clinics and including the
emergency room recorded an aggregate of 79,430 visits, an increase
over 1955.
The School of Nursing had 106 students, and 33 graduates. The
hospital was affiliated with the M. M. Washington Vocational School
for the training of practical nurses. An inservice training program
for professional and nonprofessional nursing personnel was begun.
The hospital provided graduate training for 42 medical residents,
18 medical interns, 4 medical externs, 2 dental interns, and 8 clinical
research fellows. 'To broaden the scope of the program in medical
education, an affiliation was established with the Chelsea Soldiers
Home in Massachusetts, and plans were made to extend this program
to Norfolk Community Hospital in Virginia, and to Denmar Sana-
torium, Beard, W. Va. |
Ten dietetic interns completed requirements for certification by the
American Dietetic Association, which reviewed the program during
the year and extended continued accrediation. Sixteen persons par-
ticipated in training programs in medical technology, pharmacy, hos-
pital administration and social service.
In 1955 a study commission, appointed by the Secretary of Health,
Education, and Welfare, surveyed Freedmen’s Hospital to determine
its future role. The commission recommended transfer to Howard
University and the construction of a new general hospital building.
Efforts were made in 1956 to implement the commission’s recom-
mendations and at the recommendation of the Department, legisla-
tion was introduced in Congress to bring about the transfer.
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Public Health Service 117
Foreign Quarantine
In spite of smallpox being epidemic in many countries of South
America, Asia, and Africa, the United States was free of it for the
third consecutive year. This achievement may be attributed in part to
the fact that the United States requires persons arriving at ports of
entry to present evidence of smallpox vaccination within 38 years.
The northward sweep of yellow fever in Central America continued.
In fiscal year 1955 the disease reached the area near San Pedro Sula
in northwestern Honduras, not far from the Atlantic coast. While
no human cases were reported in Central America in fiscal 1956, infec-
tion in monkeys occurred again in Honduras, and the disease crossed
the border into Guatemala where infected monkeys were found south-
east of Lake Izabal. Bolivia reported 5 cases of yellow fever, with
4 deaths in Caranovi, about 75 miles northeast of La Paz. The last
preceding report of cases from this area was in 1947. There was some
yellow fever, including fatal cases, in locations in Brazil, Venezuela,
and Colombia.
Cholera was quiescent in the Far East until spring, when an epi-
demic occurred in Calcutta. Case and mortality rates were the high-
est since 1953 ; by the end of June the epidemic had tapered off. Only
five ports were infected with cholera during the year, a figure com-
parable to the small number infected in recent years.
For the first time since 1951 a case of human plague was reported
in the United States. It occurred in California, where the disease
has been endemic in wild rodents. There was an outbreak of pneu-
monic plague during January in Amherst, Burma, which was checked
within the month. An outbreak of plague in Bolivia was associated
with a population movement from the highlands to the more produc-
tive areas of the lowlands.
INTERNATIONAL TRAFFIC VOLUME
International traffic subject to Public Health Service requirements
increased again, as follows: airplanes inspected for quarantine or
immigration-medical purposes from 54,759 in 1955 to 56,891 this
year; ships inspected from 27,551 to 30,126; arriving persons subject
to foreign quarantine regulations from 42,861,862 to 46,993,370; small-
pox vaccinations by quarantine officers from 481,190 to 485,967. The
number of persons released subject to further medical examination at
destination decreased from 17,831 to 9,670; persons detained in isola-
tion at ports decreased from 229 to 3.
MEDICAL EXAMINATIONS
In the Refugee Relief Program of immigration, medical examina-
tion services were provided in Austria, Belgium, Denmark, Egypt,
118 | Department of Health, Education, and Welfare, 1956
England, France, Germany, Greece, Iran, Italy, Jordan, Kuwait,
Lebanon, The Netherlands, Norway, Sweden, Turkey, and the Far
East. The number of persons examined abroad increased from 38,928
in 1955 to 92,519 this year. The number of those examined in this
country increased from 26,882 to 72,382. There were 1,619 refugees
certified, abroad and in the United States, for diseases excludable
under the immigration law.
The number of aliens other than refugees examined abroad by
Service officers increased from 158,074 in 1955 to 194,736 in 1956.
Those examined in this country increased from 1,861,787 to 2,111,237.
Most of those examined abroad were prospective immigrants. The
majority examined in this country were crew members and temporary
visitors; arriving aliens usually receive a brief inspection, with fur-
ther examination when indicated. There were 4,263 aliens certified,
abroad and in the United States, for diseases excludable under the
immigration law.
In the farm placement program of recruiting agricultural workers
from Mexico, 415,210 laborers were examined, with 10,057 rejections,
at 4 migratory centers in Mexico; and 435,332 examinations were
made, with 5,757 rejections, at 5 reception centers in California,
Arizona, and Texas.
OTHER QUARANTINE ACTIVITIES
Control measures were applied to more than 30,000 aircraft and
numerous ships and land vehicles arriving from other countries to
kill mosquitoes and related carriers of disease.
Because of the northward movement of the yellow fever virus,
the Division and other interested units of the Service considered plans
for controlling Aedes aegypti, the yellow fever mosquito prevalent in
the southern part of the United States.
In two instances larvae of Culex quinquefasciatus Say mosquitoes,
chiefly a pest form, were found alive in water in old tires brought to
Miami, Fla., from South America in cargo planes, illustrating how
insects that may transmit disease can be introduced unless preventive
measures are taken.
Nearly 580,000 copies of the International Certificates of Vaccina-
tion form were issued to clerks of court, passport agencies, and health
departments; this was an increase of 33 percent over the number
issued in 1955. In addition, 968,018 copies were sold by the Superin-
tendent of Documents—double the sales for the previous year.
Foreign quarantine regulations were amended to apply the rabies
immunization requirement to dogs brought in from Canada, and the
physical inspection requirement to both dogs and cats brought in
from Canada. This change was made because of the presence of
rabies in animals in Canada. :
' Public Health Service 119
ES AE iE a de AES Ra te DS ee PN aA
During the year, a technical advisory committee to the Division
of Foreign Quarantine was established. Composed of leaders in
public health and medicine, this group will help insure that the most
effective means are used to prevent introduction of disease by the
increasing volume of international traffic. A subcommittee on tuber-
culosis will assist in determining when prospective immigrants with
a history of confirmed or suspected tuberculosis may be considered
free of the disease under the immigration law, which denies admission
to aliens with tuberculosis in any form.
Hospital and Medical Facilities
The Division of Hospital and Medical Facilities administers the
Hospital and Medical Facilities Survey and Construction program.
The legislation of 1946 authorizing this program was amended in 1954
to include earmarked Federal aid for the construction of hospitals
for the chronically ill and impaired; nursing homes; diagnostic cen-
ters or diagnostic and treatment centers; and rehabilitation facilities.
The appropriation for construction grants of all types in 1956 was
$96 million, including $21 million for the new phase of the program.
Shortly after the close of the fiscal year, Congress extended the pro-
gram for an additional 2-year period.
The first hospital to be built under this program was completed
and opened in October 1948. As of June 1956, 3,047 hospitals, health
centers, and related facilities were approved for construction. Of
these, 2,050 were completed and rendering community service, and
806 were under construction. The remainder were in the planning and
preconstruction stages. Federal aid for these projects amounted to
$781,421,267.
The 3,047 projects will add 133,239 hospital beds, 2,259 nursing
home beds, 748 health units, and many related medical facilities to
the Nation’s resources. Of the beds, 108,955 are in general hospitals;
11,403 are in mental hospitals; 7,010 are in tuberculosis facilities; and
5,871 are in chronic disease facilities. The total cost of these projects
is $2,467 million, toward which the Federal Government contributed
_ $781 million, and State and local sources $1,686 million. Two dollars
in State and local funds are being spent for every Federal dollar.
Of the 1,031 new general hospitals being built under the program,
549 are in communities that had no hospitals before the program was
_ begun, and 236 are in communities where the only hospital was obso-
_ lete or unsuitable. Fifty-four percent of the new facilities are lo-
_ cated in communities of less than 5,000 population, and only 12 percent
are in cities of more than 50,000.
| Fifty-seven percent of the new hospitals have fewer than 50 beds
and only 21 percent have 100 beds or more. Among the larger proj-
120 Department of Health, Education, and Welfare, 1956
ects are teaching hospitals approved for intern and residency train-
ing. Thus, in addition to meeting rural needs, the program is serving
the training needs of larger institutions.
The hospital bed deficit in the Nation is still large. Although this
program in 10 years has provided almost 136,000 beds, and nearly
twice that amount of hospital construction has been done during the
same period without Federal aid, the need for hospital beds is ac-
centuated by an annual population increase exceeding 2.5 million.
Also, every year large numbers of hospital beds become obsolete or
in need of modernization.
Additional facilities for early diagnosis and treatment of ambula-
tory patients would reduce the demand for general hospital beds.
The aging of the population has intensified the need for facilities for
the chronically ill. Twice the average number of hospital care days
are required for persons 65 and over. Many patients now in general
hospitals could be cared for in nursing homes and chronic disease
hospitals at less cost than is possible in the general hospital.
The amendments of 1954 are designed to help meet these needs.
By June 30, 1956, all the States had revised and supplemented their
State hospital construction plans to include nursing homes, diagnostic
centers or diagnostic and treatment centers, chronic disease facilities,
and rehabilitation centers; 204 of these projects had been approved
at a total estimated cost of $24,482,910. A 53-bed nursing home in
Florence, Ariz., was the first project approved—in July 1955.
Grants for research, experiments, and demonstrations relating to
the effective development and utilization of hospital facilities, services
and resources were authorized by Congress in 1949. ‘The 1956 appro-
priation was the first to include funds to implement this research
program, in the amount of $1.2 million. Twenty-seven research
grants for hospital services were approved during the fiscal year.
Health Services for Indians
Fiscal year 1956 was the first year the Public Health Service had
complete responsibility for the Federal Government’s Indian health
program. Personnel and facilities were expanded to meet more fully
the backlog of accumulated needs of the increasing Indian popula-
tion. The Division of Indian Health administers this program.
The Public Health Service provides medical care and preventive
health services for some 315,000 Indians hving mainly on reserva-
tions, and 385,000 Indians, Aleuts, and Eskimos in the native villages
of Alaska. Most of these groups are thinly spread over vast sparsely
settled areas, generally lacking adequate facilities for transportation
and communication. This dispersion and isolation, and the absence
Public Health Service 121
of well developed community health resources, are major obstacles
in providing health services for Indians and Alaska Natives.
Although the health of the Indians has been undergoing gradual
improvement in recent years, it still contrasts sharply with that of
the general population. The average age at time of death among
Indians is only 39, compared with 60 for the population as a whole.
A third of the deaths among Indians occur before the fifth year of
life, whereas only 8 percent of the deaths in the general population
are in this age group. The Indian death rate from influenza and
pneumonia is nearly 4 times that of the general population. The
death rate from tuberculosis is 5 times greater, and from enteric
diseases 10 times greater, than corresponding death rates in the popu-
lation as a whole.
In carrying out its responsibilities for Indian health, the Public
Health Service encourages self-reliance and independence on the part
of the Indian people, and seeks their participation in planning health
activities. It endeavors to give full consideration to the customs and
traditions of each tribe or group. The Indians are assisted in making
use of State and local services of health, vocational rehabilitation,
and crippled children’s agencies.
In fiscal 1956, in accordance with a request by the Committee on
Appropriations of the House of Representatives, the Public Health
Service began a comprehensive survey of Indian health needs and
facilities (see p. 92).
To enable the Public Health Service to obtain the judgment of
authorities on Indian affairs, the Surgeon General early in May
named an Advisory Committee on Indian Health. This committee,
with members representing medicine, science, law, education, journal-
ism, and the Indian peoples, is aiding in the development of policies
to improve health services to the Indians.
The health program provides both curative medical care through
hospital and clinic services, and public health services to promote
health and prevent disease. The two major phases of the program
are equal in importance and, for the most part, fully integrated.
Preventive activities are provided in all Indian health facilities, and
treatment is administered at many field installations. Increases in
the number of professional personnel permitted an expansion of serv-
ices during the fiscal year. ‘The number of physicians on duty with
the program, for example, was increased from 121 to 190, and the
number of dentists from 46 to 64.
HOSPITAL SERVICES
Hospital services are provided at 48 Public Health Service Indian
hospitals and at 8 Alaska Native Health Service hospitals, as well
408691—57_9
122 Department of Health, Education, and Welfare, 1956
as at more than 160 non-Federal hospitals under contract to the
Public Health Service. The latter include community general hos-
pitals, State and county tuberculosis sanatoriums, and State mental
hospitals.
The 56 Public Health Service hospitals operated for Indians and
Alaska Natives have a bed capacity of approximately 3,800. Except
for 9 large facilities with 100 or more beds, the majority of these
hospitals are general facilities of 25 to 35 beds. There are provisions
for 1,800 beds in the contract hospitals, two-thirds of which are for
patients with tuberculosis.
Patient loads in all hospitals increased. The average daily patient
census in the 48 Indian hospitals increased by 4 percent, and that of
the Alaska Native Health Service hospitals increased by more than 7
percent. The average daily patient census in contract general hos-
pitals within the United States was almost twice that of 1955.
The combined daily patient census for all hospitals—both Public
Health Service and contract—was approximately 4,200. Of these
patients, about 1,300 are Alaska Natives.
Therapeutic and preventive services are provided at outpatient
clinics in all Indian hospitals. Outpatient treatments and preventive
services at Indian and Alaska Native Health Service hospitals in-
creased by 15 percent during the year.
The most significant development in the Indian hospitals was the
increase in their medical and supporting staffs. Nearly all the smaller
hospitals now have at least two medical officers. Food service,
maintenance, administration, and other functions were also improved.
Another significant development was the inauguration of a system
whereby the larger medical centers provide supportive services for
the smaller outlying hospitals. Higher standards and greater eflfici-
ency are being achieved through centralizing some of the functions
of the pharmacy, medical records, and dietetic services.
FIELD HEALTH SERVICES
More than half of the deaths and most of the illness among Indians
are caused by diseases that can be prevented or controlled. These
facts suggest that preventive health services are the key to the great-
est improvement in Indian health. Consequently, the Public Health
Service is intensifying efforts to work with Indians in their own
communities to help apply modern knowledge of sanitation, diet,
health habits, and other aspects of disease prevention.
Health education is a major part of this effort. Professional staff
members carry on educational work in their day-to-day relations
with Indian patients, families, schoolchildren, and community leaders.
Health education activities are coordinated by a small staff of health
Public Health Service 123
educators, assisted by a number of college-trained community work-
ers—most of whom are Indians.
It long has been apparent that much illness results from polluted
drinking water, insufficient quantities of water available, unsafe prac-
tices in the disposal of wastes, improper handling of food, high levels
of infestation by insect carriers of disease, and inadequate housing.
Empasis was given to increasing the services of Indian sanitarian
aides on reservations and in Indian communities. Working under the
sanitary engineering staff in the field, these aides are fostering wider
knowledge of sanitation among the Indian people.
One new feature of the Indian health program begun in the South-
west during the year was an extensive effort to control rabies by in-
oculating dogs on reservations.
Public health nursing services were substantially increased in 1956,
and home visits were devoted to health problems of entire families
rather than to acute illnesses of individuals. A similar shift of em-
phasis in public health nursing also occurred at clinics, where greater
demands for preventive health services and better acceptance were
evident.
Field health services are provided from the Indian and Alaska
Native Health Service hospitals, and through a system of some 100
health centers and field clinic installations at more than 100 other
locations. Staffs at field health facilities supplement the work of
the hospitals by diagnosing, treating minor illnesses, referring cases
to hospitals, following up on discharged patients, and conducting
ease-finding programs. Clinic staffs provide prenatal, maternity and
infant, and preschool services; mothers receive instructions and chil-
dren are immunized and treated for common infections.
Wherever it is advantageous to Indian beneficiaries and the Gov-
ernment, and where the necessary facilities are available, health serv-
ices are provided by State agencies and private physicians or clinics
under contracts monitored by the Division of Indian Health. The
Public Health Service now has in effect contracts for such services
with about 30 State or local health departments and numerous physi-
cians and dentists. A total of $7.6 million was spent for contract
patient care in 1956, compared with $5.8 million spent for this purpose
iy 1900.
DENTAL AND SOCIAL SERVICES
Dental services are provided in hospitals and at other locations in
the field. Since 1950, dental services have included preventive and
control measures as well as treatment. Preventive dentistry now is
provided at about 230 locations, with particular attention to school
age children.
124 Department of Health, Education, and Welfare, 1956
During 1956, greater emphasis was placed on restorative dentistry,
but extractions continued to constitute a substantial portion of the
total dental services rendered. Topical fluoride treatment was
brought to additional communities, and to larger numbers of school
children than ever before.
A total of 118 man-years was devoted to the dental health program
in hospitals and field installations. The dental staff comprised an
average of 60 dental officers, 44 dental assistants, 4 dental laboratory
technicians, and 10 persons engaged in dental educational and preven-
tive activities. Dental officers were increased by 20 and auxiliary
dental personnel by 26 over 1955.
Medical social work services to Indians were nearly doubled during
1956, with the addition of 10 medical social workers to the staff.
In 1955, nearly all of the medical social workers in the Indian health
program were stationed at tuberculosis hospitals. During 1956, how-
ever, medical social service was extended to general patients. Since
the assignment of medical social workers to the six Indian health area
offices, consultative services have been provided to contract hospitals
and additional services obtained for Indians through arrangements
with community social agencies.
TUBERCULOSIS CONTROL
Control of tuberculosis among Indians and Alaska Natives is an
effort that concerns both the hospital and the field health staffs. The
Indian death rate from this disease is 5 times that of the United
States population as a whole. The tuberculosis problem is particu-
larly serious in Alaska, where the mortality rate is 5 times that of the
rate for Indians within the continental limits of the United States.
A chemotherapy program to control tuberculosis in Alaska was
begun in 1954, and was substantially expanded in 1956. Ten chemo-
therapy nurses now cover more than 70 native villages in western
Alaska. These nurses dispense medications, train chemotherapy
aides to assist them in the village clinics, visit patients, follow up with
tuberculin testing, and find new cases. This program has nearly elim-
inated the backlog of tuberculous patients awaiting hospitalization.
Contracts are in effect with several State agencies for tuberculosis
case-finding, treatment, and followup activities. This is in keeping
with Public Health Service policy to work closely with State health
departments on Indian health matters, and to use State and local re-
sources whenever possible.
In research, Cornell University is conducting a study for the Public
Health Service to determine clinical effects of new chemotherapeutic
agents used in controlling tuberculosis among Indian patients. The
University of Pennsylvania is conducting research among the United
Public Health Service 125
Pueblo Indians to determine the effectiveness of using antibiotic
drugs to prevent development of tuberculosis in children.
TRAINING OF INDIANS
To meet the needs in Indian and Alaska Health Service hospitals
for practical nurses, the Public Health Service operates practical
nurse schools at Albuquerque, N. Mex., and Mount Edgecumbe, Alaska.
Sanitarian aides are given special orientation training courses con-
ducted at Phoenix, Ariz., and in Alaska, after which they return to
their reservations or villages. Dental assistants and dental techni-
cians are being trained and employed, and plans were made in 1956
to establish another training facility for dental technicians beginning
in 1957. Community health workers receive on-the-job training
supervised by schools of public health under contract. Approxi-
mately 90 Indians were trained by the Public Health Service during
the year for employment in these occupations in the Indian health
program.
CONSTRUCTION AND RENOVATION
Congress appropriated $5 million for the construction and renova-
tion of Indian health facilities in 1956. Four new general hospitals
were authorized, and nearly $2 million of the funds was allocated for
the construction of one facility and the planning of the other three.
A site was selected for a 75-bed hospital at Shiprock, N. Mex., and
preliminary plans were drawn up. Sites were under consideration
for 50-bed hospitals at Sells, Ariz., and at Kotzebue, Alaska. Pre-
liminary plans were drawn for a 200-bed medical center at Gallup,
N. Mex., which will be a referral hospital for some 80,000 Navajos
and other Indians in that area.
Preliminary plans. were made for the conversion and renovation
of 4 existing clinics on the Navajo reservation, and bids were received
for the construction of 5 new ones. A site was selected for the con-
struction of the Santa Rosa clinic to serve the Papagosin Arizona. In
the Aberdeen, S. Dak., area, program plans were completed for the
construction of 6 health stations and clinics. Major alteration proj-
ects were started at the Phoenix, Ariz., medical center and at the
Tuba City, Ariz., hospital.
To overcome a serious housing shortage for health personnel, more
than $2 million was used for construction of permanent housing in
Alaska at Bethel, Barrow, and Tanana, and for the relocation of some
325 surplus Government housing units in the United States. By the
end of the year, 250 housing units from Camp Pickett, Va., had been
dismantled, and about 200 had been moved to locations in the South-
126 Department of Health, Education, and Welfare, 1956
SE er amen nee a gh RE ee
west. Relocated in the Northwest and North Central States were 50
housing units and 25 trailers.
Dental Resources
Major program emphasis of the Division of Dental Resources con-
tinued to be in the field of dental manpower. Studies of supply,
utilization, and distribution of dentists and dental auxiliary personnel
were the principal activities. The Division was also active in studies
relating to voluntary prepayment dental care.
DENTAL MANPOWER
A study of the characteristics, finances, and practice plans of dental
and dental hygiene students, begun in 1954 by the Division and the
American Dental Association, was completed. It provides compre-
hensive information on the expenditures of dental students as well
as facts on the personal and family characteristics of students and
their plans for location of practice.
A study of dental manpower requirements in the 11 Western States,
Alaska and Hawaii, initiated in 1955 in cooperation with the Western
Interstate Commission for Higher Education, was carried on with
the assistance of the American Dental Association and the W. K.
Kellogg Foundation. Its primary purpose was to determine needs for
additional dental training facilities in the West. The collection of
data was completed, an analysis was made, and arrangements were
made for publication in fiscal 1957.
The cooperative study by the Division and the American Dental
Hygienists’ Association of supply, characteristics and distribution
of dental hygienists, begun in 1954, was continued. This will be pub-
lished as “Health Manpower Source Book, Section 8: Dental Hygien-
ists,” providing a source of information not previously available.
PREPAYMENT DENTAL CARE
Two projects relating to prepayment for dental services were com-
pleted. ‘The first was an evaluation of the predictability of dental
treatment needs in adults by developing data collected in an earlier
study of time and service requirements in a group service program.
The second was an assessment of some of the possible effects of com-
munity water fluoridation on a dental care prepayment program for
children by applying a fixed fee schedule to services rendered in se-
lected counties that have fluoridation and counties that do not have it.
Information on all existing dental prepayment programs was cata-
logued. A comprehensive study of one of these programs, that of the
St. Louis Labor Health Institute, was begun.
Public Health Service 127
Nursing Resources
The Division of Nursing Resources is a focal point in national
efforts to augment the nurse supply. The Division assists States,
hospitals and local groups to analyze problems of nursing services
and to take action to improve the nursing care given patients. The
work of the Division was expanded in fiscal year 1956.
NEW RESEARCH GRANTS PROGRAM
For the first time Public Health Service aid for medical and scien-
tific studies included grants and fellowships specifically for nursing
research. The new program was carried on cooperatively by the
Division of Nursing Resources and the National Institutes of Health.
An appropriation of $625,000 was made for the year. The National
Advisory Health Council approved 20 grants, totaling $496,176, for
studies in problems of nursing service and the needs of patients, the
selection of nursing as a career, the development of leadership quali-
ties In nurses, and refinement of the basic curriculum in schools of
nursing. In addition, $124,578 was awarded to nurses for graduate
training in research methods. This amount provided 27 full-time
fellowships and 62 part-time fellowships in 16 schools of nursing.
STATE SURVEYS OF NURSING NEEDS
The Division published “Design for Statewide Nursing Surveys:
A Basis for Action,” a manual to help States and institutions analyze
and improve their nursing resources. In the past 7 years the Di-
vision has assisted 38 States in surveying nurse supply and planning
remedial programs. States that have made changes on the basis
of these surveys are reporting success in improving nursing services
and in providing more care for patients. These surveys have in-
creased in scope. Special studies, such as nurse utilization and job
satisfaction, are now being undertaken in addition to general ap-
praisal of needs.
BETTER METHODS OF PATIENT CARE
As part of an extensive program to determine how best to utilize
the present supply of nursing personnel, the Division, in cooperation
with the American Hospital Association, conducted a study of patient
care in 60 hospitals in 7 States. The study was designed to find
out to what extent satisfaction with nursing care is related to the
number of hours of care provided. The procedures and question-
naires used were developed following an experimental study in hos-
pitals in Cleveland, Ohio. Preliminary findings indicate that the
shortage of nurses may be related to other factors, as well as numbers.
128 Department of Health, Education, and Welfare, 1956
The Division has developed methods to aid hospitals in better
utilization of nursing personnel. To date 113 hospitals in 14 differ-
ent States have been helped through self-improvement demonstra-
tions. More than a million and a half patients will benefit in a
single year from the changes being made in management and person-
nel policies, including relieving nurses of jobs other types of personnel
can do, streamlining recordkeeping systems and methods of dispens-
ing drugs, and revising ward routines.
The Division works closely with organizations such as the Ameri-
can Nurses’ Association, the National League for Nursing, and the
American Hospital Association in developing programs concerned
with recruitment and utilization of nurses. One program is the
training of nursing aides, carried on jointly with the League and the
American Hospital Association. In 2 years, more than 75,000 nurs-
ing aides in 1,350 institutions, including nursing homes, have received
this training.
Medical Services for Federal Agencies
The Public Health Service is responsible for providing medical
services to certain other Federal agencies. Through the Bureau of
Medical Services, medical, dental psychiatric, nursing, and other per-
sonnel are assigned on a reimbursable basis to agencies that request
assistance in operating their medical programs.
OFFICE OF VOCATIONAL REHABILITATION
During the past year, 7 commissioned officers (3 physicians, a den-
tist, nurse, physical therapist, and sanitarian) were detailed by the
Service to the Office of Vocational Rehabilitation. These officers
had important roles in various phases of the State-Federal rehabili-
tation program. Their responsibilities included technical assistance
to State vocational rehabilitation agencies; administration of an ex-
panded training program for physicians, nurses, physical therapists,
and occupational therapists; consultation to voluntary agencies and
medical schools on the design of research and demonstration programs,
as well as on the development and expansion of rehabilitation services.
Details regarding these activities may be found in the section of this
report devoted to the Office of Vocational Rehabilitation.
BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR
Medical care, compensation for wage loss, and rehabilitation serv-
ices are provided to Federal civilian employees by the Bureau of
Employees’ Compensation for injuries in performance of duty and
diseases attributable to conditions of employment. Facilities of the
Public Health Service are utilized for the medical care program
RE Te gE ee eS Pee ee ee ee a ee ee ar Re ne
Public Health Service 129
where possible; facilities of other Federal establishments are also
utilized where available. In addition, approximately 3,000 physi-
clans in private practice are designated by the Bureau to furnish
medical care under the Federal Employees’ Compensation Act.
Medical officers of the Public Health Service administer the medi-
cal care program and serve as techincal advisors to the Bureau. They
also assist in the rehabilitation program, staff educational activities:
identification of special problems in industrial health, and liaison
with employing establishments in the safety program.
Special studies are made of conditions of obscure etiology and con-
ditions suspected to have occupational origin. In 1956 special at-
tention was given to hearing loss at a military proving ground and
to cases of tuberculosis among employees of Federal hospitals. Re-
habilitation of injured employees through vocational rehabilitation
agencies was extended during the year. Many patients were cared
for through cooperative arrangements with State vocational rehabili-
tation agencies.
MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE
The Public Health Service assisted the Office of Seamen’s Services
with the review and release of clinical information from the medical
records in custody of the Maritime Administration and supplied
medical and dental staff for outpatient and inpatient care at the Patten
Hospital, U. S. Merchant Marine Academy, Kings Point, N. Y. The
Service staff at Kings Point consisted of the chief medical officer of
the Academy and three dentists.
UNITED STATES COAST GUARD, TREASURY DEPARTMENT
Ninety-two Public Health Service officers were on duty with the
Coast Guard at the close of the year. ‘There were 37 medical officers,
45 dental officers, 8 nurses, a sanitary engineer, and a scientist. Medi-
cal officers were assigned to ocean vessels; both a medical officer and
a dental officer were assigned to the vessel engaged in the Bering Sea
Patrol.
Considerable progress was made in improving dental facilities
within the Coast Guard and obtaining new equipment, thus making
possible an increase in dental services given. ‘The sanitary engineer-
ing program, begun in 1954, was maintained with good results.
FOREIGN SERVICE, DEPARTMENT OF STATE
Existing health units in New Delhi, India; Baghdad, Iraq; and
Kabul, Afghanistan, were expanded by the addition of a doctor. Po-
sitions were established and doctors have been selected for Vientiane,
Laos. New health units with nurses in charge were approved for
Seoul, Korea; Rio de Janeiro, Brazil; and Amman, Jordan; and
130 Department of Health, Education, and Welfare, 1956
La Paz, Bolivia. A new unit with a physician in charge was estab-
lished in Katmandu, Nepal.
The Medical Director visited 20 countries and 23 posts during the
year; in general, the medical as well as the sanitary and living condi-
tions have improved greatly during the last 5 years.
Poliomyelitis vaccine was distributed to all Foreign Service posts
which do not receive medical services from the Department of
Defense. All children of eligible ages and pregnant women were
given injections. Arrangements were made for Foreign Service posts
to pay emergency medical expenses of local employees injured in per-
formance of duty; reimbursement is then obtained from the Bureau
of Employees’ Compensation.
The Foreign Service Act of 1946 was amended to authorize medical
care for dependents, with certain limitations; medical travel when
local medical facilities are inadequate; examination of dependents of
applicants; and increased medical facilities at Foreign Service posts.
This program will be implemented in fiscal year 1957.
BUREAU OF PRISONS, DEPARTMENT OF JUSTICE
The Public Health Service has provided medical and related serv-
ices for prisoners in Federal penal and correctional institutions for 26
years. ‘Today, the medical staffs not only provide general medical
care, but also participate in rehabilitating prisoners to return to
society. Medical personnel serve as instructors in correctional officer
programs; participate in classification meetings where programs are
developed; advise on disciplinary problems, especially where neurotic
or emotional problems exist; and participate in other aspects of
administration.
In 1956 over 41,000 persons in 28 institutions in 23 States were pro-
vided with care. ‘There were 13,818 admissions to the hospitals for a
total of 489,608 hospital relief days; 953 major and 4,910 minor opera-
tions were performed. Outpatient departments provided 818,176
treatments and performed 25,991 routine physical examinations.
A number of research projects were conducted at various penal
institutions. These included: development of new psychological
tests; study to learn how and why youthful delinquents form cliques
or gangs; experimental work with d-lysergic acid and possible anti-
dotes; chloriquinized salt in malaria control; rates of absorption and
excretion of DDT; study of an attenuated vaccine for poliomyelitis;
and a study of effects of industrial noises on hearing.
BUREAU OF OLD-AGE AND SURVIVORS INSURANCE,
SOCIAL SECURITY ADMINISTRATION
A Public Health Service officer served as chief medical consultant
to the Division of Disability Operations of the Bureau. His work
ee ee Oe, ee ee
Public Health Service 131
included advising on development of medical policies and guides to
determination of disability; conduct of a medical training program
for central and field office personnel, including the referees of the
Appeals Council; and the recruitment, training, and supervision of a
medical staff for evaluation of medical impairments. He attended
several medical conferences to familiarize physicians with the admin-
istration of the disability insurance program.
BUREAU OF PUBLIC ASSISTANCE,
SOCIAL SECURITY ADMINISTRATION
A Public Health Service officer served as the Bureau’s medical
consultant. Much of his work was in connection with the program
of aid to the permanently and totally disabled in which 45 States are
providing assistance. In field consultations on medical aspects of this
program, attention was given to strengthening the working relation-
ships between public assistance agencies and State health departments.
Bureau of State Services
The Bureau of State Services is the principal unit through which
the Public Health Service carries out its programs in disease control
and in the improvement of public health services. It provides assist-
ance to State and Territorial health agencies and administers the
health aspects of international programs involving the United States.
The Bureau also cooperates with voluntary health agencies and pro-
fessional organizations in encouraging widespread application of
existing knowledge about the prevention and control of disease.
General Health Services
The programs administered by the Division of General Health
Services are: State grants, program development, public health edu-
cation, public health nursing, the National Office of Vital Statistics,
the Arctic Health Research Center, and emergency health services
(civil defense). One of the major activities of fiscal year 1956 was
the administration of the poliomyelitis vaccine program.
POLIOMYELITIS VACCINE PROGRAM
To assure an equitable distribution of poliomyelitis vaccine while
it was in short supply, States and manufacturers cooperated with the
Public Health Service in an allocation program which allowed each
State a proportion of each new supply of vaccine corresponding to the
proportion of persons in the priority groups which were set by the
National Advisory Committee on Poliomyelitis Vaccine. Initially,
132 Department of Health, Education, and Welfare, 1956
priority was limited to children 5-9 years of age, but the group was
gradually expanded until it included all children under 20 and preg-
nant women. The Division administered the allocation system,
notifying the manufacturers of the distribution among the States of
each lot of new vaccine released and notifying each State of its
allotment.
On August 12, 1955, Congress enacted the Poliomyelitis Vaccination
Assistance Act—patterned after legislation recommended by the ad-
ministration—authorizing Federal grants-in-aid for the purchase of
poliomyelitis vaccine and the administration of vaccination programs.
In February 1956, the act was extended to June 30, 1957, and addi-
tional funds were appropriated. All States and Territories applied
for grants and submitted plans which were approved after they were
reviewed for conformity with the requirements of the Federal law
and regulations.
Policies for export of vaccine, for limited purposes, were worked
out in cooperation with the Department of Commerce and the De-
partment of State. Cooperation was also given to the National Foun-
dation for Infantile Paralysis in its program of promoting widespread
domestic use of the vaccine.
STATE GRANTS
Federal funds available for grants-in-aid to States for health pro-
grams totaled $194,538,000 in fiscal year 1956. This amount included
$109,800,000 for hospital and medical facilities construction and $58,-
600,000 for poliomyelitis vaccination programs. The following break-
down shows amounts and purposes for which actual payments were
made:
General health services___..___-____. 3.) 13 Sa * $18, 332, 038
Venereal disease special projects______________________-_ > 1, 187, 906
Tuberculosis ‘ controli. 242. ete ele ee 4, 488, 026
Mental health .activities...01_ 24. <2.224. oe ee 2, 980, 547
Cancer control. 3Jess2 203 2 en eee A ee 2, 217, 825
Heart disease control_~_.2 ee 5 1, 088, 061
Medical facilities survey and planning____________________ 287, 064
Construction of community facilities_____________________ 647, 240
Hospital .constructionsush 2 oe swe a ee ee 54, 372, 562
Poliomyelitis : vaccine assistance___._.__ _____.__1- 2 _ Bae 24, 358, 678
1Includes $3,607,160 earmarked for distribution and use of poliomyelitis vaccine.
2 Includes $195,347 in services and supplies furnished in lieu of cash.
Table 4, page 158, shows the distribution of these sums by State.
State appropriations available to health departments, exclusive
of those for the operation of sanatoriums and general hospitals and
construction, amounted to $134,542,853. This was an increase of about
10 percent over the preceding year,
Public Health Service seliteheall 133
A comparative study of 1955 and 1950 expenditures by full-time
local health units was initiated during the year; the purpose was to
determine current trends in different areas and in different types of
units. Technical assistance and consultation were given to States on
budgeting, accounting, and other management and fiscal problems by
specialists in the Division.
PROGRAM DEVELOPMENT
A special branch was established in the Division to explore and
make preliminary plans relating to new public health programs.
This first year, it served as a focal point for Service activities in migra-
tory labor, rural health, and school health.
In cooperation with the Children’s Bureau and other units of the
Department, a uniform health record for migrant families has been
developed for testing and eventual use in States where large numbers
of migrant workers are employed. Two guides to health services
for migrants were developed and distributed, one for 10 East Coast
States, and one for 12 Western States. Work also progressed on the
development of uniform standards for farm labor camps, on a sug-
gested State code for the transportation of migrant workers, and
on a summary of tax advantages which accrue to employers when
health, education, and welfare services are made available to migrants.
Reports were prepared on the relationships of public health agencies
to the rural development program of the Department of Agriculture.
In cooperation with the Office of Education, Children’s Bureau and
other units of the Department, State plans for school health programs
were reviewed and analyzed.
PUBLIC HEALTH EDUCATION
Through research, training, and consultation, the health education
staff assists other units of the Public Health Service, State health de-
partments, educational institutions, and other organizations in devel-
oping health education programs that will influence health habits.
Research included a study of health improvements that resulted
from having a professional health educator on the staff of a teacher
education institution; an evaluation of a public health fair which is
held annually in a large city; a study of the health education aspects
of a community’s reaction to a flood disaster. In cooperation with
other programs in the Bureau, the research staff identified behavioral
factors which are significant in planning tuberculosis, heart disease,
and other control programs.
Training activities in the health education field included work with
schools of public health in improving curricula; lectures in schools
of medicine; and assistance in training health educators for service in
foreign countries.
134 Department of Health, Education, and Welfare, 1956
ee
Consultation was given to 14 States and to 6 foreign countries. In
addition, health education consultants stationed in 4 regional offices
gave continuing consultation and technical assistance to States in
their areas.
PUBLIC HEALTH NURSING
With the trend toward home care programs for the chronically ill,
health agencies are placing increasing emphasis on the development
of sound public health nursing programs. This is reflected in the
extensive consultation work carried on by the PHS nurses this year.
Aid was given to the California Health Department in developing a
base for determining the number of nurses needed in local health de-
partments and in designing studies of public health nursing services
in special programs. The North Carolina Health Department was
assisted in planning a 4-day workshop on consultation. Washington,
Texas, Maryland, New York, Michigan, and Florida were also aided
through special training programs.
A field study designed to establish a baseline for measuring the
utilization of public health nursing services to patients was conducted
in 8 local health departments. A formula for determining public
health nurse staffing patterns and units of work is being developed
to provide a simplified method of interpreting budget needs and to
guide appropriating bodies, management firms and other surveyors
in their attempts to quantitate health department services.
An annual census of nurses employed in public health activities dur-
ing 1955 was compiled. It revealed that, of the 27,112 nurses em-
ployed by public health agencies and boards of education, 37 percent
had completed one or more years of academic study in public health
nursing. Forty-four percent of the more than 27,000 were employed
by local official health agencies, practically the same number as in 1950.
The number of nurses employed by boards of education for school
nursing increased by more than 30 percent during the same period.
VITAL STATISTICS
The National Office of Vital Statistics works closely with State
health agencies to compile the national statistics on births, deaths,
marriages, divorces, and communicable diseases. This includes rou-
tine reporting of the numbers of new cases and epidemiologic infor-
mation on unusual occurrences of diseases. Such data provide a
current basis for planning programs in public health, social welfare,
education, defense, business and market analysis, and in medical
and demographic research. The Office also cooperates with the World
Health Organization and its member countries to develop comparable
international statistics.
ae ee ee ee Ae a ee
Public Health Service 135
Coordination and improvement of the vital statistics system are
effected mainly through the Public Health Conference on Records
and Statistics. The year’s achievements included: completion of a
draft of the Model State Vital Statistics Law; final criteria for
admitting States to proposed marriage and divorce registration areas;
a standard form of reporting adoptions and a standard form to permit
movement of a body for burial; a recommended definition of prenatal
mortality rates; and a guide for using service statistics in home
accident programs.
The National Office consulted with and gave direct assistance to
several States in surveying statistical operations, developing new or
improved procedures, and clearing up backlogs of unprocessed rec-
ords. It also conducted regional institutes for State personnel.
The most notable achievement in processing vital statistics was
the publication of the NOVS annual statistical report for 1954 ahead
of schedule. Besides the routine weekly, monthly, and annual pub-
lications, NOVS issued many special reports, including 48 State
reports on life expectancy, a study of economic characteristics of
recently married persons, the first 12 of 31 reports on selected causes
of death during 1900-53, and a study of the relation of birth weight
to causes of death in the neonatal period.
Revisions of the Standard Certificates of Live Birth and of Death
were distributed and recommended for State adoption.
ARCTIC HEALTH RESEARCH CENTER
Epidemiologic studies constitute an important part of the pro-
gram of this Center. House-to-house surveys in several native vil-
lages have been made in connection with enteric disease studies. New
evidence has been acquired indicating that small mammals may be
an important factor in the epidemiology of trichinosis in Alaska.
Three additional species of fish tapeworm have been discovered and
other data offering valuable clues to the control of this health prob-
lem have been compiled.
A study of diabetes in Alaskan Eskimos was completed. The di-
sease is extremely rare among Eskimos, but it is not yet known
whether this is due to heredity or to nutritional factors. If it is the
latter, increased prevalence can be expected due to the increasing
use of nonnative foods.
Home treatment for tuberculosis was begun for over 1,200 Alaskans
in 66 villages, and mass X-ray surveys of villages are in progress.
With the help of villagers, Center staff constructed the first experi-
mental well ever developed in a permafrost area. This was part of
an experimental sanitation program carried out in a few isolated
villages to demonstrate and test the practicability of developing water
136 Department of Health, Education, and Welfare, 1956
supply and sewage disposal systems in permafrost areas. Winter
operations are being carefully watched to determine needed modifi-
cations of design or operation.
EMERGENCY HEALTH SERVICES
The emergency health services staff coordinates Bureau activities
in civil defense and disaster relief and gives leadership in the develop-
ment, improvement, and continuity of regional, State, and local pub-
lic health civil defense plans and organizations. The staff developed
the Bureau emergency plan which was adopted for use during Oper-
ation Alert 1956.
The general inadequacy of existing civil defense programs in the
States is a matter of serious concern. During the year, information
covering the activities and organizational responsibilities of the States
for civil defense was analyzed and distributed to health officers and
others concerned. Consultation and training were provided by head-
quarters and regional staff and the PHS field centers.
Disaster relief functions during the year were concerned primarily
with damages caused by hurricanes in the East and floods in Oregon,
Washington, and California. A critique covering Public Health
Service emergency operations following the disasters was prepared,
and recommendations were made concerning the development and im-
provement of memoranda of understanding with other national
agencies, a personnel readiness program, a PHS disaster aid plan,
and a PHS regional disaster plan.
Division of Special Health Services
The Division of Special Health Services is concerned with the
problems of personal health maintenance and the development and
application of improved health maintenance and preventive tech-
niques. Through demonstration, training, research, and consultation,
the Division works closely with health agencies at all levels and assists
in the establishment and extension of programs in adult health serv-
ices, and chronic disease, heart disease, occupational health, medical
aspects of air pollution, tuberculosis, and venereal disease.
CHRONIC DISEASE PROGRAM
This unit conducts continuous studies to establish and maintain
current estimates of the size and characteristics of the chronic disease
problem in terms of incidence and prevalence of disability, death from
various chronic diseases, and needs for service by the chronically ill.
These studies indicate that there are now about 2.5 million persons
with long term disabilities who are not amenable to vocational
rehabilitation.
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Public Health Service 137
To help States meet some of the health needs of this group, the
Chronic Disease Program, in cooperation with the State and Terri-
torial Health Officers Association, sponsored a seminar in September,
1955. The meeting brought together for the first time representatives
from all State health departments to exchange ideas, and establish
principles and patterns for State and local activities in chronic disease
prevention and control.
The need for more emphasis on chronic disease in the curricula of
schools of public health was recognized and consultations were held
with faculty members of the major schools. Members of the program
staff also served as guest lecturers.
Six training courses in public health diabetes programs were given
for regional, State, and local public health staffs.
Three basic studies are under way to determine the social and med-
ical needs of the chronically ill. One is a nursing home study, in
St. Louis, Mo.; one is a study of rehabilitation services for the aged,
in the New York City hospital system; and the third is a study on
patient education, at Denver General Hospital.
Special emphasis continued to be given to the problems of diabetes
prevention, detection, and control. A long range study is in progress
to determine whether insulin given during pregnancy will prevent
or delay the occurrence of the disease in diabetes-prone mothers and
their offspring. Numerous studies, designed to develop increasingly
effective mass screening techniques for the early detection of diabetes,
are also in progress. At present, it is estimated that at least half the
persons suffering from diabetes do not know they have the disease and
are receiving no treatment.
In cooperation with the National Society for the Prevention of
Blindness, the Chronic Disease Program is working on the develop-
ment of effective mass screening techniques for the early detection of
glaucoma. 3
HEART DISEASE CONTROL PROGRAM
To assist States in reducing deaths and illness from heart disease,
the Heart Disease Control Program carries on three major activities:
operational research, training programs, and consultative activities.
A study by the California State Health Department with the sup-
port of the Heart Program provided data on the mortality experience
of 577 elderly persons whose nutritional status was assessed by history
and laboratory methods 5 years previously. Findings indicated that
the serum cholesterol was not prognostic of coronary diseases in this
group. There was, however, an association of vitamin C deficiency
by history and low serum vitamin levels with increased mortality from
subsequent coronary disease.
408691—57-—10
138 Department of Health, Education, and Welfare, 1956
“pa eae ei i a
Other studies of the relationship of animal fat in the diet as related
to serum cholesterol levels were carried on in a group in Boston. A
study was also initiated in the Washington, D. C., area to assess the
severity of atherosclerosis in a group whose diet is largely vegetarian.
The relationship of obesity as contrasted with overweight due to
body build was studied to determine which of these is a more important
factor in the excess mortality from heart disease.
The use of the mass X-ray programs for detection of heart disease
was studied further. Findings to date indicate that with appropriate
criteria the X-ray chest films should be able to detect approximately
20 percent of all diagnosable heart disease.
Geographic patterns in mortality in the United States and various
parts of the world are being studied. Mortality rates for coronary
heart: disease were twice as high in some areas of this country as in
others. Differences among States appear to be as large and real as
differences observed among countries.
An epidemiological study of census tract mortality data conducted
in Chicago has yielded the following preliminary observations: la-
borers have more coronary disease than executives; low income fam-
ilies more than high income families; housewives more than working
women. Further study will be necessary before these findings can
be confirmed.
A pilot center was established at the University of Minnesota School
of Public Health to provide 3 months of intensive training in cardio-
vascular disease to nurse consultants, supervisors, and instructors from
all fields of nursing. Plans for a similar training center at another
university are in progress.
Several State health departments have set up training programs,
either in cooperation with existing courses in schools and universities,
or as on-the-job training. Extensive training activities were also
conducted among social workers, many of whom deal with heart dis-
ease patients in welfare agencies and in hospitals.
Consultative services were given by physicians, nurses, social work-
ers, and nutritionists to State and local health departments and to
voluntary agencies and professional groups. Cooperation of health
departments in the “Stop Rheumatic Fever” campaign of the Ameri-
can Heart Association was encouraged and supplementary material
on the campaign was prepared for physicians and the public.
OCCUPATIONAL HEALTH PROGRAM
The continuing efforts of medical, engineering, and other occupa-
tional health specialists to protect and improve the health of the
Nation’s working force achieved new scope during the year.
Fim pin * i
PwC. eye ee ee ee ee
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Public Health Service 139
With the establishment of a pilot program in agricultural pre-
ventive medicine, a first step was taken to apply to agricultural
workers the protective measures available to industrial workers. The
project is being conducted cooperatively with the South Dakota De-
partment of Health and is designed to develop basic information
that can be applied by other health departments.
A beginning was also made toward the development of critically
needed information on the long-term effects of low-level exposures
of workers to radioactive substances. Lack of such knowledge has
been the principal deterrent to the use of atomic energy for peaceful
purposes. To develop the necessary clinical data, a radiological
health research program was instituted during the year.
In the area of adult health maintenance, a study was made of the
attitudes of industrial executives toward preventive health services
for employees. The results will be used in demonstration projects
to encourage the expansion of privately financed preventive services
in industry.
A new experimental approach in preventive industrial toxicology
holds promise for the development of new tests for overexposure or
early diagnosis of occupational disease before the exposed individual
has any signs or symptoms. Other research conducted during the
year involved studies of pneumoconiosis in the diatomite-producing
industry; the prevalence of silicosis in the United States; industrial
toxicology ; effects of noise and vibration ; and various other industrial
health problems, including the control of radon and radon daughters
in uranium mines.
AIR POLLUTION MEDICAL PROGRAM
This unit conducts and helps support studies designed to discover
more about the relationship between air pollution and human health.
Studies initiated during the year include analyses of geographical
patterns of causes of death; possible relationship of different types
and degrees of air pollution to the medical impairments of persons
breathing such air; studies of the toxic effects of air pollutants on
laboratory animals; and various analyses of the toxicology of common
air pollutants upon human blood tissues and enzyme systems. Lim-
ited consultative services were provided to help State and local health
departments appraise and cope with air pollution as a health problem.
TUBERCULOSIS PROGRAM
The principal objectives of the Tuberculosis Program are: (a) the
removal of tuberculosis as a cause of death; (b) the prevention of
illness from tuberculosis; and (c) the prevention of the spread of
tubercle bacilli from infected to uninfected persons. To achieve
these objectives, the following activities are carried on: (1) re-
140 Department of Health, Education, and Welfare, 1956
CN i a a
search, (2) promotion of casefinding among population groups at
high risk, (8) establishment of standards for home care and case
management, (4) measurement of the extent of the tuberculosis prob-
lem, (5) provision of technical information and health education
services and (6) financial assistance to States to strengthen State and
local programs.
National data on the tuberculosis problem reveal a continued de-
cline in morbidity and mortality rates. In 1954, the morbidity rate
for the continental United States was 48.8 per 100,000 as compared
to 46.4 for 1955; and the mortality rate dropped from 10.2 per 100,000
persons in 1954 to 9.1 in 1955.
A study of nonhospitalized tuberculosis patients was undertaken to
ascertain facts which would be helpful in planning future control pro-
grams, since, with modern drugs, a considerable number of tubercu-
losis patients are being treated at home rather than in sanatoriums.
The study was based on a sample census of the number and status of
nonhospitalized tuberculosis cases for the United States as a whole.
It was found that 56 percent of the tuberculosis patients are in hos-
pitals; 44 percent are at home. Of those at home, half are 45 years
of age and older; there are twice as many males as females; 87 per-
cent are in advanced stages of disease; almost half left the hospital
against medical advice; a third are under care of private physicians;
the sputum status of almost half is unknown; 40 percent of the active
cases have had neither drugs nor bedrest recommended.
Studies continued on the use of isoniazid as a preventive, and pre-
liminary plans for trials in human beings were explored. The pos-
sible value of isoniazid in preventing meningitis and other complica-
tions in tuberculous children was the theme of another significant
study. Other research dealt with evaluation of drug therapy, and
additional projects designed to yield more knowledge about prevention
and control.
Cooperative clinical investigations with 26 hospitals throughout the
country have gone forward in determining the most effective drug
combinations in the treatment of tuberculosis. A study of the char-
acteristics of patients in these hospitals was also completed.
Direct assistance to State and local programs included the loan of
more than 40 pieces of X-ray equipment; assistance to hospitals in im-
proving nursing practices to prevent the spread of tuberculosis; con-
sultation services; and review and evaluation of several State and
county programs.
VENEREAL DISEASE CONTROL PROGRAM
For the first time since 1947, the number of cases of primary and
secondary syphilis reported by State and Territorial health depart-
ments in 1956 was greater than in the previous year. This increase
Reaper iaeiemam deh inc inaan arn
ri lh
Resi
Public Health Service 141
indicates a significant upward departure from the trend previously
established. The increase is not due to a sudden resurgence in a few
areas; it represents a slowly growing national trend which is not
limited by race, sex, or geographic area.
More than 150 interviewers and investigators from the Venereal
Disease Program were assigned to State and local health departments
this year to assist in venereal disease control programs. Almost 2 mil-
lion people were examined in clinics and about 16 percent were found
to be infected. In addition, over 350,000 people, living in areas or
belonging to groups where the incidence of venereal disease is high,
were tested in house-to-house campaigns and public testing stations;
30,000 of them were found to be infected.
The problem of venereal disease among migrant workers received
increasing attention. During the year, more than 65,000 migrant
workers were tested, with 7,300 identified as potentially in need of
treatment for syphilis.
In venereal disease research, the most important achievement was
the development of the Treponema pallidum complement fixation test,
(TPCF). This technique—which uses a reacting substance made
from the organisms that cause syphilis—makes it possible for State
and other laboratories to test blood serum more accurately and at
about one tenth of the cost of any previously known method. Other
research projects included continued studies of syphilis immunology,
gonorrhea studies, chancroid studies, and numerous long-term sero-
logic studies.
An outstanding educational project of the year was the Interna-
tional Symposium on Venereal Diseases and the Treponematoses,
held in Washington, D. C., May 28—June 1, under the cosponsorship
of the Public Health Service and the World Health Organization.
Over 800 physicians, scientists, nurses, and other health workers from
54 countries attended.
Training courses were conducted for laboratory personnel, epidemi-
ologists, nurses, and physicians.
Sanitary Engineering Services
The Division of Sanitary Engineering Services cooperates with
State and local health departments and other groups on environmental
problems associated with water, food, air, and housing.
ROBERT A. TAFT SANITARY ENGINEERING CENTER
A cooperative training program with the Federal Civil Defense
Administration was given to Commissioned Reserve Officers. It in-
cluded courses on radiological health protection, chemical warfare
defense, nuclear weapons defense, and water supply and water pollu-
142 Department of Health, Education, and Welfare, 1956
Ce Se
tion decontamination techniques. A highlight of the year was the
first organized training presentation on the Division’s air-pollution
abatement program.
The Center’s Chemical Analytical Reference Service provided a
comprehensive mechanism for evaluating chemical laboratory meth-
ods and raising standards of test performance in its own and other
sanitation laboratories.
ENGINEERING RESOURCES
Recruitment of inactive reserve officers in preparation for civil de-
fense emergency was continued. There are now 580 reserve environ-
mental health officers recruited toward an ultimate goal of 1,000.
A total of 14 Commissioned Reserve engineering personnel were
mobiled for disaster relief activities in connection with the hurri-
canes which struck the northeastern part of the country in August,
1955, and with the California floods of January 1956.
Five training courses covering various phases of disaster relief
were conducted and were attended by about 80 reserve officers.
MILK AND FOOD SANITATION
Research during the year on the effect of pasteurization on the
@-fever organism showed a need to raise the temperature from 143°
to 145° F. for 30 minutes by the vat pasteurization method. State
milk authorities and the milk industry were notified of this finding.
Trends in public buying habits have promoted increased emphasis
on the sanitation aspects of processing, storing, and distributing pre-
cooked and frozen foods. Regulatory measures applicable to auto-
matic vending machines are being developed with the cooperation of
the National Automatic Merchandizing Association.
Field work in conjunction with several States on sanitation rating
methods should develop standard evaluation procedures which will
more accurately reflect the effectiveness of State and local food con-
trol programs. Studies are in progress to determine any correlation
between the training of food-service personnel and the sanitary rat-
ings of food establishments.
In conjunction with the American Dry Milk Institute and the
Universities of Wisconsin and Minnesota, plans were initiated for re-
search on the factors involved in the formation of toxins in dry milk.
WATER SUPPLY AND WATER POLLUTION CONTROL
During the year, the Congress enacted new legislation (P. L. 660)
to extend and broaden the water pollution control program. The
legislation authorized an expanded program of research and tech-
nical assistance, basic data collection, simplified enforcement pro-
cedure, grants to State and interstate water pollution control agencies
Public Health Service 143
(provisions recommended by the President), and construction grants
for sewage treatment works.
It has been estimated that current annual expenditures of approxi-
mately $230 million for municipal sewage treatment plant construc-
tion need to be doubled for each of the next 10 years to eliminate the
existing backlog, and provide for obsolescence and expected population
erowth. A study of municipal pollution trends indicates that to
attain a desired level of municipal sewage control, by 1985 all munici-
pal wastes will require secondary treatment, and present techniques
will have reached the upper limits of practical treatment.
The President’s Committee on Water Resources Policy endorsed
the established policy of primary State responsibility for controlling
pollution at its source. It recommended that the Federal Government
aid the States through research, investigation, and technical assistance.
In addition to Federal enforcement of interstate pollution abatement,
the Commission recommended that the Federal Government prescribe
basic criteria and participate in the planning of long-range programs
for pollution abatement.
A compilation of industrial waste research projects in progress
during 1955 was made available to interstate agencies.
A study of ground water supplies will help to provide a pattern
for similar surveys in large metropolitan areas since underground
supplies are not vulnerable to contamination by radioactive fall-out
resulting from thermonuclear warfare. ‘This source would provide
safe drinking water to evacuated populations.
The Interagency Report of Studies of the Arkansas-White-Red
River Basins and the New York-New England Area Survey of Water
and Land Resources were transmitted to the Congress. These studies
will provide an overall view of the developed and undeveloped
resources of the regions covered, for use by Congress and govern-
mental agencies in specific program development.
A Water Facilities Inventory of 570 communities of 25,000 popula-
tion and over was completed and sent to State health authorities and
others for water development planning purposes.
AIR POLLUTION CONTROL ACTIVITIES
Public Law 159, 84th Congress, authorized a comprehensive pro-
gram of community air pollution research and technical assistance to
States, communities, and other organizations.
To date, over 250 requests for technical assistance have been
received. Included were requests for surveys, technical information,
assistance in developing legislation, and plant studies. All requests
were met within the limits of available resources. 3
Personnel were assigned to the Connecticut State Health Depart-
ment to help evaluate statewide air pollution problems, and to the
144. Department of Health, Education, and Welfare, 1956
Los Angeles Air Pollution Control District to assist in the conduct of a
specialized aerometric survey and oil refinery studies. Another
cooperative study was initiated in January 1956, in Louisville-Jeffer-
son County, Kentucky, on the source and character of air pollutants
in that area.
A total of 29 research projects were undertaken at the Sanitary
Engineering Center. Of these, 11 have been completed, including a
revised plan for the operation of the National Air Sampling Network,
initial installation and operation of a pilot plant for testing air clean-
ing apparatus, and field trials of newly designed stack-sampling
devices.
RADIOLOGICAL HEALTH
At the request of the Atomic Energy Commission, the Public
Health Service set up and equipped a nationwide radiation-surveil-
lance network. At present, 33 stations are recording increases, over
normal radiation background, which result from nuclear weapons
testing in the United States and other countries. This network pro-
vides State health officers with on-the-spot information on local
radiation intensities.
During the spring Pacific test series of nuclear devices, PHS officers
performed off-site functions for the protection of people located near
the Pacific Proving Grounds. At the Nevada test site, personnel
supervised radiological safety in connection with nonnuclear tests.
Public health implications of the nuclear power industry were
studied, as well as the contemplated widespread industrial use of
nuclear energy. Waste disposal, radiation-control techniques, and
the development of radiation-protection standards were given atten-
tion, in cooperation with several States. Training programs, appli-
cable to civil defense needs at the local level, were provided for physi-
cians and other groups. Requests by State and city health depart-
ments for control of radioactive water pollution increased markedly
during this period.
GENERAL ENGINEERING ACTIVITIES
Three major shipping companies received the Public Health Serv-
ice special citation for having attained a Certificate of Sanitation for
each of their operating units.
The Public Health Service collaborated with the American Public
Works Association in the collection and development of basic data and — |
information in the field of refuse sanitation.
Decontamination procedures were carried out after leakage of live
poliomyelitis virus in an air shipment. An amendment to the Inter-
state Quarantine Regulations is being developed in cooperation with
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Public Health Service 145
other interested government agencies, covering the shipment of
etiological agents.
Staff personnel helped formulate a resolution, adopted by the Sixth
Inter-American Travel Congress, to develop minimum sanitation
standards for tourist accommodations throughout the Americas.
As recommended and issued by the President’s Committee, min-
imum standards of housing and environmental sanitation were
developed to assist State and local health authorities. Staff consul-
tation was also given on sanitation aspects of mass evacuation, munic-
ipal and rural sanitation problems, sanitation in aircraft and the new
lightweight trains.
ACCIDENT PREVENTION AND HYGIENE OF HOUSING
Plans are now under way to broaden the accident prevention activi-
ties of the Public Health Service. One of the purposes is to apply the
public health techniques which have been found effective in home
accident prevention to the total accident problem.
There was an increased number of requests for technical assistance
on basic definitions, relationships between physical and psychological
limitations and accidents, and methodology for recognition, treat-
ment, and susceptibility to, and occurrence of, accidents. |
Poison information centers increased in number among the States.
Fifteen centers are now in operation and 12 others are in advanced
planning stages. The American Public Health Association provides
consultation to health departments and medical societies in the initial
development of these centers. The feasibility of a National Poison
Information Center received consideration.
In cooperation with the National Office of Vital Statistics, a survey
was made of the accident-prevention activities sponsored by State
and. local health departments. The data reflected increased interest
and activity and a greater demand for technical services.
Public Health Service activities in hygiene of housing were re-
viewed during the year. Considerable attention was given to housing
rehabilitation and to increased emphasis on research associated with
technological developments in housing.
Communicable Disease Center
This Division, with headquarters in Atlanta, Ga., maintains labora-
tories and field stations in various parts of the United States. It
assists States in preventing and controlling outbreaks of communicable
diseases through direct aid in epidemics and disasters; continuing
field studies on the epidemiology of diseases; laboratory investiga-
tions for more rapid, accurate, and economical diagnostic techniques ;
development of more effective disease control materials and methods;
146 Department of Health, Education, and Welfare, 1956
ak ch AA EN SIE tM BRS SN eae Re
consultations and demonstrations; and training of public health
personnel.
During the year, the Congress approved the construction of a
new building for the Communicable Disease Center, which has been
housed in temporary quarters at widely scattered locations. It will
be built on land donated by and adjacent to Emory University,
Atlanta, Georgia.
EPIDEMIC AND DISASTER AID
An important part of the Communicable Disease Center (CDC)
program is providing aid in epidemic and disaster situations which
tax or exceed State health resources. Thirty-five requests for epi-
demic aid came from 30 State and Territorial health departments,
and units of the Armed Forces. About 20 separate diseases or con-
ditions were involved, and they required the services of physicians,
veterinarians, statisticians, nurses, bacteriologists, mycologists, engi-
neers, and entomologists. These personnel helped identify the out-
breaks and their sources, and assisted public health workers in
applying effective control methods. |
Emergency assistance was given on 18 occasions where natural
disasters such as floods, tornadoes, hurricanes, or droughts created
vector control or water supply problems. In these instances, CDC
furnished manpower, special equipment, and materials as needed.
SURVEILLANCE AND INVESTIGATION OF DISEASES
The purpose of the CDC surveillance program is to prevent the
reintroduction or resurgence of diseases now rare or absent in this
country, and to accelerate the decline of others. CDC also serves as
a clearinghouse for information on diseases of national importance.
Although major emphasis was given to poliomyelitis this year, small-
pox, leprosy, diphtheria, malaria and other vector-borne diseases
also came under surveillance, with special attention directed to the
arthropod-borne encephalitides.
CDC’s Poliomyelitis Surveillance Unit, in cooperation with States,
evaluated the safety and effectiveness of the poliomyelitis vaccine.
In addition, CDC supported State and other non-Federal programs
for the laboratory diagnosis and confirmation of poliomyelitis and
poliomyelitis-like diseases. It also contracted with reference labora-
tories for special investigations concerned with the typing of viruses
that produce poliomyelitis-like syndromes. Laboratory evaluation of
over 10,000 cases reported as poliomyelitis indicated that a significant
proportion of nonparalytic cases were due to causes other than the
poliomyelitis viruses. An outbreak of poliomyelitis-like disease in
Marshalltown, Iowa, involving about 1,000 persons, was investigated
and found to be caused by an ECHO virus. This was the first time
oo ee ee ee ane =
eo ee
Ls cg ome
ee Ree
Public Health Service 147
a so-called “orphan” virus was related to a specific disease outbreak
involving a sizable community. ‘
The year 1955 was marked, generally, by low incidence of the viral
encephalitides. Hastern equine encephalitis occurred sporadically in
human beings but widely in horses and pheasants throughout the
Atlantic and Gulf States. St. Louis encephalitis was seen in epidemic
form in two areas of the country—the lower Ohio River Valley and
Nevada. CDC aided in investigating the encephalitis outbreaks and
stimulating more complete reporting of this disease.
The steep downward trend in incidence of diphtheria showed a
reversal during the past 18 months. However, the mortality rate,
which has never declined significantly, remained at about 6 to 7 per-
cent. Hence, this disease again became a threat, calling for intensified
immunization programs and surveillance in particular localities and
population groups.
A sharply defined outbreak of viral hepatitis, involving 232 cases
in Pennsylvania, was traced to a contaminated municipal water supply.
A followup study of an earlier outbreak in Kentucky, with emphasis
on detecting residual effects of the infection, revealed that approxi-
mately 30 percent of the cases evidenced chronic liver disease.
The majority of psittacosis cases were attributed to contact with
parakeets and other psittacine birds. However, the most serious out-
break involved 60 persons in Oregon who had contact with infected
turkeys on farms and in rendering plants.
The incidence of rabies among dogs continued to decline as a result
of immunization programs, but the known incidence in wild animals
increased. Approximately 20 percent of the human cases in this
country during the past 4 years have been attributed to exposures to
rabid wild animals, pointing up the need for more intensive studies
of the disease in nature.
Sylvan animals, particularly rodents, were found to be a possible
source of leptospiral infections in domestic animals and man. A re-
view of 35 human cases of the disease showed that 32 of the patients
had known association with animals or with their contaminated
environments.
LABORATORY SERVICES AND NEW TECHNIQUES
During the year CDC performed the following laboratory services:
(1) processed 27,762 reference diagnostic specimens received from
State health departments, from other Federal agencies, and from
foreign countries; (2) prepared and stocked 32 types of antigens and
antisera, which are not available commercially, for use by State lab-
oratories; (3) served as a referee for intrastate laboratory programs,
evaluated the parasitology diagnosis for six States and bacteriology
148 Department of Health, Education, and Welfare, 1956
Se a
diagnosis for seven, and evaluated the vector control program in
Puerto Rico.
A fluorescent antibody staining procedure has been worked out for
the detection of Vibrio comma, Brucella sp., Pasturella pestis, Bac-
terium tularense, and two species of Malleomyces. Low concentra-
tions of Malleomyces pseudomallei can be detected rapidly even in
heavily contaminated materials, and it is believed that other agents
can be stained under similar circumstances. This time-saving tech-
nique would be vitally important in the event of a national emergency.
An apparently specific diagnostic test for myoglobulinuria using
paper electrophoresis has been developed. A new procedure for read-
ing stained patterns in paper electrophoresis studies indicates that the
change in gamma globulin reflects, within limits, the trend and degree
of nonspecific abnormality of all serum proteins.
In airborne pathogens studies, an impinger which collects micro-
scopic particles and is capable of sampling large volumes of air at
high velocity was designed and fabricated.
VECTOR CONTROL
Investigations were continued to develop increasingly safe and
effective methods of controlling flies, mosquitoes, rodents, and other
disease vectors. The fact that mosquitoes create problems to health
and comfort other than transmission of disease has led to further
control efforts.
In field experiments in the Milk River Valley, Mont., residuals
from preflood treatments with dieldrin and heptachlor larvicides for
the control of mosquitoes (principally Aedes vewans and Aedes dor-
salis) in irrigated areas were completely effective throughout the 1955
season. On experimental plots of fertilized irrigated land in the
Milk River Valley of northern Montana, mosquito production was
eliminated and yields of western wheat grass were increased fivefold.
In all, approximately 100 Federal water resources development proj-
ects were studied, and recommendations were made on the incorpora-
tion of vector control into planning, construction, and operation.
In studies on the toxicity of insecticides, investigation was made
of the adverse effects suffered by fruit thinners in parathion-sprayed
orchards. Respiratory exposure appeared to be negligible, but sig-
nificant dermal contamination indicated the validity of a 48-hour
waiting period before entering sprayed orchards.
Experiments in high-rate mechanical composting of municipal
refuse to eliminate or minimize vector breeding and feeding demon-
strated that the addition of 20 and possibly 25 percent of raw garbage
to composting refuse does not interfere with the normal process.
When composting is kept on a continuous basis, the breakdown proc-
ess can be completed in 4 or 5 days. At Phoenix, Ariz., a “high
a Oe Le ee ee
ee eee, es eee eo ey
ean Lilet ee Bie el neha eal a es
Public Health Service 149
grade” compost no longer attractive to flies was produced outdoors
in 6 weeks when raw refuse was ground and piled in windrows.
Vector control demonstration projects were conducted at Laredo,
Tex.; Cedar Rapids, Iowa; Gadsden, Ala.; and Boise, Idaho. They
were designed to assist the States with such problems as refuse hand-
ling and disposal, elimination of insanitary privies, rodent control,
proper maintenance of animal shelters, and control of mosquito pro-
duction in manmade breeding places such as irrigated lands and log
ponds.
TRAINING
During the year, 73 organized training courses were presented on
approximately 250 separate occasions. They were attended by more
than 5,000 people, including employees of State and local health de-
partments, other Federal agencies, and industries, and health workers
from foreign countries. Individual instruction was given to an ad-
ditional 100 people. Courses were held in Atlanta, in CDC field sta-
tions, and in various States. CDC also distributed more than 100,000
items of training material, including audiovisual aids and literature.
To extend the benefits of laboratory training services, qualified in-
dividuals and State laboratories were supplied with specimens for
review and practice in diagnosis. More than 4,000 parasitology,
mycology, pulmonary mycology, and tuberculosis specimens were
distributed.
Dental Public Health
The Division of Dental Public Health works toward better dental
health for every citizen. To this end, the Division develops public
health methods for reducing the prevalence of dental disease, and
aids States and communities in applying these methods.
PROGRAM SERVICES
During the year, four additional States initiated dental public
health programs, making a total of 50 States and Territories that
now have such organized programs. The dental health program
guide, developed by the Division in 1954, was widely used by State
dental health directors in planning their activities.
States continued to request and receive consultative services from
the Division. Several States were helped in developing various ele-
ments of their programs; and several communities were assisted in
conducting various types of dental surveys.
A recruitment program was conducted for State and local dental
programs. This program included talks to student dentists and dental
hygienists, courses and lectures on dental public health presented in
150 Department of Health, Education, and Welfare, 1956
I
schools of dentistry, and consultation with personnel of State health
departments on methods of recruiting, examining, and evaluating
applicants for dental public health positions. Aid was also provided
in the orientation and training of dental personnel in State and local
health work.
OPERATIONAL RESEARCH
The Division of Dental Public Health also conducts a program of
operational and developmental research. Significant research in
progress this year includes:
1. Development of a model chemical feeder which makes it possible
to use calcium fluoride in the fluoridation of water supplies. This
product is plentiful and is more economical to use than the fluoridating
agents now employed.
2. Testing of home fluoridators which can be used to fluoridate
individual water supplies.
8. Examinations and analysis of the 11th year experience of the
Grand Rapids, Mich., water fluoridation project.
4. Completion of three-fourths of the second round of examina-
tions and treatment of 4,000 children participating in the Gainesville,
Fla., dental study program representing 90-percent participation of
the school population; and completion of the second series of exami-
nations and treatment of 2,000 children participating in the Cam-
bridge, Md., dental study program representing 88 percent of the
school population.
5. Preliminary work which indicates that aqueous methyl red may
be an effective device for indicating caries activity and predicting
where new caries will occur.
6. Analysis of data which will lead to development of a method
of determining the appropriate fluoride concentration in water sup-
plies under varying climatic conditions.
7. Study of dental care problems in a chronic disease institution
to determine dental needs and evolve effective and economical measures
for meeting them.
8. Collection of data on fluoridation. By the Spring of 1956, over
26 million people living in 1,300 communities were served by fluori-
dated water supply systems. Major cities which began fluoridation
during the year included St. Louis, Toledo, Cleveland, and Chicago.
Division of International Health
Through the Division of International Health, the Public Health
Service maintains active relationships with the World Health Or-
ganization (WHO), the Pan American Sanitary Organization, and
Public Health Service 151
other health agencies. The Division is also the primary source of
assistance to the Department of State in international affairs related
to health, and to the International Cooperation Administration (ICA)
of the Department of State for staffing and technical aid to United
States Operations Missions abroad.
During the year the chief and other officials of the Division served
on United States delegations to five major international conferences.
These included the Ninth World Health Assembly, which met in
Geneva, Switzerland, the Directing Council of the Pan American
Sanitary Organization, which met in Washington; the meeting of the
Regional Committee of the World Health Organization for the West-
ern Pacific, which met in Singapore; the Third South Pacific Confer-
ence; and the Fifteenth Session of the South Pacific Commission in
Suva, Fiji Islands. In addition, members of the Division served as
the United States members at two meetings of the Executive Board of
the World Health Organization, and represented the United States
at three meetings of the Executive Committee of the Pan American
Sanitary Organization.
TRAINEES AND VISITORS
The Public Health Service aided health personnel of 72 countries
who visited or studied in the United States during 1956. Training
programs were arranged for 886 foreign trainees, of whom 634 were
sent to the United States by ICA Missions in 47 countries, and 252
ae sponsored by WHO and other United Nations agencies, foreign
governments, and private foundations and organizations. The larg-
_ est number, 356, came from the Far East, 286 from Latin America,
72 from Europe, and 172 from the countries in the Near East, Africa,
and South Asia.
Fifty academic and 20 clinical institutions and 19 other organiza-
tions such as State health departments were used for the training of
these foreign health workers.
Among the visitors to the United States was a delegation of four
medical scientists from the Union of Soviet Socialist Republics, the
first official health delegation from that country to visit the United
| States since World War II. The Division made arrangements for
| their visits to laboratories and other facilities associated with the de-
| velopment and production of poliomyelitis vaccine. Arrangements
| were made by the Division for a reciprocal exchange visit in May of
| five American microbiologists to the U. S. S. R.
FOREIGN MISSIONS
The Division of International Health provided personnel and tech-
nical support to the United States bilateral technical assistance pro-
152 Department of Health, Education, and Welfare, 1956
grams under the terms of the Department of Health, Education, and
Welfare-International Cooperation Administration agreement. The
Division recruited and assigned to ICA 186 public health workers. It
reviewed and evaluated 299 proposals for the initiation, continuation,
or expansion of health projects in 44 countries.
Public Health Service specialists in tuberculosis control, schisto-
somiasis control, sanitary engineering, nursing, health education, and
medical technology consulted with U. S. Operations Missions in
10 countries in Asia, the Near East, and Africa and in 5 countries in
Latin America.
The Division provided staff assistance to the International Develop-
ment Advisory Board in preparing a report recommending intensified
United States support of the WHO malaria eradication program.
INTERNATIONAL EPIDEMIOLOGY
Material relating to the world distribution of disease, the status of
national health organization, and the development of health facilities
in foreign countries was collected and classified by the Division. This
was made available to orientate personnel receiving foreign assign-
ments, to answer inquiries, and to advise research workers in a number
of fields.
Public Health Service
153
eee
Table 1.—Statement of appropriations, authorizations, obligations, and
balances, fiscal year 1956
[In thousands]
Appropriations
Appropriations, Public
Health Service_________
Control of tuberculosis_________
Control of venereal diseases-_ _ __
Assistance to States, general____
Control of communicable dis-
Disease and sanitation investi-
gations and control, Alaska__
Sanitary engineering activities_
Foreign quarantine service_____
Hospitals and medical care____-
Salaries and expenses, hospital
construction services________-
Indian health activities_______-
Construction of Indian health
TSOUMGS 4 2 Sp SAE es
Grants for hospital construc-
Construction of housing facili-
MesMOMmanimals=. 2...
Surveys and planning for hos-
pital construction____________
Patients’ benefit fund, Public
Health Service hospitals____-
Operating expenses, National
Institutes of Health__________
Salaries, expenses, and grants,
National Cancer Institute_-___
Mental health activities________
Salaries, expenses, and grants,
National Heart Institute_____
Dental health activities________
Buildings and facilities, Cin-
cinnarhOhiors 222.25.
Arthritis and metabolic dis-
Gaon aha) Ch a rr ae
Microbiology activities_-_______
Neurology and blindness ac-
AVAL OSM eae 2 Se
Gorgas Memorial Laboratory - -
Construction of Biologics
Standards Laboratory Build-
Was. ol a ee rr
Grants to States for poliomye-
litis vaecination.4.._2...._...
Construction of research facili-
Retired pay of commissioned
officers (annual)
Retired pay of commissioned
officers (no year)
Salaries and expenses---__------
Appropriations, special
project funds made
available by other
meemelese.. sees. 2 aL
Salaries and expenses, Bureau
of Prisons (allocated working
fund to HEW, PHS)
American Sections, Interna-
tional Commissions, State
(allocated working fund to
os Es) a ee aie
Refugee Relief, Executive
(transfers to HE W, PHS)----
Funds available for obligation
Appropri- Net Prior year
ations | transfers | Repay- | unobli-
and au- | between | ments for; gated
thoriza- | appro- | services | balances
tions priations
$395, 508 $535 | $16,931 | $64,174
395, 462 535 16, 931 64, 071
6, 062 10 WG potas seed
3, 616 10 155 Serer ere
DSSS thal Poe ere my fra NE a ee
6; 451) Seeee ee 289 eee eas
1, 139 6 1 Se (ein se Pas
4880) kee eee! 103K) ee
Pei Tied Uae ae ed EE ee AU
305 O00 Wile eae ees net 22 TOE ects poe
1, 290 fis ORE CR ee
34, 990 —174 538 1— 398
, 000 BeOtth eee we es sea
AAT OO0n ee=- ee ers see ce 61, 204
600 | ae ad bt aa
Dee os Reever. -5| (Sep he «3 34 2 1 PS Oe Mma gs 1, 827
OG eee e apes | te ee 15
D929) Se ee se 12 Q4G Ali eee ee
pf DN § ya NP eee yo S| ey See re al Jenene sb
LSZ008 || a2. eee 20), | See aees
18, 808 OO eee eh eee eae
Q2007Gr St oka ee TER ee ROS SS See ee
416325 6) eee
12840) | Shs ee oes | eee a ee ee ee
RTRSY cele Bek Se 1 ey Sey ee | Ee a Ss a
OU S6 te Bee aes ee ee eee ere
TAGS ee Oe ee eee ae
3, 190 310 eee | 2
57, 800 mA Fy | aac eet | ee rece
nea eso = SL On 2 see 1, 417
1 GOO home ee sees |e aera as | ec oe oe
[ato Oe es ae isa/ic te TM eames.
See footnotes at end of table.
408691—57 11
Total
funds
476, 999
6, 079
3, 641
18, 514
5, 740
5, 585
172, 204
510
10, 840
7, 775
9, 861
147
3, 500
57, 755
1, 107
1, 355
8, 561
1, 491
Amounts | Balances
available | obligated
$485, 709 | $361, 272
353, 686
, 053
3, 624
17, 577
5, 723
1, 158
4, 996
3, 154
38, 351
1, 282
34, 690
1, 947
93, 187
506
130
970
7, 562
1, 486
$124, 437
123, 313
2
23,588
379, O17
EE EEE
999
51
154 Department of Health, Education, and Welfare, 1956
Table 1.—Statement of appropriations, authorizations, obligations, and
balances, fiscal year 1956—Continued
[In thousands]
Funds available for obligation
Total
Appropriations Appropri-| Net Prior year| funds | Amounts} Balances
ations | transfers | Repay- | unobli- | available | obligated
and au- | between | ments for| gated
thoriza- | appro- | services | balances
tions priations
Operations, Federal Civil De-
fense Administration (allo-
cated working fund to HEW,
ELS) a SU er ie 1 ree RS eee oe | ed ba ee eee ae ee 154 152 D742
Atomic Energy Commission
(allocated working fund to :
3 SWORN ee) ad os) a Seeds Sane ot Dew eee ee a eee es een) Vee eee eee gel ee. 2 86 71 215
Research and development,
Navy (allocated working
fund) TOPE Wie PES) etsee se eae oe Sak |e eee eee ae aie || eee ee 93 2 221
Naval working fund (allocated
working fund to HEW,
PELS) SoS 2 tte ee eo Se ee ce ee etiam ieee eens 36 27 29
Research and development,
Army (allocated working
fanidtopERe WerePES) 228 22 i) pote Set Gee Ce ee ee 191 172 219
Research and development,
Air Force (allocated working
{une COREE W.5~ PES) eee eee a es ee ee |e Se 65 17 2 48
Army, industrial fund (allo-
cated working fund to HEW,
PES) Oe ey ea ve cate ce el te UN ee ee ee 25 12 2:13
Farm labor supply revolving
fund, Bureau of Employ-
ment Security (allocated
working fund to HEW,
| ofl se) Fp sas Silay «as ER i Ke Cerca ed beam A ee Sere. all: Veen A 318 307 211
Technical Assistance to Ameri-
can Republics and Non-
Self-Governing Territories of
the Western Hemisphere,
Executive (transfers to
SITS WV) Ses cg ser cach ZA eh Eee yes AN On eee |e a 144 —50 2194
Technical Assistance, U. S.
Dollars Advanced from For-
eign Governments, I. C. A.
(transferston Eh W2)eee oy 28 al eee IE 9 ae ake ee 5 4 21
Plant and equipment, Atomic
Energy Commission (allo-
cated working fund to HEW,
A oil a Wa) ioe coma ah esky 2S lh LR OS a es Ol eee eae eo A Ae. 15 3 212
Defense support, Europe, Ex-
OCUCLVE(ErASLOTS LOVEABS Wi) Sa ete ee | hese alee 18 17 1
Administrative expenses, Sec-
tion 411, Mutual Security
Agency Act, Executive
(transferred von ElhiWys) eee 8 cae Aton mete eee ea pellet a ee ee 114 110 4
Technical cooperation, general,
Executive (transfers to
et EW ) Glory ear) 22 Set ee cs Jee A ok le oR les ee 1, 322 1,141 2181
Technical cooperation, general,
Executive (transfers to
EU Wo (anneal) ooo ees ce Se a eto oe or he Se a 2, 893 2, 594 2299
Salaries and expenses, civil
defense functions of Federal
agencies, Federal Civil De-
fense Administration (allo-
cated; working fund: tovEh Wi) | beeen sees eee ee eee ee | ee 807 703 104
Defense support, Asia, Execu-
Give (transfers: CO, BIW i)b = 2 be | ea | | eee 153 146 7
Gift funds donated for
general and_ specific
DULTDOSES= ee a owen eae AGING Sores ae eeeee |e een 103. 2 149.3 24.3 2 125.0
Public Health Service uncon-
ditional gift fund-- 2% 2-2-4: NAR GH eS eee See D Tiloik 89. 7 7 289.0
Public Health Service condi-
tional gift fund... -t__._._-= Sh i eee ee eee 26.1 59.6 23.6 2 36.0
1 Liquidation of contract authorizations obligated in 1955 fiscal year.
_ 2 Available for obligation in subsequent years.
|. § $78,602 available for obligation in subsequent years.
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Table 4.—Payments to States, fiscal year 1956
[In thousands]
Polio- | Medi- | Hospi-
Vene- myeli- | cal fa- | taland | Com-
State real | Tuber- |General] Mental! Cancer| Heart | tis vac- | cilities | medical] munity
disease | culosis | health | health | control | disease |cination| survey | facili- | facili-
special | control control | assist- | and /tiescon-| ties
projects ance | plan- | struc-
ning tion
otaleseessee 1$1,188 | $4,488 |2$13,332| $2,981 | $2,218 | $1,088 |$24, 359 $287 |$54, 373 $647
Alabama._-22-22 222 34 109 420 65 54 30 847 2 Deere eas
ATI ONG eee see ee 28 55 99 19 17 1 150 25 © 68S eee
TARA Sa Sessa ees 29 81 225 40 37 21 400 1 (995 |e
Californig= eee 14 270 801 182 143 50 | 1,396 SP 358000 aaa
Colorado's. peers | ee 34 145 25 24 16 291" Beeceteees Bis pairs a
Connecticut___----- 2 49 119 36 28 16 346 6 10GH 22
Delaware... -.------ a 16 24 19 5 11 29) | yas ae 200 S2 Soares
Dist. of Columbia_- 45 42 50 19 10 13 LOL? | aes 228 4\ ye oa eee
Blonda === aaa 83 81 331 63 50 25 Vid ee 1, 392 34
Georgian see eae 113 112 369 72 57 ol 894 10} 2,557 49
Tdgho2. eee ee 6 17 85 19 13 13 95 2 212) tage Se
Min OL Saas 18 230 491 145 117 388 | 1,194 9 556 225
Indians ss sae ie | es eee 88 215 57 54 25 218 24 SOA ee ee
LOW aes ee ae eae 38 159 44 40 21 84 8 PAS bol Bes Se
KEATS Sse te eee 2 39 192 36 30 17 456 10 | 1,074 214
Wentucksyeese see 27 129 346 60 51 27 690 3 D5 38622 meee
OWISIAn ee sees eae 32 92 271 56 44 22 665 6 | 2p2565\- eae
Maines S228 S562 le eee 23 107 19 18 14 77. |22 nee SOC leew nee
iINMaryiandiae eee 6 86 185 42 25 ily 190 21 1129 108
Massachusetts_..--|__-_---- 118 356 84 70 28 960 19 O59) 2 ee
IMB AVR ee 36 147 475 117 84 33 1, 008 23 Vals Ue
INGIMNeSOTa ess en eee 51 274 53 45 23 876 Hint eoed e258 e| See eae
Mississippi se eee ce 42 80 363 51 47 27 5f4:| eee 1 O02: epee ae
MSSOUTIA eee eee ae 25 110 341 73 61 27 182 4 2186); ae
INontaia see es 22 | eee te 20 78 19 13 13 85 8 TOs eegaee ee
INebraskawo-2 22 -2= 5 25 122 22, 16 13 112 5 [44 | 2
INievadae22 222522252 2 12 36 19 6 10 12 2 421 4
New Hampshire_-__|_______- 9g 53 1G) lesen tee 10 OG aaa Be 303: eee
New Jersey -------- 44 125 338 86 65 25 852 9 84
New Mexico-_-_---- 19 33 106 19 15 14 154 6 122 222-2
IN CW GOL Kee ee 100 385 940 248 189 46 | 2,110 12\| 8; 5663/2 =
North Carolina. --_ 83 109 465 83 65 29 678 1492.47 8) |S
North Dakotaese =| =e aees 23 91 19 14 13 234 3 439): || eres
OHIO Re Ee ean ae 55 187 438 142 108 38 ols ee 1 286cl cee ee
Oklahomaseeses-— 10 64 224 42 36 21 259 2 1, G56: foo ee
Oregon isse Saas | eee eee 34 150 26 21 13 80 10 468. ee
Pennsylvania_.___- 48 282 744 184 129 49 600 1 3, 80) so ae aoe
RO Gees lam Caer |e ae 25 63 19 12 10 160i ee 150): )2 wee
South Carolina_____ 62 75 286 46 37 24 701 4 950 tee
South Dakota____-_- 1 15 79 19 15 13 207 2, 7G: eee
‘Tennessee____-____- 61 127 373 67 45 29 727 Dy || SS Die pee a
ROXAS Wie ae ome eee 91 211 660 151 lil 39 465 ue 2, LOL Hee
Withee ae aes | se ae ee ee 7 85 19 13 13 224 a4 66. Petes oa
WiCTIN OMG 22 Ss oa |) nee 16 46 19 8 312 19: ele LES: eee ce
Wairciniae ees 24 111 310 67 43 9 968 TA“ 2R23G6 q | eeome eee
Washington________ 1 50 188 39 32 19 200: |S aees 336 5
West Virginia______ il 60 203 35 31 18 289 5 Sioaite neers
WHSCONSIN Sas ee sane 51 281 57 43 16 OL" |aaeeeee IG LSS eae
Wi Onin geese sees 2; 3 54 12 8 i 1D kee Ol: eee S
Alaska hates ere eres! Se ee eas 43 63 DS Ni Pa eel 6 22 4 AD ee
EVA WALD ee aero key S| eee 31 51 19 it 13 5f Bs pander PE eee
er cbouRico= eres = 23 242 354 50 12 25 785 6210948 haem
Virgin Islands_-_____ 7 6 7 0S Jah fess Parte eee 1 TL |. 2 ke eee
Canal Zoner ase. 5 vets eee al eee ee ws 8 eee Da eran Ll. |. 222332 | ee eee
GRO: 00 Pc a Ried tes co fae any he | ee vale eae ee See I ee Sige ae oS 17 2225025) eee
American Samoa.--_-
1 Includes $195,000 in services and supplies furnished in lieu of cash.
2 Includes $3,607,000 earmarked for poliomyelitis vaccine distribution and use.
3 Vermont allotment paid to Vermcnt Heart Association.
4 An additional payment of $638,000 was made to Alaska for disease and sanitation investigation and
control activities.
Office of Raientiein
I. Introduction
Fiscau YEAR 1956 was unusually significant for American education
and for the Office of Education. Throughout the country there was
unprecedented recognition of the contribution of the schools to the
national welfare—recognition that what the schools contribute to an
individual they contribute to the strength of the Nation. The empha-
sis was on citizen-educator cooperation, on getting the facts, on action
to improve the schools. At local, State, and National levels educators
and laymen organized to appraise the accomplishments of schools,
to identify and look squarely at the problems facing schools. They
found much to be done.
At the local level, in rural communities, small towns, and cities,
parents and other citizens displayed an increased interest in their
schools; they served on curriculum and other planning committees,
assisted with the school-lunch program, and worked on the school
playground. Ten million members of parent-teacher associations
discussed school programs, problems, and policies. They all asked
for facts.
State departments of education sought solutions to old and new
problems and better methods of serving the schools. They too asked
for facts. In many States legislatures provided for greater financial
support for schools, improved provisions for teacher welfare, and
studied various methods of providing for a better education for their
children.
State and local interest and activity, as well as official recognition
of the severity of the educational problems, were reflected in action
at the Federal level: In the White House Conference on Education,
in the President’s Conference on the Fitness of American Youth, in
139
160 Department of Health, Education, and Welfare, 1956
the President’s appointment of a committee on education beyond the
high school, in the volume of legislative activity, and in increased
demands on the Office of Education.
The Office of Education, as the agency of the Federal Government
established “to promote the cause of education,” was vitally concerned
in all this educational ferment. Its functions, as defined by the organi-
zation act of 1867, are to collect such statistics and facts as shall show
the condition and progress of education, to diffuse such information
as shall aid the people of the United States in the establishment and
maintenance of efficient school systems, and otherwise promote the
cause of education.
The Office’s primary means of discharging its responsibilities for
these functions is through the collection, interpretation, and publica-
tion of statistics; through research and publication of its findings; and
through rendering consultive and advisory services. From time to
time administrative functions have been added to Office responsibili-
ties, and in 1956 the Office administered Federal funds under three
programs: for vocational education of less than college grade, for
land-grant colleges and universities, and for school assistance in fed-
erally affected areas. Thus it will be seen that the Office is authorized
to work primarily in three areas: Research, services, and the adminis-
tration of grants. Some of its major accomplishments in each area
will be summarized in this report.
For many years the Office has cooperated with other Federal
agencies in educational and related programs, some in voluntary asso-
ciation and some in response to legislative mandate. The Office
continued such cooperation in 1956.
White House Conference on Education
THE CONFERENCE
The Eighty-Third Congress, in response to the President’s request,
authorized and appropriated funds for use of the States and Terri-
tories for local, regional, and State conferences leading to a White
House Conference on Education. In December 1954, President Eisen-
hower named a 34-member Committee for the White House Conference
on Education to plan and conduct an overall study of the Nation’s
elementary and secondary school needs. More than 4,000 local,
regional, and State conferences on education were held during 1955,
involving more than a half-million citizens. Under the American
system of local school control, each State and Territory evolved its
own program without direction from the President’s Committee. The
year’s activity was the most thorough, widespread, and intensive
study the American people have ever made of their educational system.
The White House Conference, held November 28 to December 1, 1955,
Office of Education 161
in Washington, D. C., climaxed the series of State and Territorial
Conferences. More than 1,800 persons within the States and Ter-
ritories, including representatives of national organizations, took part
in the discussion of the six topical questions posed at the conference.
There has been widespread agreement that the White House Confer-
ence emphasized the importance of education to the well-being of the
Nation and the individual, made available to many interested citizens
information on needs of education and the existing resources, and
stimulated interest in education. In his Special Message to the Con-
gress, January 12, 1956, the President commented on the conference:
Benefits are already apparent. About half a million people across the
Nation, representing all segments of life, came to grips with the problems
of education. The status of American education—where it is; the future
of American education—where it should and can go—have been illumi-
nated as never before. Most important of all, there has been a reawakening
of broad public interest in our schools * * * no more potent force can
be devised for assailing a problem than the common will to do the job.
For the improvement of our educational system, the people themselves
have laid the foundation in understanding and willingness to do the job.
REPORT TO THE PRESIDENT
In April 1956 the Committee for the White House Conference on
Education presented its report to the President. The 126-page report
is in three parts: (1) The committee’s statements and recommenda-
tions, (2) the Report of the White House Conference on Education, and
(3) asummary of the State conference reports.
THE COMMITTEE REPORT
The committee report contains 79 specific recommendations for the
improvement of schools in the 6 areas of elementary and secondary
education the conference was asked to study. From its own studies and
results of State and Territorial conferences and the White House
Conference, the 34-member committee concludes that the schools now
affect the welfare of the Nation more than ever before in history.
The report embraces the traditional concept of education in a
democracy : Schools free men to rise to the level of their abilities; they
stand as the chief expression of the American tradition of fair play
for every one and a fresh start for each generation. The committee
also accepts the broadened functions of education: To improve the
child’s health; to provide vocational training; and to do anything else
within its power to help bring the child up to the starting line as nearly
even with his contemporaries as his native skills will permit.
The committee report recognizes the progress that has been made
in American education, but points out that schools have fallen far
behind the aspirations and the capabilities of the American people.
To help close the gap between educational ideals and realities, the com-
162 Department of Health, Education, and Welfare, 1956
mittee makes a number of recommendations. Some of them are sum-
marized below.
1. That school authorities emphasize priorities in education, that school chil-
dren be given first things first.
2. That American people deny funds, other than local, to districts which do
not organize on an efficient basis.
3. That local boards quickly assess their school building needs, give the in-
formation to chief State school officers, who in turn can relay it to the Office
of Education; That State and local communities do all they can to construct
new buildings and that where necessity is shown to exist, Federal funds be used
in such emergencies as the present.
4. That greater inducement be offered to attract and retain good teachers and
that, while the shortage exists, greater effort be made to use teacher services
more efficiently.
5. That a new look be taken at the question of how much money the Nation
should spend on education. (A doubling of present expenditure during the next
decade would be an accurate reflection of the importance of education to society.
Funds must come from all levels of government. Good schools are admittedly
expensive, but not nearly so expensive in the long run as poor ones.)
6. That every possible step be taken to encourage the interest and activity of
citizens in school affairs.
7. That a White House Conference on higher education similar to the one on
elementary and secondary education be held promptly.
CONFERENCE REPORT
Part 2 of the report to the President—the official report on the White
House Conference—presents the six summary conclusions reached by
the discussion groups on the six questions participants had been asked
toconsider. A few significant conclusions are quoted below.
What Should Our Schools Accomplish?
It is the consensus of these groups that the schools should continue to
develop:
1. The fundamental skills of communication—reading, writing, spelling
as well as other elements of effective oral and written expression; the
arithmetical and mathematical skills, including problem solving. While
schools are doing the best job in their history in teaching these skills,
continuous improvement is desirable and necessary.
New Challenges in Education
Consideration must be given to the need for continuing growth and
development in education at all levels in amount and scope, to keep up
with the economic, social, and moral implications resulting from the ad-
vances in technology and science.
What Are Our School Building Needs?
It appears that under present plans only 2 or 3 States have been quoted
as stating that they can meet their building needs for the next 5 years.
We have taken the question exactly as stated. Under the present plans
and time limitations stipulated, it seems to be virtually impossible for
most of the States to meet school building needs.
Office of Education 163
The general consensus was this: No State represented has a demon-
strated financial incapacity to build the schools it will need during the
next 5 years. But, with the exception of a few States, none of the States
presently has plans which indicate a political determination powerful
enough to overcome all of the obstacles.
Some Territories and a few States may need outside financial assistance.
How Can We Get Enough Good Teachers—And Keep Them?
We believe that, to increase the supply of good teachers from any source,
three basic considerations must be kept in mind:
1. The prestige and status of teaching must be comparable to other
professions within the community.
2. The salary structure must be high enough and flexible enough to com-
pete effectively with other fields bidding for quality manpower.
3. The teacher’s job must be so defined as to challenge and attract the
interest of talented people.
How Can We Finance Qur Schools—Build and Operate Them?
The participants approved by a ratio of more than 2 to 1 the proposition
that the Federal Government should increase its financial participation
in public education. Of those favoring such increase, the overwhelming
majority approved an increase in Federal funds for school building con-
struction. On the issue of Federal funds to the States for local school
operation, the participants divided almost evenly. A very small minority
was opposed to Federal aid for education in any form.
How Can We Obtain a Continuing Public Interest in Education?
We agreed that the energy, intellectual effort, and investment of money
on the White House Conference on Education will be futile unless specific
and positive actions are undertaken at the local, county, State, and
National levels to meet the existing crisis in education and plan for future
needs.
Five of the six conference reports commented on the role of the
Office of Education in the current effort to improve the Nation’s
schools. Among the recommendations on the Office were the follow-
ing: That the Office be further strengthened to perform the functions
it isnow performing in making reports, in carrying on research, and in
providing promptly statistical information needed; that the Office
make a study of certification standards and establish a basis for re-
ciprocity in certification among the States.
The official report also recommended that a White House Conference
on Education be held periodically at national, State, and local levels.
STATE AND TERRITORIAL SUMMARIES
Part 3 of the report, a summary of State and Territorial reports,
made a number of recommendations and suggestions on the Office and
Office activities. Among them were the following: That the Office
increase its staff in adult education; disseminate its findings more
164 Department of Health, Education, and Welfare, 1956
a cea
widely; and expand its services to include regular communications on
research in school building construction.
FOLLOWUP
Many States and national organizations are following up the White
House Conferences in a variety of ways. Missouri is planning 6
followup conferences; Oregon has held 32 followup meetings; and
other States have organized planning committees. National Organ-
izations are working on topics of the White House Conference, teacher
recruitment, school financing, organization of citizen committees, and
others.
In the Office of Education an Advisory Committee of National
Organizations composed of lay and educational organizations advises
and makes recommendations to the Commissioner and his staff “to
promote the cause of education throughout the country.” It also ad-
vises on Conference followup work.
The Report of the White House Conference Committee is available
from the Superintendent of Documents, U. S. Government Printing
Office, Washington 25, D. C.
President’s Conference on Fitness of American Youth
Because of his concern that we “do more than we are now doing
to help our young people become physically fit and therefore better
qualified, in all respects, to face the requirements of modern life,”
President Eisenhower called a Conference on Fitness of American
Youth. This conference was held at the U. S. Naval Academy, An-
napolis, Md., on June 18-19, 1956. The Office of Education assisted
the White House and Vice President Richard M. Nixon, who served
as conference chairman, in the planning, conduct, and followup of this
important meeting.
The 150 participants included representatives of local, State, and
Federal Governments; professional education, health, medical, and
recreation organizations; child and youth-serving agencies; civic
groups; the motion picture industry; radio and television networks;
amateur and professional athletics and sports; and newspaper and
magazine editors and publishers; sportscasters and sportswriters.
The conference discussion resulted in a number of important find-
ings and recommendations. Among these were the following:
1. A fitness program should provide for development of the total]
person—physical, spiritual, mental, emotional, social, cultural—and
should recognize the interrelationship of all personality factors.
2. Research is needed to determine the full nature and dimensions
of the youth fitness problem and to supply the facts essential in formu-
lating new policies, plans, and programs, and in improving old ones.
Office of Education 165
3. Schools, community recreation agencies, youth organizations, and
other groups should take steps to expand and improve programs of
health, physical education, recreation, sports, and other aspects of
youth fitness by providing necessary leadership, programs, and fa-
cilities to meet the needs of all the Nation’s boys and girls.
4, Within the community, and on regional, State, and national levels
as well, full coordination and cooperation among public and private
agencies and organizations and interested citizens are needed to insure
wise planning and efficient use of fitness resources.
5. Although a regimented national youth program is to be avoided,
a number of Federal agencies do provide appropriate services relating
to youth fitness. Therefore, the President should provide for exten-
sion and improved coordination of Federal services and should estab-
lish a citizens’ advisory group to lend assistance toward this end.
In response to the last recommendation, President Eisenhower,
through an Executive order issued on July 16, 1956, established a
President’s Council on Youth Fitness and a President’s Citizens’ Ad-
visory Committee on the Fitness of American Youth. The council
is composed of the Vice President of the United States, who serves as
chairman, and the heads of departments that are concerned with the
activities of young people—the Departments of Health, Education,
and Welfare; Agriculture; Interior; Justice; and Labor. The crea-
tion of a council at cabinet level should provide for better coordina-
tion of the activities of some 30 Federal agencies that touch the lives
of children and should stimulate and improve existing programs.
The Citizens Advisory Committee will be appointed because the
conference recommended and the President agreed that the American
people need to be made freshly aware of the importance of physical
and other recreational activity. The President points out the need for
a comprehensive study and reevaluation of all government and non-
government activities relating to the fitness of American youth.
Through the work of the council and the committee, American
citizens in general should benefit from the findings and recom-
mendations.
The Office of Education will cooperate with the council and the
committee.
The Report to the President of the U. S. on the Annapolis Con-
ference is available in booklet form from the Superintendent of Docu-
ments, U. S. Government Printing Office.
President’s Committee on Education Beyond the
High School
In his special message to the Congress on January 12, 1956, Presi-
dent Eisenhower expressed concern about the growing problems in
166 Department of Health, Education, and Welfare, 1956
the field of education beyond the high school and his belief that imme-
diate action on the problem was needed. He said:
Shortages now exist in medicine, teaching, nursing, science, engineering,
and in other fields of knowledge which require education beyond the
level of the secondary school. Changing times and conditions create new
opportunities and challenges. There are now possibilities for older per-
sons, properly trained, to lead more productive and rewarding lives. The
tide of increasing school enrollment will soon reach higher educational
institutions. Within 10 years we may expect 3 students in our colleges
and universities for every 2 who are there now.
Higher education is and must remain the responsibility of the States,
localities and private groups and institutions. But to lay before us all
the problems of education beyond high school, and to encourage active
and systematic attack on them, I shall appoint a distinguished group of
educators and citizens to develop this year, through studies and confer-
ences, proposals in this educational field. Through the leadership and
counsel of this group, beneficial results can be expected to flow to educa-
tion and to the Nation, in the years ahead.
The President’s concern for this area of education was shared by
the Committee for the White House Conference on Education and by
interested citizens generally.
In April 1956, President Eisenhower appointed a committee of
83 prominent lay leaders and educators to undertake a large-scale
study of post high school education.
At the first meeting the committee agreed on basic objectives: First,
to collect, assemble, and disseminate information for the purpose
of increasing public awareness of the problems which lie ahead in
the field of education beyond the high school; second, to encourage
the planning and action that should be undertaken by institutions and
groups of institutions, locally and nationally, publicly and privately,
to meet the impending demands; and third, to advise the President on
the proper role of the Federal Government in this field.
In considering these objectives at its first and second meetings, the
committee discussed a wide range of problems on which facts were
needed and on which planning and action should be forthcoming.
For example, the following questions presented themselves:
What aims should guide the provision of education beyond the high
school? What should be done to supply the quantity and quality of
persons for science, industry, government, and education? to meet
other educational needs of persons with a wide range of abilities and
interests before, during, and after their work careers? to staff the
schools and colleges with qualified teachers? How can physical
facilities—classrooms, laboratories, libraries, dormitories—be pro-
vided for the 5 to 7 million students who will be ready for college by
1970? What will be the annual cost of educating, or of failing to edu-
cate, the number of persons necessary to serve the vocational and other
Office of Education 167
needs of an increasing population? What adjustments may be needed
in existing institutions? What, if any, changes in the role of the Fed-
eral Government in this field should be made? What implications are
there for higher education in the international and defense activities
of the United States?
The committee has reached general agreement upon the most effec-
tive method of working.
The President’s committee, assisted by a small staff and by con-
sultants, will collect, compile, and organize statistics and other infor-
mation needed to shed light upon the true dimensions of the problem
areas mentioned above, and will publish a series of reports. States
will be asked to organize State committees, made up of educators and
lay leaders to study the State conditions and stimulate interest and
action at the institutional, local, and State levels. During the spring
of 1957 the President’s committee will sponsor a series of perhaps five
regional conferences to emphasize current problems and to assist the
States in framing the basic issues for consideration at the local and
State levels.
States will then develop their own studies, and conferences will be
held to clarify and crystallize public views on such questions as those
suggested above, and to encourage institutional, local, and State activ-
ity to accomplish agreed-upon objectives.
During this process the President’s committee will have a good
opportunity to decide whether it should call a national meeting. If
such a conference is held its purpose will be to have representative
Americans, well grounded by their State and regional studies, gather
to discuss these problems from a national perspective and to advise the
President’s Committee on pertinent matters.
Legislation
Fiscal year 1956 was a period of increased legislative activity. A1-
though the number of public laws enacted by the United States Con-
gress affecting education was relatively small, the scope and variety of
education bills introduced and considered indicate a growing concern
with the Nation’s educational system. Some of the bills introduced
proposed scholarships and fellowships, veterans’ educational benefits,
loans for college housing, assistance for medical school construction,
oraduate and undergraduate traineeships, tax deductions or exemp-
tions for tuition payments, international exchanges of students, gen-
eral aid for school construction, aid for federally affected areas, nurse
training, and fine arts.
The area of greatest activity consisted of proposals for general
Federal aid to school construction. During the 84th Congress the Ad-
ministration’s legislative program included recommendations for the
enactment of such legislation, and the President, on February 8, 1955,
168 Department of Health, Education, and Welfare, 1956
mrp renee a a
and again on January 12, 1956, submitted to the Congress special mes-
sages on this subject. A general school construction aid bill was re-
ported to the House of Representatives in 1956 and debated, but failed
to pass.
Among the measures enacted by the Congress during 1956, 6 are of
direct interest to education: Public Laws 204, 221, 345, 382, 597, and
634.
Public Law 345, approved August 11, 1955, amends Title IV of the
Housing Act of 1950 by increasing the amount of college housing loans
that may be outstanding at any one time, from $300 million to $500
million. It also expands the program to permit loans on additional
types of self-liquidating education facilities (dining halls, student
centers, infirmaries, etc.), provides for a decreased interest rate for
borrowers, and lengthens the maximum maturity on loans from 40 to
50 years. The added funds will help colleges build to meet expanded
enrollments.
Several amendments to legislation providing assistance for schools
in federally affected areas (Public Laws 815 and 874, as amended)
were enacted during the year.
Public Law 204, approved August 1, 1955, which amends Public
Law 874, provides for the continued operation of a limited number of
schools on military installations. Under the amendment the responsi-
bility for determining whether the free public educational facilities
available to children residing on military installations are “suitable,”
within the meaning of Public Law 874, will be exercised jointly by the
Commissioner of Education and the Secretary of the military depart-
ment concerned, after consultation with the appropriate State school
agency.
Public Law 221, makes Oak Ridge, Tenn., and Richland, Wash.,
atomic energy installations, eligible for payment under the provisions
of Public Law 874.
Public Law 382 amends Public Laws 874 and 815, as amended, by
extending for 1 additional year assistance to local agencies in areas
affected by Federal activities; liberalizes the formula for calculating
payments; postpones for 1 more year the 3-percent absorption require-
ment; provides for the transfer of title to certain federally constructed
school facilities to local educational agencies and improves the admin-
istrative machinery for certain “unhoused” and Indian children.
Public Law 597 approved June 19, 1956, established a 5-year, Fed-
eral grant-in-aid program to the States to assist in extending public
library services to rural areas. The act authorizes Federal appropria-
tions of $714 million annually for the fiscal year 1957 and each of the
next 4 fiscal years for payments to States whose plans for the further
extension of public library services to rural areas without such services,
Office of Education 169
or with inadequate services, have been approved by the Commissioner
of Education.
The act provides for a minimum allotment of $40,000 annually to
each of the States ($10,000 to the Virgin Islands) plus an allotment
from the remainder of the appropriation based upon each State’s rural
population in relation to the rural population of the United States as
a whole. The allotment for each State must be matched by the State
on the basis of a formula which takes into account the relative financial
ability of the States.
Public Law 634, approved June 29, 1956, establishes an educational
assistance program for children of servicemen who died as a result of
a disability or disease incurred in line of duty during World Wars I
and II or the Korean conflict. Approximately 156,000 war orphans,
average present age 10 to 14 years, will be entitled to 36 months of
education and training under the act.
During the year the Office of Education further developed its serv-
ices in the field of school law, particularly by providing information
on State legislation to educators and laymen who are working to 1m-
prove the nation’s school system.
Progress and Problems
President Eisenhower in his special education message to the Con-
gress, January 12, 1956, said:
Signs of heartening progress have come to light. Among these are
classroom construction at a higher rate than ever before; teachers’ sal-
aries increased in many communities; the number of small, uneconomical
school districts reduced; substantially more young people preparing for
the teaching profession ; private gifts to higher education at new heights;
support of education at all levels greater than ever before.
Encouraging as these advances are, they are not enough to meet our
expanding educational needs. Action on a broader scale and at a more
rapid rate is clearly imperative.
We still do not have enough good classrooms for our children. There
is insufficient emphasis on both short-range and long-term research into
the core of educational problems. We need examination and study, from
a broad viewpoint, of the increasing needs of higher education. These
lacks are magnified by an ever-increasing stream of student enrollment
and the increasing complexity of modern society.
In his message the President called for action on some of the most
pressing problems in education: Federal aid to relieve the classroom
shortage, a vigorous program of educational research to be conducted
by the Office of Education, State and local attention to the need for
good teachers, and for a commission study of education beyond the
high school.
408691—57——-12
170 Department of Health, Education, and Welfare, 1956
ENROLLMENT
A few figures will indicate the size of some of these problems.
Total enrollment in public and nonpublic schools, including higher
institutions, in 1955-56 was estimated by the Office of Education at
39,798,700, an increase of 1,670,200 over 1954-55. (See table 1.)
Total estimated population in the United States was 165,271,000 at the
beginning of fiscal year 1956. Total estimated enrollments therefore
represented 24.1 percent of total population.
The estimated enrollment in elementary and secondary schools was
1,101,300 higher than the total in 1954-55, an increase of 3.1 percent.
Elementary schools enrolled an estimated 776,200 more pupils in
1955-56, an increase of 2.8 percent over 1954-55, and secondary schools
an estimated 325,100 more, an increase of 4.4 percent.
A total of 2,996,000 students enrolled in colleges and universities, the
largest in our history and the fourth year of consecutive increases,
with each of the last 2 years adding about one-fourth of a million
students. This increase was the result of larger high school gradu-
ating classes and a larger percentage of students going on to college.
TEACHER SHORTAGE
The teacher shortage continued. When schools opened in the fall
of 1955, they faced a shortage of 141,300 qualified elementary and sec-
ondary teachers. (See table 2.) The shortage had to be met by
additional emergency teachers, by the reentrance of former teachers
into the profession, and by further overcrowding of the classrooms.
In the computation of the total shortage the additional teachers needed
to reduce the present overcrowding or to enrich the curriculum were
not taken into account.
CLASSROOMS
A record 62,600 classrooms and related facilities for elementary
and secondary schools were constructed during the 1955-56 school year
at an estimated cost of $2.4 billion. Even with this large construction
total, the gap between the number needed and the number of class-
rooms available remains wide.
MIGRANT CHILDREN
The Office continued its efforts to improve the educational oppor-
tunities of children of agricultural migrant laborers, estimated at
600,000 children in the United States in 1956. During the year Office
staff members worked with two interagency groups devoted to the
problem: The subcommittee of the President’s Interdepartmental
Committee on Children and Youth (now the Subcommittee on Chil-
dren of Agricultural Migrants) and the Committee on Migratory
Labor. The Office also periodically distributes packets of materials
Office of Education 171
on the education of migrants, inventories of State and Federal re-
sources, and analyses of problems.
SCHOOL DROPOUT PROBLEM
The dropout problem continued to be serious. Of the 414 million
16-to-17-year-olds in this country, over a million were not in school,
and of these only a few more than half were employed. Some progress
has been made, however, according to Office studies. A larger per-
centage of high school youth (age 14 to 17 years) in public and private
schools is enrolling in high school—85 percent enrolled in grades 9 to
12 in the fall of 1955, as compared with 62 percent 10 years ago, and a
larger percentage of those who enter is staying to graduate, 63 percent
in 1954 as compared with 47 percent 10 years ago. The Office, in coop-
eration with the Department of Labor, conducted a Back-to-School
Campaign during the summer of 1956.
MANPOWER SHORTAGE
Few developments in recent years have had such vast implications
for American education as the growing public concern over existing
shortages of technically trained manpower. Public concern, inten-
sified by reports that the U.S. S. R. was producing increasing numbers
of scientists and engineers, stimulated interest in scientific and tech-
nical training programs in U. S. colleges and universities.
Central to any consideration of this manpower problem is education,
and the chief factor in the expansion of trained manpower is the
capacity for training—the facilities for education, the need to improve
teacher qualifications, curriculums, methods of instruction, facilities,
and equipment, all are part of the problem. For this reason the
responsibility falls on education to consider the needs created by
technical and scientific advances. The Office of Education worked
closely with the National Science Foundation, scientific organizations,
Federal defense agencies, professional education and teacher-pre-
paring organizations to coordinate efforts to increase the supply and
improve the quality of trained scientists, engineers, and teachers in
these fields.
SIGNS OF PROGRESS
There were other signs of progress in education, among them the
following: More than 9 million pupils, or 81 percent of the total,
were transported to and from school daily. Expenditure per pupil in
average daily attendance increased from $351 in 1953-54 to $380 in
1955-56. The movement toward teaching foreign language in elemen-
tary schools gained momentum; 15 years ago fewer than 15,000 pupils
were getting foreign language instruction in elementary schools, but
in the school year 1955-56, nearly 300,000 were. ‘There was increasing
172 Department of Health, Education, and Welfare, 1956
cooperation between local schools and State departments of education
and between State departments and the Office of Education.
At every level plans were being made. In the Office of Education
plans provided for a broader program of research and for expanded
service to education.
The Office of Education has made an effort to improve these phases
of education all along the line. Specialists in science and mathematics
have made a number of research studies, written reports of their find-
ings, and served in consultive and representative capacities with
professional associations and groups to improve the status of education
in these fields. During the year the Commissioner organized an
informal Office task force to keep abreast of rapid developments in the
scientific manpower field and to publicize these developments in the
interest of better coordination of all activities related to the field.
Office specialists organized and disseminated data on educational de-
velopments pertaining to the shortage and with possible solutions.
Continuing studies were made of earned degrees and offerings and
enrollments in science and engineering.
Three Office specialists worked with the National Committee on
the Development of Scientists and Engineers on methods and pro-
cedures of improving mathematics and science education in elementary
and secondary schools.
Through its periodicals, School Life and Higher Education, the
Office made information available on scholarships and grants offered
for science study and digests of studies.
Research
Authoritative information is being sought about education at every
level. Federal agencies, national associations in commerce, industry,
and the professions, State departments of education, and local groups—
all are demanding more facts. Probably at no time in history has
there been greater need for factual information on education nor a
greater audience for it than in the last few years.
In his special education message to the Congress the President
said: “Basic to all endeavors in improving education is a vigorous
and farsighted program of educational research.”
In 1956 the Office of Education took major forward steps to provide
an expanded and strengthened research program. Under the ex-
panded program Office research is conducted under cooperative agree-
ments with agencies outside the Federal Government, by the Office
Research and Statistical Services, and by Office specialists. Although
the cooperative phase of the program was emphasized in 1956, each
phase of the program is important, each phase supplements the other,
Office of Education 173
and each contributes to the strength of the overall program. The
intent and scope of the program were indicated by Secretary Folsom
in October 1955. He said:
In the educational field, as we have already seen in health, one of the
most basic needs is more research. We are working now on plans for an
expanded program of educational research, which we hope to submit to the
next Congress. The purpose is to help our Office of Education render a
still more significant and effective service in leading the way for better
education of all our children. We plan to study such specific problems as
educating the retarded child, so he can lead a normal productive life. We
also plan more research into the problems of educating the child with
special abilities, so the Nation may utilize these abilities more fully. We
plan research into the chronic problems of school housing, teacher staffing,
and school financing. We hope to bring some light to unanswered ques-
tions that have handicapped our educational program for many years. In
a related field, we hope to make vast improvements in our educational
Statistics, so we may specify more definitely just what and where our
problems are and what needs to be done about them.
Some of the plans described by Secretary Folsom were put into op-
eration in 1956. Details on the recently developed and the continuing
programs are reported in the following sections of this chapter.
COOPERATIVE RESEARCH PROGRAM
The Office of Education operates three types of research programs:
(1) Research studies conducted by Office of Education specialists,
(2) statistical studies conducted by the Research and Statistical Serv-
ices Branch, and (3) cooperative research with colleges, universities,
and State educational agencies. All three programs are important,
but cooperative research is the newest and is therefore given the most
attention in this report.
Under Public Law 531, 88d Congress, the Commissioner of Educa-
tion is authorized to “enter into contracts or jointly financed coopera-
tive arrangements with universities and colleges and State educational
agencies for the conduct of research, surveys, and demonstrations in
the field of education.” As a first step in initiating a research program
under this law, the Commissioner asked specialists on the Office staff
to identify a number of the most pressing problems in education.
Then, with the advice of several leaders in education and research who
served the Office as consultants, these problems were reviewed and
ten of them were selected as particularly appropriate for concentration
of efforts in the beginning phases of this program.
In developing the program the Office had the advice of an ad hoc
committee of five outstanding research specialists in the field of edu-
cation. Later the Commissioner appointed a permanent, nine-member
committee which included the five members of the ad hoc committee
and research specialists representing the social sciences, medicine, and
the physical sciences.
174 Department of Health, Education, and Welfare, 1956
ae Eras TE SN Oa I NS PRO DO ch DORNER GIONS NOSSO
The program emphasizes three broad areas of interest—the con-
servation and development of human resources, the staffing and housing
of our Nation’s schools, and the educational implications of our
expanding technology and economy. In the human resources area
there are included such problems as the education of the mentally
retarded, the development of special abilities of students, the educa-
tional aspects of juvenile delinquency, and the retention and continu-
ation of students. In the second area attention is focused on the
problems of staffing the Nation’s schools and colleges and the planning
and costs of school construction, with special emphasis on institutions
of higher education. In the third area there are such problems as the
implications of expanding technology for vocational education, the
educational problems resulting from population mobility, the educa-
tional needs of low-income, rural families, and the educational uses of
television.
A general proposal for an attack through research was prepared
on each of these ten problems. The proposals were reviewed by the
ad hoc research advisory committee and by outstanding specialists
in certain areas who served the Office as consultants.
Because of current public concern with the education of mentally
retarded children, a special staff was set up to plan for research in
this area and an ad hoc advisory committee on the education of the
mentally retarded was appointed. With the advice and guidance of
the committee, the Office prepared an extensive statement on the major
research needs in this area and the facilities in institutions of higher
education and in the State educational agencies which may be suitable
and available for research.
The research advisory committee established the following criteria
to be used in selecting proposals suitable for support by the Office:
A project should (1) promise to have a value within a reasonable
time, (2) attack a problem in which progress has been delayed by
wide gaps in knowledge, (8) have significance for the country as a
whole, and (4) give preference to new projects or to those in which
duplication would be desirable as a scientific check on earlier conclu-
sions. In recommending projects to be carried out in the cooperative
research program, the committee will also consider (1) the competence
of the person who will direct the project, (2) the research resources
of the institution or State department of education under whose aegis
it will be directed, (8) the scientific merit of the project, (4) the extent
to which the project will help to develop research personnel, and
(5) the need for research in the area proposed in terms of the total
educational research picture.
Development of this program was a major activity of the Office
during the year. By the end of June the Office had received 70 pre-
Office of Education 1 ss
liminary proposals for research, and the number seemed likely to in-
crease rapidly after information on the availability of funds became
known.
RESEARCH AND STATISTICAL SERVICES
Reference Service
The work of the research and statistical reference service of the
Office continued to expand throughout the year. New procedures
for making current statistics available were instituted. In response
to demands from governmental agencies, educational associations,
and private industry, annual projections to 1965 were prepared for
public and private elementary and secondary enrollments; projec-
tions to 1970 were prepared for total enrollments, fall enrollments,
and first-time enrollments in institutions of higher education; and
number of degrees to be conferred, by level, and by sex were projected
to1970. In addition, annual projections to 1965 were made for degrees
to be conferred in six major fields of study (biological sciences, engi-
neering, healing arts, physical sciences, social sciences, and “all other’’).
A 31-page set of National and State statistical tables on education
was prepared for the Statistical Abstract of the United States (a
Department of Commerce publication). UNESCO was furnished
a 33-page report on educational statistics for the period 1950-54,
inclusive, and on the attitude of the government toward the stand-
ardization of educational statistics for use at the Geneva UNESCO
Conference.
Prompt publication of summaries of recent statistical studies was
obtained through articles in School Life and Higher Education.
Research Consultation
Consultive services and appropriate statistics were provided to
the President’s Commission on Veterans Pensions, to an ODM sub-
committee on specialized personnel, and to the Subcommittee on Low-
Income Families of the Joint Committee on the Economic Report.
RESEARCH STUDIES BY OFFICE SPECIALISTS
Office specialists in the various subject matter fields and levels of
education made a number of research studies in 1956. Some of the
studies were made at the request of professional agencies and organi-
zations; for instance three projects were carried out at the request
of the Council of Chief State School Officers. Other studies dealt
with problems widely recognized as urgent by educators, Federal offi-
cials, or laymen, such as Supervision in Rural Schools. Studies made
under this phase of the research program are discussed under the
appropriate subject heads in this report. Published reports of the
176 Department of Health, Education, and Welfare, 1956
ee ee
specialists’ findings, interpretations, and suggested applications are
listed under Publications.
Services to Education
One of the ways in which the Office has traditionally promoted
the cause of education is through service to State and local school
systems. In rendering this service the Office provides information,
consultation, and advice on education at the different levels and in
fields.
ADMINISTRATION
One of the most significant educational developments in the 20th
century is the continued rise in leadership of State departments of
education. This movement has been accentuated in the past few years
and is reflected in the growing stature of the professional staffs of these
departments, the higher level of salaries attached to the positions,
and the recognition by local school officials, by college and university
staffs, and by the public in general of the expanding program of
services which the departments are now giving. No small part of
this increase in leadership has been due to the efforts of the departments
themselves. The Office of Education has assisted them by making
nationwide surveys and studies which define the role of State agencies
in the educational scheme and delineate the responsibilities of per-
sonnel in the departments in the various areas of service.
During the 1956 fiscal year the Office of Education engaged in
several nationwide cooperative studies which have bearing on policy
and good practices in State school administration. Studies dealing
with the responsibilities of the State departments of education for
school plant services and for pupil transportation were published
during the year.
During the year the Office, in cooperation with the American As-
sociation of School Administrators, the Association of School Busi-
ness Officials of the United States and Canada, the Council of Chief
State School Officers, the Department of Rural Education, the Na-
tional Education Association, and National School Boards Association,
completed a study entitled, “Financial Accounting for Local and State
School Systems.” Nearly 200 representatives of the cooperating or-
ganizations participated in 2 national and 8 regional conferences
which shaped the financial accounting handbook. The handbook will
be the basic guide in the United States for financial accounting for
local and State school systems. To reflect accurately the condition
and progress of education at local, State, and national levels, educa-
tional data must be a matter of record at its source and must be recorded
in terminology that means the same thing from place to place. This
Office of Education 177
handbook will serve education everywhere as the guide for recording
financial data so that it will have the same meaning to all. It will
greatly improve the basis for educational research, the comparability
of educational information, and the reliability of State and national
summaries.
ORGANIZATION
The establishment of soundly organized local school districts con-
tinued to be a major problem in American education—in 1955 there
were over 59,000 school districts in the Nation; of the total number
nearly two-thirds had fewer than 10 teachers, over half were organized
for elementary school purposes only, and more than 1 of every 7 did
not operate a school of any kind. Practicable approaches to dealing
with this problem effectively were the concern of a special Office project
which was virtually completed during the year, with publication of
the report scheduled in fiscal year 1957. This project is the first major
school district reorganization study undertaken by the Office of Edu-
cation since completion of the Local School Units Project in the late
1930’s.
Coincident with carrying on the project, the Office rendered con-
sultive services to legislative councils, special commissions, State de-
partments of education, and other agencies in a number of States where
efforts were being made to develop more effective reorganization
programs.
The rapid growth of the National School Boards Association and
of State associations and an increasing recognition of the importance
of effective school board stewardship have emphasized the need for
research on statutory provisions governing local school boards and the
procedures employed by them in carrying out their responsibilities.
To meet this need a series of studies was launched; the first in the series
was largely completed in 1956, and a report of the study is scheduled
for publication in fiscal 1957.
SCHOOL FINANCE
Throughout the year the Office provided service and information
on financing the schools. More and more difficulties of financing the
programs of education became evident. To help finance the schools
the State legislatures have been approving larger appropriations and
enacting laws which provide improved methods of allocating State
funds to the schools. Local boards of education have also been ap-
proving larger budgets, securing larger amounts from the general
property tax, and seeking new sources of local revenue for the public
schools. Increases in enrollments, demands for additional school
services, and the need for the new school buildings indicate that the
178 Department of Health, Education, and Welfare, 1956
A TO Tie SO ER SNE sn ain
methods of financing the schools will continue to require more atten-
tion in the months ahead.
SCHOOL HOUSING
The Nation is continuing to spend more than $2 billion a year for
public elementary and secondary school construction. This annual
expenditure, however, is not sufficient to erase the existing deficit of
classrooms, to house the increasing enrollment, and to replace the
schools that become obsolete each year.
Activity within the States indicates a trend toward improving the
pattern of financing school construction, through such measures as
district mergers, increasing legal bonding limits, and State financial
assistance through grants and loans.
The Office of Education promoted and participated in cooperative
planning by educators, architects, and lay groups to improve the edu-
cational adequacy of new facilities.
One of the major school plant problems, which is still only partly
solved, is the acquisition of adequate and properly located sites to ac-
commodate the ever-increasing requirements for new schools to serve
a growing and mobile school population.
A recent Office study of State school plant services revealed a trend
toward the provision of more and better school plant services and in-
creased leadership by State departments of education.
ELEMENTARY EDUCATION
The Office has continued to give leadership to professional and lay
organizations concerned with education at the elementary level, to
elementary staff members in State departments of education, to super-
visors in county schools, and to individuals and groups in local com-
munities through in-service activities in town or city, or sponsored by
colleges and universities. This leadership has been concerned with
rounding up sources of information as well as specific items of informa-
tion on many problems, and interpreting school problems and pro-
grams to parents and to teachers needing such help.
One of the important ways of identifying major problems and of
working on these problems has been the Annual Conference on Ele-
mentary Education held this year with 62 national professional and
lay organizations represented. The theme of the conference was
“Working Together for Children in 1956.”
Research was used in such studies as Status of Physical Education
for Children of Elementary School Age in City School Systems;
and what some States have been doing about the recruitment of
teachers. Reports of these studies are scheduled for publication in
fiscal 1957.
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Food and Drug
Administration
Fifty Years of Progress
THE YEAR 1956 is the Golden Jubilee of Federal food and drug con-
trol. Nationwide commemorations by consumer, industry, and scien-
tific organizations; and local, State, and Federal control groups have
focused attention on progress since President Theodore Roosevelt
signed the Food and Drugs Act on June 30, 1906. They have also
brought consideration of problems the future may bring, and resolu-
tion to solve them to best protect public welfare.
The transition from the corner grocery, with a few hundred bulk
items to be scooped or ladled from unprotected bins and barrels, to the
supermarket of today, with about 5,000 largely prepackaged food
items, has been surpassed in public benefit only by medical progress.
The average life expectancy has increased more in this 50-year period
than in the previous 24 centuries. Not only new disease treatments,
but also food sanitation and nutritional improvements have
contributed.
Dr. Harvey W. Wiley, who, more than any other, was responsible
for the enactment of the 1906 law, came to the Department of Agri-
culture as Chief Chemist in 1883. It was only after 23 years of scien-
tific research under his direction, culminating in a popular crusade,
that the law to protect consumers was passed.
This research included studies into the composition of food in a
period of transition of food processing from the home or local com-
munity to factories often in far-off areas. His investigations
included reports by State officials of the scope of adulterated foods in
their own areas, and the enforcement problems that could not be met
locally. It included studies into the chemical preservatives being
employed to aid mass production, and the effect such chemicals had
197
198 Department of Health, Education, and Welfare, 1956
on the health of human guinea pigs—his “poison squad” of young men
who volunteered to eat only the foods served them, at his “hygienic
table” and to let the scientists test the results.
When the law was finally enacted, new ground had to be broken
to administer it. Federal controls over industrial practices were
new to all concerned. ‘The industries needed education; the Gov-
ernment needed better scientific data for wise enforcement. Inspectors
had to be recruited and trained by persons inexperienced in making
inspections. Court actions were specified in the law, but there were
no judicial decisions to serve as guide lines.
Industry had many readjustments to make. Most constructive for
the years to come was the formation of associations to learn to live
with the law and to pool resources to employ technicians who could
guide them in improving their products. As the Chief Chemist stated
in the 1917 report:
The act has been one of the influences which has helped to draw competitors
together into associations like the guilds of Middle Ages, associations shorn
of the special privileges which the ancient guilds often enjoyed. These associa-
tions have come to understand the value of constructive work and some of them
devote considerable sums annually to experimental research designed to solve
the technical problems with which the industry is confronted. ‘Thus, there is
made available to the small manufacturer scientific assistance which would
ordinarily be obtainable only by large corporations maintaining their own staff
of investigators. Since the Bureau of Chemistry has always regarded it as its
duty not merely to report violations of the law but also to prevent violations by
constructive work intended to improve methods of manufacture, it cooperates
actively with such associations of manufacturers. Such cooperation by the
various Government agencies is bound to exert the profoundest influence on the
country’s industrial and social development.
Despite controversies within the Department of Agriculture as to
how the new legislation was to be enforced, and pressures from some
commercial interests to nullify the provisions they had opposed, a
critical observer of more than 50 years has commented that more
was done in the first 5 years to correct the abuses the law was designed
to control than in any subsequent period in its history. The gross
adulterations and misbrandings were largely stopped; it was for the
future to cope with the more refined cheats, and with new processes
and new, often untested, ingredients developed to meet the growing
demand for factory-processed commodities.
The population has not quite doubled in the past 50 years, but
traffic in canned foods has shown an 1,100-percent increase. Bulk
staples changed to package staples, which in turn are rapidly being
replaced by premixed, precooked, and frozen items. More and more
fresh vegetables, meats, and other uncooked foods are found in the
retail markets—cleaned, weighed out, and packed as convenience foods.
These have reduced the housewife’s time in the kitchen to about 25
percent of that of her grandmother.
Food and Drug Administration 199
At the same time she has, in effect, largely delegated control over
sanitation and ingredients used in foods to the food manufacturer
and the food control official. The present law, however, provides the
sanitary controls that will protect her, if the added manpower these
new conditions superimpose on the FDA staff is provided. Control
of new ingredients clearly needs improvement, as discussed later.
In drugs, the transition was slower, but it was on the horizon when
the 1938 law was enacted to bring controls up to commercial progress
and to remedy defects revealed by judicial decisions. Some advances
had been made in the first decade, particularly in the encouragement
of basic research to improve manufacturing controls, and in an amend-
ment designed to curb fraudulent claims. Material strides in con-
sumer drug protection came under the 1938 act, which provided for
the establishment of the safety of new drugs before marketing, and
for better control over the labeling of medicines for safe and effective
use.
Expanded medical and pharmaceutical research resulted in the de-
velopment of the many drugs that have been introduced in the last
18 years, which are incorporated in 90 percent of physicians’ prescrip-
tions today. The safety requirements imposed under the 1938 act
and its certification amendments have contributed materially to this
startling advancement in medicine during that period.
Pharmacology, in 1938 a relatively minor science in terms of gradu-
ates and their employment, mushroomed as both manufacturers and
control officials needed more and more evidence of safety, through
studies on animals instead of primary testing on man.
The labeling provisions of the 19388 act, strengthened by judicial
decisions tending to thwart subterfuge in accompanying labeling, have
given the public more protection than ever before against being victim-
ized by directly false claims. However, there remains the serious
problem of cleverly worded promotional material which, by indi-
rection and innuendo, creates a misleading impression as to the thera-
peutic usefulness of the article.
This summary does not permit detailed review of the many other
developments during the past 50 years. A few cannot be ignored,
even if listed only by title:
The evolution of the science of nutrition, with the word “vita-
min” coined only in 1911, and recognition of foods for special
dietary purposes first given in the 1988 act.
The change from arsenic and lead for agricultural crop control
to new pesticides developed during and after World War IT, with
full legal control over “poisonous residues” effective only after the
end of the 1956 fiscal year.
Cosmetics which were not even mentioned in the 1906 law and
fell into some disrepute through injuries from a few types of
200 Department of Health, Education, and Welfare, 1956
thi AR a SA IN A A Ss RR Aaa a a
products. The 1938 law brought them under control, and cos-
metics now enjoy full public confidence.
Therapeutic devices, which also were not controlled by the 1906
act and presented many problems. Under the 19388 act, they have
been brought under regulatory control in much the same manner
as drugs.
The change from the old-type drugs, usually administered
orally or topically, to new, potent preparations, often injections
requiring sterility and absence of irritating impurities.
Control over illegal sales of prescription drugs, which has be-
come an increasing problem since 1938.
Certification of insulin in 1941, and a number of antibiotic
drugs developed during and after World War II.
Use only of certified coal-tar colors, provided by the 1988 act.
Newly developed methods are being employed to reevaluate the
safety of some colors long accepted as eligible to the certification
list.
Official food standards, the country’s most important cookbook,
which specify the ingredients of a fair share of staple foods, and
provide uniform factors for their enrichment when it is found
in the consumer’s interest.
These all still present problems requiring the most constructive
work of government and industry alike to advance consumer welfare.
The 50th Anniversary commemoration ended with a high resolve to
continue the “50 years of progress” through future protection of the
public’s food, drug, and cosmetic supplies.
Industry and consumer groups have both hailed the Citizens Ad-
visory Committee recommendations to provide for FDA’s future
ability to fulfill such obligations. The 1955 report outlined the
recommendations of this Committee, appointed by the Secretary of
Health, Education, and Welfare, to study the Food and Drug Ad-
ministration’s obligations and responsibilities and its facilities to
fulfill them.
~ The Committee’s recommendation for a 8- to 4-fold expansion in
ithe next 5 to 10 years, the first year to be from 10 to 20 percent, was
met by Congress in appropriating about a million dollar increase for
fiscal year 1957 over that of 1956, which will provide a staff increase
from 872 to 1,017.
Its recommendation for a new headquarters building in Washing-
ton to consolidate administrative and scientific personnel has pro-
gressed to the stage of approval by the House and Senate Public
Works Committees under the Lease-Purchase Act.
An internal reorganization calculated to provide for more efficient
operations and to set up an expansible framework to absorb a bigger,
more complex organization has been put into effect.
Food and Drug Administration 201
Many of the other recommendations of the Committee must await
increased funds in the future.
Educational efforts for better compliance and benefit through more
understanding of the law have been paramount to its administration
from the inception of Federal food and drug control. Soon after
the original act was passed, experts in sanitary controls went into the
factories to teach processors how to prepare foods without preserva-
tives to prevent spoilage. FDA inspections and improvement rec-
ommendations, as well as administrative conferences, have also been
constructive factors in education of industry toward more and more
effective compliance.
Consumers have had many exhibits, programs, and other 50th anni-
versary observances to remind them of their benefits under the food
and drug laws and their part in full participation. If they are to
continue an interest in this essential provision for their welfare, how-
ever, the recommendations of the Citizens Advisory Committee will
require more educational efforts directly sponsored by the Food and
Drug Administration.
“Each generation needs to learn anew the why and wherefore of
its institutions and blessings; otherwise they are taken for granted.
Today, the right of the public to pure foods, effective drugs, safe
cosmetics, and truthful labels has become generally accepted. It was
not always so. We need to be reminded of Dr. Wiley and his 23-year
struggle to obtain our first Federal pure food and drug law. It helps
us understand and appreciate the value of the protective laws we now
have, and the truly wonderful progress made by our food, drug, and
cosmetic industries in this half century. It also helps us understand
our problems of today and our obligation to insure that food and drug
products of today and tomorrow will continue to be the best in the
world.” +
Food, Drug, and Cosmetic Act
DISASTER AND DEFENSE ACTIVITIES
Two major natural disasters required supervision of damaged foods
and drugs to prevent use of polluted goods in the stricken areas or
shipments to other places.
Hurricane Diane in August 1955 affected 22 primary areas in New
England, Northeastern Pennsylvania, and New Jersey. Prompt proc-
lamations by the Governors of the regions inundated by contami-
nated waters closed flooded food and drug establishments until
sanitation could be restored and flooded stocks removed for destruc-
1 Larrick, George P.: Public Health Reports 71: 557 (1956).
508691—57 14
202 Department of Health, Education, and Welfare, 1956
tion or salvage under official supervision. Thirty-nine FDA men
drove 18,673 miles to assist State and local officials control the dam-
aged merchandise and establishments. No poisoning attributed to
flood-contaminated products was reported. Loss of foods and drugs
in New England alone approached $18 million and $2 million more
from October floods.
In California, the Governor proclaimed a state of emergency on
December 22, because of serious floods in the northern and central
areas. FDA inspectors were alerted and a number spent Christmas
week assisting State and local control officials. A harbor flood in
Los Angeles also required surveillance.
While embargoed goods offer many segregation and disposal prob-
lems, the situation becomes even more serious when merchandise is
swept downstream. In New England, drums of toxic chemicals were
lost from a manufacturing plant and a public alert was sounded to
prevent injury to salvagers. In California, 2,000 barrels of olives
with loose bungs and substantial quantities of beer and wine, flooded
out of storage areas, were retrieved by the owners who planned to
handle them as usual until State quarantines were imposed.
The FDA civil defense training program for State and local food
and drug officials, designed to help equip them to safeguard the food
and drug supplies of the Nation in case of enemy attack, was con-
ducted in 58 courses in 45 States. Nearly 2,000 people, including some
representatives of other Departments and industry, attended 5-day
courses on problems that might be engendered by attacks employing
chemical, biological, or nuclear weapons, and procedures necessary to
test exposed products and to restore production facilities for a safe
food and drug supply.
Investigations were continued into the safety and nutritive value
of foods exposed to atomic explosion in 1955, and an interim report
has been released. The vulnerability of packaged foods to bac-
teriological attack and satisfactory decontamination procedures were
also under active investigation during the year and plans were pre-
pared for extending the scope of the program. Again in 1956, Pa-
cific tuna monitoring was conducted to check on radiological contami-
nation from weapons tests. Examination of tuna from 17 vessels
on a cross-section sampling basis gave negative findings.
ON THE FOOD FRONT
Potential Health Hazards
Agricultural poisons —The establishment of pesticidal residue tol-
erances for agricultural crops is discussed under “Regulations.”
With publication of established tolerances, there has been increased
interest by growers, commercial dusters and sprayers, and the chem-
Food and Drug Administration 203
ical industry in the proper and timely application of insecticides, and
better appreciation of the significance of toxicity determinations.
FDA Washington and field staff members responded to many in-
vitations from such groups to address meetings and discuss the new
regulations and how to comply with them. Inspectors surveyed
growers’ practices, often in cooperation with State and county offi-
cials, and warned against potential misuse.
In one area, reports were received that growers intended to apply
Endrin to a cabbage crop just before harvest, contrary to recom-
mended use, which would have resulted in dangerous and illegal
residues. An experienced inspector went into the area and prevented
the applications, by use of press, radio, and television warnings, plus
personal interviews with individual growers, shippers, pesticide deal-
ers, aerial applicators, packing plants, county agents, and others.
Inspectors making later visits found that his warnings had been
continued locally and that the whole area was well informed about
hazardous use of pesticides. No violative residues were encountered
there.
The first enforcement actions under the new regulations were re-
quired when growers employed Endrin for lettuce, for which no
tolerance had been proposed or set. Two carloads from a field
sprayed 2 weeks before harvest were shipped across the continent
and seized on arrival in the East. Other seizures removed from
consumer use 4,500 cases of frozen spinach prepared from spinach
that had been sprayed with DDT only 7 days from harvest. Custom-
ary washing and blanching at the freezing plant removed about three-
fourths of the spray remaining on the harvested crop, but the frozen
product still contained more DDT than is permitted on the fresh
vegetable. The first import detentions under this amendment in-
volved 75 lots of pears and 8 of apples which bore lead residues in
excess of the tolerance. Other actions against nonpermitted uses of
pesticides on raw agricultural crops included seizures involving more
than 550 tons of grains treated for seed use with mercurial compounds
and later diverted to food use.
Imports of one variety of Canadian wheat in demand for seed
because of its resistance to rust, increased the treated seed problem.
Unless certified, such wheat had to be treated with a fungicide before
admission. Since some of these fungicides are colorless, sampling
and analysis of the colorless seed wheat was undertaken and 75 lots
were detained. One was reexported and the others distinctively
colored to prevent diversion into food grains.
Complete disregard for label warnings on a poisonous rodenticide
against use directly on food by three California bean warehouses
was observed during FDA inspections. Thousands of bags of beans
204 Department of Health, Education, and Welfare, [956
had been dusted heavily with the poison and the contents were danger-
ously contaminated. The State placed blanket embargoes on remain-
ing lots and a countrywide followup led to Federal seizure of 150
tons and various State seizures of 500 tons. An estimated 5,000 tons
are being treated to remove the pesticide.
Other careless pesticide use in the New Orleans area brought
Federal seizure of 52 tons of flour and 31% tons of green coffee beans,
and city seizure, pending removal of a poisonous insecticide, of 2,330
tons of rice.
Food poisoning.—Two outbreaks of illness resulted from popcorn
intensely colored with coal-tar dyes which were subsequently with-
drawn from the list of certifiable food colors. The first involved
Hallowe’en “cats” so heavily colored with FD&C Orange No. 1 that
some contained eight or more times the cathartic dose for an adult.
Outstanding lots were recalled. In the second case, plastic Christmas
stockings filled with popcorn colored with FD&C Red No. 32 caused
178 illnesses following an industrial firm’s Christmas party for its
employees and their families. The firm recalled other lots, which
had been distributed only locally.
FDA investigators traced 44 other outbreaks of food poisoning
reported during the year. In 18, staphylococcus was the causative
agent, with inadequate or complete lack of refrigeration contributing
to the growth of toxic organisms. Others were caused by locally
prepared wieners containing excessive nitrates, wild mushrooms, and
salmonella contamination of chicken. Five outbreaks of botulism,
involving 15 individuals of whom 4 died, were traced to home-canned
foods. ‘Twelve became ill after eating an imported fishery product;
remaining stocks contained many defective cans which were removed
from the market.
Inadequately processed canned mushrooms and canned goats’ milk
and a canned baby food in defective containers were recalled from
the market because of active spoilage. No illnesses were reported.
Other recalls that may have prevented illnesses involved crabmeat
contaminated with LZ’. cola.
To Keep Food Clean
Food seized because it was filthy or decomposed totaled nearly 2,600
tons and accounted for 86 percent of the food seizures. Of the 79
criminal cases filed in the food field, 71 were based on filth charges.
Educational programs were pursued as far as FDA facilities would
permit, and with the active assistance of industry and agricultural
oroups.
The improvement of the sanitary storage of grain—the key to the
success of the entire clean grain program—was brought to the at-
tention of farmers and elevator operators by intensive educational
Food and Drug Administration 205
work, with the active participation of the U. S. Department of Agri-
culture, county agents, State agricultural colleges, farm youth or-
ganizations, farm publications, and the grain trade. This better
knowledge of how to keep grain clean was reflected in the fact that
fewer carload lots of contaminated grain were seized in the entire
fiscal year 1956, than in the 6 months of the previous fiscal year when
the reactivated program was in effect. Actionable levels of con-
tamination were reduced, effective July 1, 1956.
Every hatchery received, through industry association letters,
FDA’s warning against diversion of decomposed incubator rejects
into edible egg channels. Hatcherymen, visited by inspectors in the
spring of 1956, all remembered the warning and some told of pre-
cautions they had taken to avoid unsuitable disposition of their re-
jects. A major outlet for incubator and candling room rejects went
out of business, following a second prosecution within a year.
Table 1.—Actions on foods during the fiscal year 1956
Criminal
Projects Seizures prosecu- | Injunction
tions in- petitions
stituted
ANU 5 oe 2 I Safe a Sr Pa, er Se AT 689 79 6
Beverages and beverage materials__._____ Ree eiek e(aenea ears ae) eee 8 0 0
Bakery, ready to eat cereal, and macaroni products________________- 36 14 0
Cereals and grain products:
UNE MEIC PERE Oe Serna roe ce ha oe ee a 131 8 0
JQCTSIETEY TESS eles See ee ae eg a Se See eee 1 1 0
Chocolates, sugars, and related products______________________-____- 15 8 0
Dairy products:
inter amarcnurning Creams. 24 224 yee re eh sete bees 15 3 0
neecomnato nerd alry Products... 845. 22. soos ee ee 5 4 0
ee ee Gucig 2 2822 coe dost este s-- ee eee 15 3 0
Tiere coed, 200 COUCIMeN(S se ewe eben 36 4 1
iol atiGh shel by DTOGUCLS jo 22 te ey bse 5s ool ee eee eee iss de 66 2 0
eee le DOULITY. oo na oe een tee eee ee ete 39 8 3
Oe te ee ae a see 49 2 0
Ota er, OleGIMarearine. 8c nee 2 0 0
Seni0 OCegeeEe eerawety eee et YS aes eee Teer Gosek EL 71 5 1
Vegetables and vegetable products.__._____._..-_._-----.----------- 134 6 1
Mascellamecousioods (mixed lots) *ssc2e.- es 8 ose see ee ee 25 8 0
Mondmarspeciawalietary USeSs.-- 2 ee ee 41 3 0
Widlative serving of oleomargarine_-.. 2-2 2.22--0-22. 1 2 ets 0 0 0
Eight thousand raisin growers and farm driers were presented
individually with educational materials outlining their responsibil-
ities under Federal and State laws to employ sanitary handling and
drying procedures. For over a full season processors have inspected
incoming stocks, with only a few failing to join the general movement
toward industry-wide compliance. One firm was enjoined from in-
troducing into interstate commerce raisins produced under insanitary
conditions and another was prosecuted.
Public interest in the wholesomeness of dressed poultry increased
during the year, after numerous press items pointed to lack of Federal
controls similar to those provided for meat. Since Federal poultry
206 Department of Health, Education, and Welfare, 1956
an TE ea DRI SNE ER STRTE A SEMIS NUTS VEO
inspection is a voluntary U.S. Department of Agriculture service, the
only legal controls now rest. with the Food and Drug Administration
which must divide its limited inspection staff among all food, drug,
and cosmetic industries.
Educational efforts are progressing through joint efforts of the
Food and Drug Administration and the Public Health Service to
further improve the wholesomeness of poultry and poultry products.
Mass production has brought new problems, including a high dis-
ease rate in concentrated broods, desire for rapid handling in process-
ing lines, increased marketing of cut-up birds, freezing, pre-cooked
items, and long-distance hauls. Seizures of unfit poultry in 1956
were directed against diseased, fecally contaminated, and decomposed
birds. Spoilage resulted largely because of de-icing during trucking
from South Central States to the West coast. Of the 38 shipments
of unfit poultry seized, 13 contained diseased birds, in comparison
with 32 seizures, 21 because of disease, in the previous year. ‘Three
packers were enjoined from shipping filthy poultry packed under
insanitary conditions.
Growing demand for ready-to-eat foods presented problems in
storage of raw foodstuffs by bakers and other manufacturers. Some
have attempted to increase production without facilities to protect
ingredients from infestation and spoilage. Other storage problems
arose in warehouses which reduced clean-up operations because of
increased labor cost.
Increased labor cost, in comparison with raw material prices, was
reflected also in a quality decline in some parts of the New England
fish industry. Many educational meetings of industry and enforce-
ment officials were held and more are scheduled. One constructive
result was the formation of a cooperative of firms controlling more
than 40 percent of the fish landed in Boston. This group has set
up a compulsory, industry-run inspection service for its members.
The trend toward use of floating canneries and freezing ships in
remote areas of Alaskan waters is presenting an inspection problem.
While the pack is examined, insofar as possible, when it is brought
into ports in the States, detection of contamination of crabmeat and
other seafoods particularly subject to pollution is more efficient
through factory inspections.
The percentage of time devoted to tomato products each year is
governed by crop conditions. After a good early crop in the East,
hurricanes and other adverse weather caused rot and insect infesta-
tion which required unusual precautions on the part of packers and
inspectors to prevent the processing of unfit material. Heaviest
seizures were of pizza sauce and puree packed by one firm, and sur-
veillance over future shipments must be maintained.
Food and Drug Administration 207
Thirty-four carloads of Mexican tomato catsup, of 37 offered for
entry on a large contract, were detained because of pinworm infesta-
tion. Thirty-four additional carloads prepared to fill the same con-
tract may not be offered for entry as a result.
Occasionally abnormalities in canned goods develop during storage
and the affected goods are usually destroyed. However, one packer
sorted out as “normal” two carloads of canned tomatoes from a large
stock in which decomposition had developed. An inspector discovered
them on the dock awaiting shipment and collected samples which con-
firmed decomposition. Both carloads were seized before they could
reach consumers and the corporation was prosecuted and fined.
Pocketbook Protection
Although regulatory work was predominantly in the field of health,
filth, and decomposition, flagrant cheats received regulatory attention.
A Maryland oyster packer who persisted in “watering” his pack, con-
trary to the accepted practices of the industry as a whole, was enjoined
from interstate shipments after heavy seizures. A Rhode Island
retail butcher who sold, as beef, horsemeat steaks and hamburger, was
jailed.
Among seizures were cocoa powder adulterated with ground cocoa
shells and with cottonseed flour, olive oil labeled as pure but containing
a substantial portion of cottonseed 011, and a butter and cheese additive
not permitted by standards.
Continued violations of food standards were noted during the year,
such as green beans containing tips and cuts without label declara-
tion, “pitted” cherries containing pits, improperly labeled sirup con-
centrations in canned fruits, low-fat butter and cheese, and deviations
from standards by new names, such as “‘oyster stew base” with more
water than permitted for canned oysters. Increased appropriations
for the next fiscal year are intended, in part, to supply inspectional
time to curtail such violative practices.
Seafood Inspection Service
Shrimp processors and oyster canners who meet Government re-
quirements for sanitation and controls, may apply voluntarily for
FDA seafood inspection which is financed by inspected packers’ fees.
Seven firms took the service, but inspection was withdrawn from two
because of violation of the regulations. Under the inspection service,
6,978,848 pounds of whole shrimp and 29,753 pounds of headless
shrimp were processed, and 32,088 cases of oysters were canned.
PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE
Recent court cases involving misleading claims of benefit for the
use of vitamin and mineral preparations have served to call attention
208 Department of Health, Education, and Welfare, 1956
to the many media by which the consumer is misinformed about nutri-
tion. He is continually bombarded by a repetition of exaggerated
claims based on half-truths and scare techniques.
Education of the consumer in the facts of nutrition has not kept
pace with scientific developments in this field. Since World War LI,
medical discoveries have been so spectacular that the layman now
finds it difficult to differentiate between fact and fiction. He is vul-
nerable to misrepresentations not only about “wonder drugs” but also
about the value of the foods he eats each day. For example, he is
told that soils have been so depleted by cropping and erosion that ordi-
nary foods cannot be relied upon to supply even the bare necessities of
essential nutrients; that food processing destroys vitamins and min-
erals; and that his diet is so inadequate as to lead to malnutrition.
The simple remedy, he is told, is to take a tablet or capsule that con-
tains vitamins and minerals that will reinforce his faulty diet. Such
misinformation should be combatted with a program of sound nutri-
tion education.
A sizeable number of vitamin-mineral preparations are now mar-
keted by organized house-to-house sales persons who in the privacy
of homes talk not only about soil depletion and inadequate nutritional
qualities of ordinary foods, but also make outright claims for the treat-
ment of serious diseases.
The development of actions against individual salesmen is time-
consuming, but a number of prosecution cases have been successfully
terminated. ‘To date the firms distributing the products sold by such
house-to-house canvassers have, in each instance, repudiated the sales-
men’s claims as being unauthorized, and evidence to show the firms’
responsibility for the individuals’ actions was not available. There-
fore, the criminal actions were brought only against the individuals,
who were fined and placed on probation.
Late in May, a “health food” lecturer who had been found guilty
by a jury in 1955 of misbranding his wares, received a sentence of a
year and a day in jail, which he is appealing. One of the pioneers in
the field of selling herbs and natural foods to heal diabetes, tubercu-
losis, epilepsy, and other serious diseases, his broadest claim was that
his products would “put off death to the very last minute.”
During the year, the vitamin content of 890 samples was tested by
2,721 assays in which chemical, biological, microbiological, fluoro-
metric, spectrophotometric, radioactive tracers, thiochrome, and other
methods were employed. Forty-four shipments were seized because
they contained less vitamins than declared on their labels.
With the emphasis on education of packers of products purporting
to be of low-sodium content, compliance with the low-sodium regu-
lations in the 21 months since their effective date has been pro-
Food and Drug Administration 209
gressing satisfactorily. Only three seizures were made in 1956 of
so-called low-sodium foods failing to bear the mandatory labeling in
respect to their sodium content. —
DRUGS AND DEVICES
For some time, FDA has been concerned with the problem of acci-
dental poisoning among young children who eat aspirin tablets ob-
tained from packages left carelessly within their reach. An advisory
ruling, designed to help protect children against such accidental
poisoning resulting from swallowing large amounts of aspirin and
other salicylate drugs, was issued in October. Drug manufacturers
were asked to use conspicuous package warnings that such drugs
should be kept out of the reach of children. This followed a medical
advisory panel recommendation and was a part of a joint educational
program to promote the safe use of drugs.
The industry has taken commendable steps by adoption of such
warnings and other means to warn the public that all drugs should be
kept in a safe place and out of the reach of children. It has given
widespread distribution to reprints of an FDA leaflet entitled “Pro-
tect Your Family Against Poisoning,” which covers drugs and house-
hold poisons that may cause accidental poisoning.
Salk polio vaccine.—Since the great demand for Salk vaccine for
poliomyelitis might precipitate a black market, the Department re-
quested Congress to make a special appropriation to the Food and
Drug Administration to maintain surveillance over national distri-
bution and to initiate regulatory action should abuses develop.
During the period from August 1955 to June 1956, inspections were
made of manufacturers, wholesalers, and retailers to audit and verify
distribution records. These inspections were further augmented by
visits to physicians, hospitals, health agencies, and individuals. In
all, a total of 33,000 such inspections and visits were made. No major
abnormalities in the distribution of the vaccine developed. As supply
and demand came into better balance, it became evident that further
funds for a special program would not be required for the 1957 fiscal
year. Surveillance during the coming year will be maintained by all
districts as part of normal drug operations.
Recalls —Twenty drug recalls were supervised by FDA during the
year. Ten of the products involved were below the labeled potency
or strength, and one, a digitalis preparation, was excessive in potency.
Two injectables and an eye medicine were not sterile. T'wo other
injectables were pyrogenic, which would have caused a temperature
rise in patients. Two products were recalled for corrections in dosage
directions and the expiration date. Another had developed a danger-
ous pressure in the bottles after shipment. In volume, the largest
recall involved:an anti-convulsant the manufacturer voluntarily with-
210 Department of Health, Education, and Welfare, 1956
A ae NR ee scr NON ae ta insane
drew from the market because its recent toxicity study showed damage
to small laboratory animals not revealed in earlier studies.
Illegal Sales
Problems of illegal sales of dangerous drugs remain serious and
require a major segment of the available regulatory time for drugs.
Barbiturates (for sleep) and amphetamines (stimulants) are the
drugs most commonly encountered. Fewer complaints have been re-
ceived of drugstore violations, but channels unauthorized to sell such
drugs are active in bootleg operations.
Criminal prosecutions were filed against 114 drugstores, pharma-
cists, lunch counter and tavern operators and employees, filling sta-
tion men, and peddlers. Twenty-two of the actions, involving 42
defendants, developed out of complaints that truck drivers were ob-
taining “stay awake” pills illegally at roadside stops and their mis-
use was jeopardizing highway safety. FDA inspectors spent many
months in undercover investigations of the sources of their supplies.
Publicity given to these cases by the National Safety Council,
trucking associations, labor unions, and others has made not only
truck drivers but also other drivers conscious of the dangers of using
drugs to stimulate them to continue driving after normal fatigue
has set in. On the whole, conditions in the areas covered have im-
proved materially but the warnings have prompted additional com-
plaints that will require a heavy drain on inspection time there and
in other sections not yet covered.
Misbranded Drugs and Devices
Each report is another chapter in the continuing war against
worthless medicines, which reappear year after year in new or con-
tinued attempts to victimize the public.
The 1955 report outlined a diabetes remedy case lost in district
court on the ground that a 1923 patent established the validity of
current claims of efficacy for the treatment of diabetes. The Gov-
ernment appealed the case to prevent the public from being exploited
by a worthless remedy when there are effective measures available to
control the disease. The appellate court reversed the district court.
An injunction to restrain misbranded drug shipments from a Texas
cancer clinic has been discussed in a number of previous reports,
and last year seizures from its new Pennsylvania branch were re-
ported. The trial date for court contest of these seizures was post-
poned until the fall of 1956. Since people who have or fear they
have cancer are still being encouraged to go to the two “clinics” for
treatment and to depend upon the worthless medicines, FDA issued
a public warning in March 1956, which has brought heavy corre-
Food and Drug Administration 211
spondence with people who fear that relatives and friends may be
the next victims.
The 1954 and 1955 reports outlined an injunction case to ban ship-
ments of an inert glandular product misbranded with sex rejuvenation
claims. It involved a fraudulent sales promotion scheme, includ-
ing false foreign invention and manufacturing claims. A permanent
injunction was granted in November 1954, less than 2 weeks after
actual distribution began. In September 1955, the two brothers
who operated the mail-order business were fined and given 5-year
probationary terms, and their firms were fined. |
An injunction against shipments of “orgone energy” devices and
misbranding literature was reported in 1954. The manufacturer not
only did not destroy the literature and recall the products then on
lease in other States, as ordered by the court, but he continued inter-
state distribution of both the devices and literature with the aid of
armed assistants. Criminal contempt proceedings against the manu-
facturer, his “Foundation,” and his principal distributor were insti-
tuted after FDA inspectors had collected evidence of violation of
the order over a 2-year period. First declining to appear for trial,
the two individuals finally arrived under Federal arrest, and then
insisted that they had continued the traffic contrary to the injunc-
tion order. A 2-year jail sentence for the manufacturer, a 1-year
jail sentence for the distributor, and a $10,000 fine for the firm are now
under appeal. Meanwhile, they are under bond, belatedly trying
to comply with the order.
The printed material ordered to be recalled and destroyed consti-
tuted accompanying labeling as defined by the law and judicial
interpretations. The fact that some of the false and misleading
representations used in promoting the sale and rental of the devices
were contained in books with hard covers did not change the status
of this literature as “accompanying labeling.”
A long-delayed case against a mineral water, with collateral liter-
ature claims for treatment of kidney disorders and arthritis, was
brought to trial in the spring of 1956. The Government charged
that this drinking water would not be efficacious for these conditions,
but the jury did not confirm the Government’s charges.
In September 19538, the contested seizure of an antacid advertised
as stopping acid pain of diagnosed stomach ulcers was decided in
favor of the Government, and multiple seizures followed when the
advertising was not withdrawn. A criminal action based on ship-
ments made after the seizure contest brought a fine of $5,500 to
the corporation and 8 years’ probation to two of its officers in June
1956. Despite the blatant claims in full-page newspaper ads, the
label of the drug merely stated that the product was “for the tem-
porary relief of excess gastric acidity.”
212 Department of Health, Education, and Welfare, 1956
Fo et at te dh aa se gg
Another ulcer “remedy” that received attention during the year
was an imported product, promoted through popular magazine pub-
licity which created great demands for entries from Denmark and
Canada. Since no new-drug application had become effective, sev-
eral hundred mail-order shipments to individuals were detained at
entry points. At the end of the year, some lots were being released
to doctors for investigational use.
Among the 51 medicines seized for false and misleading claims
were articles composed of dried alfalfa, cereal grass, apple derivatives,
buckwheat flowers, powdered pumice, phosphates, sulfates, papaya,
royal jelly (said to be the special bee food for productive and long-
living queen bees), or a mixture of one or more of these and vitamins
and minerals. They bore claims for the treatment or prevention of
almost every disease.
Seizures of uranium ore pads, blankets, artificial tunnels, and other
containers of slightly radioactive ore and sand, completely worthless
to alleviate arthritis as claimed, were mentioned in the 1955 report.
Additional shipments of such materials were seized in 1956, and a
local warning was given to a southwest dairy farmer who was charg-
ing admission for visitors to cover aching feet with his “Uranium Ease
Foot Powder” farm dirt, and selling them the dirt in 25-pound bags.
One firm was enjoined in March 1956 from further shipments of mis-
branded radioactive pads, monazite sand, and similar items.
Veterinary Drugs
Commercial feeds have long been of major concern to State feed
officials who enforce statutes controlling protein content and label-
ing. When such feeds became a major market for drugs, such as
hormone-like substances and antibiotics, feed manufacturers became
drug manufacturers, confronted with the new responsibility of com-
pliance with both the safety and labeling requirements of the Federal
law. In January, a symposium on problems being encountered was
attended by approximately 400 drug suppliers, feed manufacturers,
livestock and poultry feeders, and control and public health officials
from all parts of the country. This meeting did much to solve many
questions that have arisen in this fast-moving, highly technical field.
Twelve veterinary medicinals were seized for false and misleading
therapeutic claims, failure to meet labeled composition or bear re-
quired labeling, and violation of the new-drug and antibiotic-certi-
fication requirements. One contested seizure was upheld by a district
court which confirmed the Government’s charge that cannibalism in
poultry flocks is a disease, and that no drug product presently known
to medical science is an effective control.
A permanent injunction in June 1956 banned shipments of a min-
eral compound that had been the subject of litigation for the past
Food and Drug Administration 213
decade. It was originally called “Stop-Bloat,” but after the Govern-
ment was upheld in a contested seizure trial, the name of the product
was changed; illustrations and representations in the labeling con-
tinued to represent it for bloat. Additional seizures were made and
the Government was upheld in another contest, but the manufacturer
persisted in misbranding the product.
New Drugs
During the fiscal year, 520 new-drug applications were submitted
to the Food and Drug Administration.. Of these, 407 were allowed
to become effective, 346 for human and 61 for veterinary purposes.
The number of supplemental applications has continued to increase.
Twenty-four hundred and ninety-two went into effect during the
year, half for veterinary preparations. No order was issued refusing
to permit an application to become effective, but the effectiveness of
one application was suspended.
From year to year new trends in therapy are reflected by submission
of applications for drugs usually developed as a result of advances in
basic medical research. Some of the drugs considered during the year
were tranquilizing agents, a central nervous system stimulant for the
restoration of depressed physical and mental activity, an anti-halluci-
natory drug, two general anesthetics administered by intravenous in-
jection, some nonbarbiturate hypnotics and sedatives, an antibiotic
useful in staphylococcic and proteus infections resistant to other
agents, a skeletal muscle relaxant, a new alkaloid from Rauwolfia, a
steroid which promotes protein anabolism, two ganglionic blocking
agents for the treatment of high blood pressure, a radio-isotopic prep-
aration for the determination of red-cell volume and useful in studies
of red-cell survival and loss, and anticoagulant solutions packaged in
plastic containers for the collection of blood.
COSMETICS AND COLORS
There were no seizures or criminal actions in 1956 based on violation
of cosmetic requirements. A coal-tar color originally consigned to
a soft drink manufacturer was seized because it had not been certified.
CHANGES IN THE LAW AND REGULATIONS
While FDA representatives testified at numerous hearings in the
2d session of the 84th Congress, only three bills were enacted in addi-
tion to the appropriation bills. AJ] were essentially noncontroversial.
Congress amended its own statutory name for dried skim milk by
changing it from “nonfat dry milk solids” or “defatted milk solids”
to “nonfat dried milk.”
A law was enacted which permitted the continued use of FD&C
Red No. 32 for coloring the skin of oranges not intended for process-
214 Department of Health, Education, and Welfare, 1956
ing. A 38-year time limit was set, unless a more suitable color is
developed in the meanwhile. This legislation arose over the fact that
the Secretary delisted and discontinued certification for food use of
this and two orange coal-tar dyes because of conclusive evidence that
they are not harmless. This evidence did not include specific findings
of toxic results from use in coloring oranges, but the law does not
give the Secretary authority to specify the foods which may contain
certified colors or limit the amount of color that may be used. He is
directed to certify colors as “harmless and suitable for use” in food
generally. The Secretary’s order delisting these colors was appealed
in three circuit courts. One of the circuit courts upheld the Secre-
tary’s action after the close of the fiscal year.
The third amendment was procedural legislation which extended
the beneficial provisions formerly applicable only to food standards
to other rule making in the absence of controversies. This legislation
was strongly supported by the Food, Drug, and Cosmetic Section of
the New York State Bar Association, which had sponsored the earlier
amendment to simplify the establishment and amendment of food
standards.
Among the numerous hearings at which FDA presented the views
of the Department, but no laws were passed, were those on chemical
additives for food, and compulsory poultry inspection.
Eleven bills were introduced in the 84th Congress to require the
testing of chemical additives for safety before they are put into foods.
There was general agreement by Government and industry that new
legislation is needed in this field. Three principal areas of differing
opinions about the form such legislation should take were:
(1) What should be done about chemicals already being used when
the law is passed ?
(2) Should there be evidence that a chemical is useful before it is
permitted in food ?
(8) How should controversies between industry and Government be
settled ?
None of the bills was enacted, but there is so much interest in this
field that new legislation probably will be proposed in the next ses-
sion of Congress.
At hearings on compulsory poultry inspection bills, FDA testified
as favoring such legislation but believing that it would be a mistake
for this organization to undertake a routine in-plant type of inspec-
tion of such magnitude, at a time when its staff and facilities are so
occupied with the important problems of expansion and development
of an organization adequate to deal with the entire food, drug, and
cosmetic supply. It was urged that efficient operations under the
Meat Inspection Act for the past 50 years have equipped the U. S.
Food and Drug Administration 215
Department of Agriculture with the pattern and principles to operate
an effective poultry inspection service.
Regulations
The removal of three coal-tar colors from the list permitted for food
use is discussed in connection with the legislation enacted concerning
FD&C Red No. 82. This red color and FD&C Orange No. 1 and No. 2
were removed from eligibility for certification as FD&C colors on
November 16, 1955, and added to the list of colors for external drug
and cosmetic use only.
New drugs.—Proposed revisions in the new-drug regulations were
published in the Federal Register on September 8, 1955, and May 80,
1956. Although the Commissioner of Food and Drugs has the
authority to publish such regulations without furnishing interested
persons an opportunity to state their views, drug manufacturers’ rep-
resentatives were given full opportunity to participate in their devel-
opment. The final order was published after the close of
the fiscal year (Federal Register July 25, 1956).
Major changes in these regulations include: (1) The establishment
of procedures for the conduct of hearings prior to the refusal or sus-
pension of an application for a new drug.
(2) Provision for the “filing” of new-drug applications refused as
incomplete by the New-Drug Branch, to furnish applicants an oppor-
tunity for administrative and judicial appeal from any arbitrary
refusal to file an application.
(3) A revised application form containing more detailed informa-
tion to assist the applicant in completing a sound application with
less individual, time-consuming correspondence.
(4) Increased emphasis on the responsibility of an applicant to
adhere to the provisions in an application, with broader grounds for
suspension if they are violated or if the application contains untrue
statements or significant omissions of material facts.
It is expected that the revised regulations will promote better appli-
cations, more careful observance of the conditions necessary to assure
the safety of new drugs, and more eflicient, faster processing of new-
drug applications.
Food standards—A number of amendments were made to stand-
ards for various cheeses. The most important of these makes sorbic
acid and sodium and calcium propionates optional ingredients of
several cheeses, process cheeses, cheese foods, and cheese spreads.
Sorbic acid and the sodium and calcium propionates retard mold
growth and are now widely used on packages of sliced cheeses.
One public hearing was called because of objections to an order by
the Commissioner of Food and Drugs declining to adopt a definition
and standard of identity for a food to be known as partially creamed
216 Department of Health, Education, and Welfare, 1956
cottage cheese. No order based on evidence taken at this hearing
was issued during the fiscal year.
Definitions and standards of identity and standards of quality for
canned pineapple and pineapple juice and a fill of container standard
for canned pineapple juice were adopted. The standards involving
pineapple are based on evidence at a hearing held prior to the passage
by Congress of the Hale Amendment.
A definition and standard of identity for canned prune juice—a
water extract of dried prunes—was adopted.
Pesticide chemicals—The Pesticide Chemicals Amendment was
scheduled to become fully effective in July 1955, with provision for
limited extension of the effective date for specific chemicals. To
prevent a hardship on agriculture it was extended for a number of
chemicals to take account of the growing season. It became fully
operative for all chemicals on July 22, 1956, shortly after the close
of the fiscal year.
Fifty-nine petitions for tolerances or exemptions were submitted
during the year. Fifty petitions were filed and the following actions
were taken: 40 petitions resulted in the establishment of permanent
tolerances; 1 petition resulted in the establishment of permanent ex-
emptions; and 5 petitions resulted in the establishment of temporary
tolerances. Since the Pesticide Chemicals Amendment was enacted,
over 1,200 tolerances or exemptions have been set for 82 different
pesticide chemicals.
The Pesticide Chemicals Amendment provides that an advisory
committee composed of experts selected by the National Academy
of Sciences may be formed to consider difficult questions of science
raised in a petition for a tolerance. One such committee was formed
at the request of a petitioner and an appropriate tolerance was estab-
lished for the pesticide chemical involved, based upon the report and
recommendations of the committee.
A tolerance was established for residues of the antibiotic chlor-
tetracycline in uncooked poultry. Evidence presented by the manu-
facturer of the antibiotic demonstrated that when poultry containing
the tolerance level of the chemical is cooked, no significant amount of
antibiotic remains; it is destroyed by heating. The data also showed
that the dip is effective only when applied to clean, freshly killed
birds. No evidence has been submitted that established the safety
and usefulness of antibiotic application to other foods.
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 1956, 4,776 batches, representing 5,296,414 pounds, were
certified, and 29 batches, representing 47,765 pounds, rejected. —
Food and Drug Administration 217
Insulin.—TVhe act provides for predistribution testing and certi-
fication of all batches of insulin marketed. Examination of 338
samples resulted in the certification of 295 batches of insulin and 42
batches of materials for use in making insulin-containing drugs. One
trial batch of Lente insulin was not approved because it did not meet
hydrogen ion requirements.
Antibiotics—The predistribution testing and certification of cer-
tain antibiotics is also provided by amendments to the act. Exami-
nations were made of 18,256 batches of penicillin, chlortetracycline,
bacitracin, chloramphenicol, dihydrostreptomycin, streptomycin, tet-
racycline, neomycin, nystatin, polymyxin, oxytetracycline, and car-
bomycin during the fiscal year. The last 5 antibiotics are not included
in the certification amendments, but are tested when they are mixed
with those requiring certification. Seventy-three batches were re-
jected for failing to meet the following standards: Potency (18),
sterility (387), pyrogens (12), and moisture (6). In addition, manu-
facturers withdrew their requests for certification of 45 batches be-
cause they failed to meet sterility and other standards. During this
period, 359 amendments and 45 new monographs were added to the
antibiotics regulations.
Enforcement of Other Acts
A total of 104,013,962 pounds of tea was examined under the Tea
Importation Act, in contrast with totals of approximately 97 million
in the fiscal year 1955 and 124 million in 1954. Rejections for failure
to measure up to the standards set by the U.S. Board of Tea Experts
totaled 94,872 pounds, or 0.09 percent. Six rejections were appealed
to the U. S. Board of Tea Appeals, which upheld the decision of the
FDA examiner in three cases, and in some portions of two others.
The appeal was sustained in other portions of these two and in the
remaining case.
Three caustic poisons were seized for failure to bear the labeling
required to warn users of their potential danger if misused. Included
were aluminum and concrete etchers and a soldering acid.
No permits were issued for importations of milk from Canada.
No legal actions were instituted under the Filled Milk Act.
New Court Interpretations
The Supreme Court did not review any cases under the Federal
Food, Drug, and Cosmetic Act during the fiscal year 1956.
An appeal from an injunction restraining the shipment of a drug
product because it was dangerous and falsely represented, was based
408691—57——_15
218 Department of Health, Education, and Welfare, [956
on the defendants’ contention that experts who testified for the Gov-
ernment had not used the product. The Seventh Circuit Court of
Appeals upheld the district court without a written opinion. This
is another decision admitting expert testimony without actual tests
of a drug.
In the first case decided under the Federal Food, Drug, and Cos-
metic Act on the question of whether the Federal court has power
to order restitution in an injunction proceeding, a district court
judge held that he did not have such powers. He concluded that
there is no indication in Congressional history that supports any other
sanction, or specifically, the power to order restitution under this
act. The Government appealed, and after the close of the fiscal year
the Ninth Circuit Court of Appeals upheld the district court’s decision.
In a seizure of tomato paste, all libels charged preparation under
insanitary conditions, and two also charged the presence of rot and
filth. The lower court held that the Government failed to prove
the charges except in the case of rot in a few codes in one libel. The
Government appealed on the grounds that the trial court’s findings
of fact were clearly erroneous. The U.S. Court of Appeals for the
Seventh Circuit reversed the lower court with respect to all codes
that showed a mold count of over 40, and ordered these codes con-
demned. The appellate court agreed with the district court that
none of the paste was packed under insanitary conditions.
A druggist defendant in an illegal sales prosecution case filed
a motion to suppress evidence gained during inspection of his drug-
store, and to dismiss the information on the grounds that inspection
authority under the act applies only to factories and warehouses. He
also argued that section 703 of the act granted him immunity. The
district court judge, however, held that drugstores are subject to
inspection under the “Factory Inspection” section of the act, and that
records may be examined and copied by Government agents conduct-
ing an inspection, if permission to inspect the record is given by
an authorized person.
A judge in a New York district court granted the Government’s
motion to dismiss the plaintiff’s suit against the Government under
the Tort Claims Act, seeking to recover damages resulting from
importations of tomato paste that were allowed entry into this coun-
try but later seized. The motion was based on the grounds that the
actions involved discretionary functions of the Government and are
not subject to the Tort Claims Act.
In 1948 a seizure was made of a macaroni product containing 20
percent protein, because it failed to comply with the standard which
limits the protein content to 18 percent when gluten is used as an in-
gredient. Through discovery procedures all questions were settled
Food and Drug Administration 219
except whether the product “purports to be or is represented as spa-
ghetti.” The Government’s motion for summary judgment was
granted by the district court judge, and the Court of Appeals for the
Third Circuit affirmed the judgment of the district court. This
opinion again upholds the integrity of food standards. From a
procedural standpoint, it exemplifies the use of discovery in narrow-
ing the issues, and decreasing the cost of trial.
When prosecuted on charges of illegally dispensing amphetamines
and other dangerous drugs, a licensed M. D. pleaded not guilty and
filed a motion to dismiss on the grounds that the act does not apply
to licensed M. D.’s. The judge of the district court overruled his
motion on the grounds that he was selling the drugs promiscuously,
without examinations. Later he fined the physician $3,000 and placed
him on probation for 3 years.
SCIENTIFIC INVESTIGATIONS
All of FDA’s research and scientific studies are aimed toward better
public protection in areas in which the consumer cannot protect him-
self. The contrast between the comparatively few and simple meth-
ods and tools available when the 1906 law was enacted and the com-
plex physical and biological methods and apparatus in use in FDA
and industry laboratories today is paralleled only by contrast in the
commodities under control at the beginning and end of this half-
century span.
Official and industrial chemists have collaborated during the years
through groups such as the Association of Official Agricultural Chem-
ists and the United States Pharmacopeia Revision Committee to de-
velop methods for the detection and measurement of constituents
that would bring comparable results in the hands of all qualified
analysts.
By thus combining forces in a purely scientific environment, meth-
ods have been developed that meet the needs of industry chemists
in compounding and labeling products and of regulatory chemists
in checking the accuracy of label declarations. This eliminates the
need for argument over methods in the courtroom, which would tend
to confuse lay juries and judges.
Particularly since 1938, collaborative pharmacological and experi-
mental medical studies have brought similar benefits in establishing
the safety and efficacy of the vast number of new medical and vet-
erinary preparations that have been developed.
Discussion of the scientific work required to solve some of the
problems presented by new products will indicate the complexity of
the factors involved in FDA’s scientific work. Other work on meth-
ods of analysis and studies on the efficacy and safety of products
220 Department of Health, Education. and Welfare, 1956
SE TE Die Rn oN eye
regulated by the Food, Drug, and Cosmetic Act are continuously in
progress. They include laboratory and clinical studies of antibiotics
and other new drugs; developing better methods for the rapid de-
tection of food poisoning agents; analysis of cosmetic ingredients;
toxicity studies of coal-tar colors, and new ingredients of foods,
drugs, and cosmetics; and studies of the nutritional effects of new
processes and components.
A substantial amount of time was spent in chemical studies of spray
residue data submitted by applicants for tolerances on raw agricultural
commodities, and in pharmacological evaluation of the safety of the
proposed tolerances. The chemical investigations included studies
of the reliability of the applicant’s method of measurement of the
residue left, and the need and practicability of the tolerance. The
pharmacologists studied the data submitted by applicants for tol-
erances and FDA chemists’ evaluations in determining whether
residues would be safe, and, if so, the amount that should be permitted
in consideration of chemicals being ingested from other sources.
Decisions could not be reached without fundamental background
data. For example, before it was determined that no tolerance was
needed for the residues of four chemical fumigants for grain, exten-
Slve investigations were required. Studies were made of fumigant
residues in wheat and milled wheat products in a pilot-scale mill
and in commercially fumigated grain. The rate of dissipation of
fumigant residue and the effect of cooking and baking on residues
were measured. ‘These investigations showed that high residues pri-
marily left on grains when these fumigants are used drop sharply with
aeration, are further reduced during the milling process, and are
completely destroyed by cooking.
Since ethylene dichloride was the most persistent of the fumigants
studied, an investigation was made of the possibility of its being
carried from feed into milk. No residues appeared in milk of cows
fed high levels for 22 days. Similar results were obtained with
parathion and several other organic phosphate insecticides. Traces
of them showed up in the milk only when exceedingly high levels
were fed.
The chlorinated hydrocarbons, on the other hand, are appearing
in market milk, according to a survey still under way. Analysis
was made of 800 samples of milk collected from retail channels by
the 16 field districts. The samples were screened by a bio-assay
test using flies, and when toxic residues were found they were iden-
tified, if possible, by paper chromatography and measured. About
62 percent of the samples were found to contain chlorinated hydro-
carbons ranging from a trace to as high as 1.5 parts per million of
DDT or related products, including benzene hexachloride, lindane,
|
Food and Drug Administration 221
rhothane, methoxychlor, and others. Some samples contained as
many as four of these insecticides:
Pharmacological studies of the safety of residues from agricul-
tural pesticides included the metabolism of chlorinated insecticides—
where the metabolites are excreted, whether they are toxic, and the
effect of solvent or spreader substances combined with them as in-
hibitors of excretion.
The toxicity of various organic phosphate insecticides was deter-
mined on animals and these findings were applied to human sensi-
tivity through the use of volunteers. Dietary levels that will cause
blood cholinesterase inhibition were established. It was further
found that when two or more organic phosphates are given together,
a synergistic action frequently occurs in which the combination is
more toxic than would be expected from the quantities of the in-
dividual insecticides alone.
The incorporation of drugs into animal feeds, to control certain
diseases and to help the animal make more efficient use of food, re-
quires close control of the amount being added. Chemical methods
for quantitative determination of two hormone-like substances—di-
ethylstilbestrol added to cattle feed and dienestrol diacetate added to
poultry feed—have been studied intensively during the year. Phar-
macological assays of tissues from stilbestrol-fed cattle indicate that
steers fed 10 milligrams a day for 150 days have no detectable added
estrogenic activity. Meat, fat, liver, kidney, and portions of the
intestinal tract were examined.
Another market milk survey—the third of a series—was made
to determine the presence and extent of antibiotics in milk. Low
antibiotic concentrations, principally penicillin, were found in 6 per-
cent of the 1,706 samples collected from the 48 States and the Dis-
trict of Columbia. A poll of authorities in the fields of antibotic
therapy, allergy, and pediatrics showed that a majority did not
consider the concentrations of antibiotics found high enough to affect
the population as a whole, but there was concern about adverse re-
actions in those people who are particularly sensitive to penicillin. It
was obvious that some farmers are not heeding the required labeling
warning on antibiotics for mastitis therapy to withhold milk from
food use for 3 days after the last treatment.
Enforcement Statistics
The 16,287 establishment inspections conducted by FDA were
divided into 12,575 for foods, 3,215 for drugs and devices, 376 for
cosmetics and colors, and 121 for miscellaneous products and items
covered by other acts. Of 17,675 domestic samples collected, 9,578
222 Department of Health, Education, and Welfare, 1956
represented foods, 7,822 drugs and devices, 206 cosmetics, and 69
miscellaneous. Import samples collected totaled 11,973.
In the 249 criminal actions terminated (or terminated for some
defendants) in the Federal courts during 1956, the fines paid or
assessed in cases pending on appeal totaled $197,067.80. The heaviest
fine in a single case was $12,000. In 66 actions the fines were $1,000
or more. Jail sentences were imposed in 54 cases involving 68 in-
dividual defendants. The sentences ranged from 1 month to 6 years,
and averaged 12 months and 3 days. Twenty-four individuals were
required to serve the imposed sentences, and for 44 individuals the
jail sentences were suspended on condition that violative practices
be discontinued.
Records of actions terminated in the Federal courts were published
in 1,240 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 1956
Total Criminal prosecu- Seizures accom-
tions instituted plished
Item Injune-
tions re-
Violative| Actions | Violative| Actions | Violative| Actions | quested
samples* samples samples
MOGs oe setae Seen es ets. 2, 214 1, 053 890 209 1,324 835 9
RoOodS 4 85.. wrys Soe Sees ee 1, 305 774 271 79 1, 034 689 6
Drugs and devices. sas = = 905 Pages 619 130 286 142 3
Cosmetics and colors_---------- 1 1 0 0 1 1 0
Causticpoisonss: 2a eae 3 3 0 0 3 3 0
*The number of samples on which the actions are based always exceeds the number of actions; in seizures
a variety of articles may be contained in a single shipment, while in criminal actions each sample usually
represents a single shipment which forms one count of the action.
Table 3.—Import inspections and detentions during the fiscal year 1956
Inspected | Inspected
Item Total | and refused and
entry released
TOtALT Ss: ches Bek 5 NE 2 seed a) Seer) Sine ee eer ee ee 31, 602 5, 234 26, 368
Woods -cb cht - Seoek (Fe Lbs it tee te eee Seer 2 Se a eee ete 28, 018 2,790 25, 228
Drugs Amd OVICES aK Gaon oe eee ea eae eae ee oe oP oe 3, 429 2, 409 1, 020
Cosmetics; colors,;ancdmiscellancous == eeser la aet ean ee eens 155 35 120
Office of
Vocational Rehabilitation
Community Enterprise Plays Key Role
in Nationwide Rehabilitation Program
WoRKING IN PARTNERSHIP with the Federal Office of Vocational Reha-
bilitation, State rehabilitation agencies and cooperating public and
private community groups intensified the dramatic assault against
disability during fiscal 1956.1. A record number of 66,273 handicapped
persons were prepared for and placed in jobs through the public
program.” This was 14.3 percent above the 57,981 rehabilitated in
1955.
The sizeable increase in the number of persons rehabilitated through
the public program last year was an indication of the mounting local
interest in the problems of the handicapped—of the fact that in many
areas coordinated activity on behalf of the handicapped was taking
on the characteristics of a genuine community enterprise. The in-
crease reflected greater awareness of the disabled as individuals with
a basic right to the same opportunity for living a full life as our
democratic society provides those without disability.
This growing grassroots concern with the handicapped and with
their problems was in no little measure due to the enactment of Public
Law 565, the Vocational Rehabilitation Amendments of 1954. This
broad-gaged legislation greatly expanded the Federal grants-in-aid
program for rehabilitation purposes, created new opportunities for
public agency-private group cooperation, and provided for a multitude
1 Unless otherwise indicated, all subsequent references to 1956 will be to the fiscal year—
that is, to the period between July 1, 1955, andi June 30, 1956.
2This total includes 65,640 persons rehabilitated by the State-Federal rehabilitation
program as well as 6383 established in employment through projects developed jointly by
community groups and State rehabilitation agencies and financed, in part, by Federal
grants.
223
224 Department of Health, Education, and Welfare, 1956
a a ha a Eg i a ae
of tools for strengthening State rehabilitation agency programs. The
law started an all-out assault against disability in all its facets.
During 1956, there were many signs that America was beginning to
harvest some of the fruits of the 1954 legislation.
Considerable progress was made in attacking problems relating both
to the administration of the State-Federal rehabilitation program and
to the social, economic and psychological aspects of the rehabilitation
effort. Impressive strides were taken in the areas of rehabilitation
research, in the development of facilities and techniques dedicated to
the prevention and elimination of economic distress among the
disabled, and in the training of urgently-needed rehabilitation workers.
During the year, public and private organizations across the nation
linked arms in the expansion, establishment and operation of rehabili-
tation facilities dedicated to restoring the severely disabled to produc-
tive lives. Federal grants helped foster and finance 80 rehabilitation
facilities and about 60 sheltered workshops in which severely disabled
persons could begin their return to economic self-sufficiency.
Increased Federal funds made available by Congress in 1956 for
basic support of State rehabilitation programs saw the States reacting
in a positive fashion as State legislatures substantially increased their
appropriations for rehabilitation purposes.
Cooperation between State rehabilitation agencies and voluntary
groups at the community level was fully consistent with relationships
existing between the Federal Office and the major national groups
directly concerned with the rehabilitation of the handicapped. Good-
will Industries, the American Hearing Society, the American Founda-
tion for the Blind, the National Society for Crippled Children and
Adults, the United Cerebral Palsy Associations—these were among
the many national organizations with which the Office maintained the
closest possible working relations.
These cooperative efforts and the record number of rehabilitations
achieved through the public program during 1956 notwithstanding,
there remained a great gap between the number of handicapped per-
sons restored to useful and productive lives and the number still in
need of rehabilitation services.
Today, an estimated 2,000,000 Americans could be prepared for and
placed in jobs if they had access to vocational rehabilitation. Each
year, an estimated 250,000 persons disabled by accident, disease or
congenital conditions come to need vocational rehabilitation.
In moving ahead against the massive disability problem in 1956,
the Federal Office, the State rehabilitation agencies, and cooperating
public and private groups have demonstrated their awareness of the
need for a broad educational and informational effort. This effort
has sought to foster acceptance of the handicapped by all segments of
the community, to stimulate appreciation of their abilities, and to
Office of Vocational Rehabilitation 225
generate a communitywide sense of responsibility for helping the
handicapped to help themselves. -
HIGHLIGHTS OF 1956
A record number of 66,273 handicapped persons was established in
employment through the State-Federal rehabilitation program. This
was 14.3 percent above the number rehabilitated in 1955, and the
highest total since the State-Federal program’s inception in 1921.
Funds appropriated by the States for rehabilitation purposes totaled
$18.5 million, an increase of 27 percent from the preceding year and
of almost 50 percent over 1954.
In the first year after their rehabilitation, the 65,640 individuals
placed in jobs by the State agencies will earn an estimated $127.3
million, as compared to $17.5 million before the rehabilitation process
began. It is estimated that these rehabilitants will pay Federal in-
come taxes at an annual rate of $10.5 million. At this rate, it is
estimated that within 3 years they will repay more than the entire
amount expended by the Federal Government for the basic support
program in 1956.
About 3,300 of these rehabilitants entered professional fields such
as education, medicine, and engineering. About 8,100 went into
skilled trades, and 5,600 into agriculture.
The Office of Vocational Rehabilitation granted $1.2 million for 29
research and demonstration projects being conducted by public or
private nonprofit organizations to help solve rehabilitation problems
of nationwide concern.
The Office awarded 154 grants totaling $1.1 million to 80 institu-
tions of learning for the teaching of rehabilitation subjects. Reha-
bilitation students received 2,070 traineeships totaling $1 million.
Working in conjunction with the Public Health Service, the Office
approved Federal grants totaling $5.3 million for the development of
42 comprehensive rehabilitation facilities in 35 States. These grants,
made under terms of Public Law 482, were matched by an estimated
$23.4 million allocated by the recipient organizations.
REHABILITANTS: FURTHER FACTS
Almost every type of disabling condition was represented among
the 65,640 men and women rehabilitated by the State-Federal voca-
tional rehabilitation agencies in 1956. Chart I, page 227, divides those
rehabilitated into eight broad disability categories.
Forty percent (26,300) of the 65,640 persons rehabilitated were dis-
abled because of orthopedic impairments—amputations or other crip-
pling conditions. Approximately three-fifths of the group of 26,300
rehabilitants were injured in accidents, and about one-fifth were
handicapped as the result of poliomyelitis, osteomyelitis, or arthritis.
226 Department of Health, Education, and Welfare, 1956
a a eee
The occupations in which the rehabilitants were placed also are
shown in Chart I. This vocational distribution has remained substan-
tially the same for several years. It is noteworthy that only 7 percent
of those rehabilitated in 1956 went into unskilled trades.
Major sources of referrals for rehabilitation were physicians, health
agencies and hospitals. ‘They referred for services 33 percent of the
disabled persons established in gainful employment in 1956.
Fifteen percent of the total number of individuals rehabilitated were
referred by public welfare agencies, and 7 percent by State employment
offices. About 12 percent applied for services on their own initiative.
Almost half of the rehabilitants of 1956 had dependents, and 65
percent were men. The average age at the time of disablement was
25, whereas that at the time the rehabilitation process began was 35.
Developments during 1956 again demonstrated the economic values
of vocational rehabilitation. About 49,000 of the 65,640 rehabili-
tants were unemployed when their rehabilitation began. An esti-
mated 13,000 received public assistance payments at some time during
the rehabilitation process. These assistance payments were at an
estimated rate of $11.1 million a year. The total cost of restoring
these 18,000 persons to productive employment was about $9.6 million.
The handicapped persons placed in jobs through the public voca-
tional rehabilitation program last year will pay—during their working
lives—an estimated $10 in Federal income taxes for every Federal
dollar invested in their rehabilitation. ‘The estimated rate of annual
earnings of the rehabilitants increased to about $127.3 million as com-
pared to $17.5 million prior to their rehabilitation.
PROGRAM DEVELOPMENTS AT THE GRASSROOTS
The major emphasis of Office efforts during 1956 was upon helping
the State rehabilitation agencies to strengthen and broaden their pro-
grams and upon creating a pattern for maximum community coopera-
tion on behalf of the disabled. Very important in this respect were
administrative surveys conducted by Office teams in Georgia and
Minnesota, respectively. ‘These surveys, requested by the States, re-
viewed past accomplishments of the State agencies concerned, assessed
current strengths, and made specific recommendations directed to the
most effective development and expansion of the State programs.
Office personnel also conducted five Vocational Rehabilitation
Accounting Workshops which were attended by more than 125 State
agency staff members. The Workshops, held in Chicago, San Fran-
cisco, New York City, New Orleans, and Charlottesville, were dedi-
cated to discussion of fiscal and accounting procedures under Public
Law 565 and to delineation of State agency fiscal responsibilities
in the disbursement of Federal grant funds.
227
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2238 Department of Health, Education, and Welfare, 1956
Cet mr i cl get
These and other Office operations in the administrative field played —
an important role in helping the State agencies to improve their pro-
grams as well as to strengthen their relationships with cooperating
public and voluntary organizations.
State Plans
Under Public Law 565, States and Territories were called upon
to submit new Plans for the approval of the Office. The State
Plan sets forth the organization of the State rehabilitation program
and the major policies and procedures to be adhered to in its operation.
By the beginning of 1956, such Plans had been approved for 88 agen-
cies in the 48 States, the District of Columbia, Alaska, Hawaii, and
Puerto Rico.
Consistent with the objectives of Public Law 565, there was a gen-
eral broadening of State Plans as compared to those of previous years.
By the end of 1956, 39 of the State agencies had provided for the
establishment of rehabilitation facilities and 36 had provided for the
establishment of sheltered workshops. In 438 States, Plans provided
for State agency-managed business enterprise programs for the blind
or for those with other types of severe disability.
Basic Support of State Programs
The Federal Government made $30 million available for basic sup-
port of State rehabilitation programs in 1956, an increase of $6 mil-
lion over the preceding year and of $7 million over 1954. ‘The States
matched the Federal funds available for basic support of their pro-
grams with $18.1 million of their own money. This was an increase
of 26 percent over the preceding year, and of 46 percent over 1954. In
20 States, total State funds for rehabilitation jumped by one-third
over the 1955 figure.
Expansion Grants
Federal grants totaling $1,065,511 were made to public and to pri-
vate, nonprofit groups in 1956 for the expansion of rehabilitation
facilities and services. These grants were made for partial support
of 102 projects in 41 States or Territories. Eleven of the awards
went to State rehabilitation agencies, the balance (91) going to other
public organizations and to voluntary groups. Eighty-five of the
grants were made to foster the establishment or enlargement of re-
habilitation facilities and sheltered workshops.
Extension and Improvement Projects
During 1956, the Federal Office made 104 grants totaling $1 million
to State rehabilitation agencies in partial support of projects dedi-
Office of Vocational Rehabilitation 229
cated to extension and improvement of facilities or services for the
handicapped. Fourteen of these-projects involve new and vigorous
programs in the mental health field, nine of them being concerned
with the mentally ill, and the remainder with the mentally retarded.
Also among the 104 projects are 18 designed to serve the blind,
13 concerned with the development of sheltered workshops for the
severely handicapped, and 7 designed to serve those with speech and
hearing defects. Other projects provide specialized services to the
tuberculous, the epileptic, and to persons with heart conditions. Still
others are for the improvement of medical consultation and super-
visory methods and techniques and the development of organized
programs to demonstrate the employment potential of the disabled.
Cooperation in Administering the “Disability Freeze”
The “disability freeze” provisions of the social security legislation
of 1954 brought about a close working relationship between State re-
habilitation agencies and Bureau of Old-Age and Survivors Insurance
Offices. These provisions were designed to protect the rights of
persons covered by the social security law whose disability is so severe
as to preclude them from engaging in substantial gainful employment.
Under agreements existing in 46 States or Territories, BOASI offices
refer applcants for the “disability freeze” to rehabilitation agencies
for determining whether such applicants are disabled within the defi-
nition set down by the 1954 social security legislation.
During 1956, the State agencies had more than 94,000 “freeze” ap-
plicants referred to them for disability determinations. The agencies
made 58,000 determinations during the year, screened 75,000 of the
applicants for rehabilitation potential, and accepted 15,000 of these
people for further consideration for rehabilitation services.
PROGRESS IN REHABILITATION RESEARCH
During 1956, the Office of Vocational Rehabilitation approved
grants in partial support of 29 new special research and demonstra-
tion projects, 11 more than were approved in 1955. The grants
totaled $925,000. This sum was in addition to $255,720 granted
for the continuation of 10 projects initiated in 1955.
The new projects, all of which show promise of contributing to
solution of a vocational rehabilitation problem of nationwide con-
cern, were approved upon the recommendation of the 12-member Na-
tional Advisory Council. on Vocational Rehabilitation which reviews
all special project grant applications. Office Director Mary E. Swit-
zer is chairman of the Council, which is made up of nationally known
leaders with an interest in the problems of the disabled.
230 Department of Health, Education, and Welfare, 1956
i lee ee ee nT eet ONO SE ARERR RINENEA NOT 3
Following is a listing of the organizations which received research
and/or demonstration grants during 1956 with a brief description
of each of the projects for which grants were awarded :
Highland View Hospital, Cleveland, Ohio, $38,395 to demonstrate
that rehabilitation is possible for long-term hospital patients dis-
abled by severe chronic diseases; New York Tuberculosis and Health
Association, Inc., New York, N. Y., $10,000 to devise and provide
appropriate nonmedical rehabilitation services to unhospitalized pa-
tients being treated for tuberculosis; Boston Psychopathic Hospital,
Boston, Mass., $47,265 to demonstrate the effectiveness of coordinated
efforts of hospital, expatients, patient groups, and community agencies
in the rehabilitation of the mentally ill.
Mount Zion Hospital, San Francisco, Calif., $17,856 to demonstrate
the role of rehabilitation as part of a community home-care program
for the chronically ill; California Bureau of Vocational Rehabilita-
tion, Sacramento, Calif., $24,692 to determine the effectiveness of a
rehabilitation program for injured workmen covered by workmen’s
compensation ; Institute of Physical Medicine and Rehabilitation, New
York, N. Y., $9,525 to explore problems involved in the rehabilitation
of disabled Puerto Ricans living in the U.S.
George Washington University Hospital, Washington, D. C., $6,614
to develop effective methods of dealing with the psychological and
vocational adjustment problems of individuals with multiple sclerosis ;
Montefiore Hospital, New York, N. Y., $27,940 to demonstrate eco-
nomic and psychological benefits of rehabilitation for permanently
shut-in, chronically ill persons; Llinois Public Aid Commission,
Chicago, I11., $44,500 to determine the extent to which disabled persons
confined to public and private nursing homes can be rehabilitated ;
Alabama Society for Crippled Children and Adults, Montgomery,
Ala., $27,800 to demonstrate that an organized marketing program can
increase employment opportunities for the home-bound disabled ; Epi-
Hab, Incorporated, Los Angeles, Calif., $27,041 for a workshop to
demonstrate that epileptics can effectively perform many kinds of jobs
from which they have been previously excluded.
National Jewish Hospital, Denver, Colo., $36,591 to develop im-
proved methods for use within a hospital in the rehabilitation of those
undergoing extended treatment for chronic tuberculosis; American
Hearing Society, Washington, D. C., $15,869 to develop standards and
guides for use by communities in the establishment of speech and
hearing rehabilitation facilities ; Site, Inc., Topeka, Kansas, $10,600 for
research into the possibility of developing—through electronic and
other means—practical sight substitutes for the blind.
Davis Memorial Goodwill Industries, Washington, D. C., $92,056 to
demonstrate that more severely disabled persons can be rehabilitated
Office of Vocational Rehabilitation 231
through establishing a complete rehabilitation center in close connec-
tion with a sheltered workshop program; Medical Society of the Dis-
trict of Columbia, Washington, D. C., $18,576 to analyze the role of a
medical society in total community rehabilitation planning; Western
Pennsylvania Heart Association, Pittsburgh, Pa., $18,960 to evaluate
the effect of employment on 1,000 cardiac patients whose work tolerance
was prescribed by a cardiac work classification unit.
Cleveland Hearing and Speech Center, Cleveland, Ohio, $7,932 to
improve hearing tests commonly used in evaluating speech discrimina-
tion in certain types of deafness in order to make more effective job
selections; Industrial Home for the Blind, Brooklyn, N. Y., $20,000 to
define successful methods used in the rehabilitation of the deaf-blind,
and to develop a manual which can be used nationally in setting up
rehabilitation services and identifying job opportunities for them;
National Health Council, New York, N. Y., $5,000 to identify person-
nel needs in fields related to the rehabilitation program, and to develop
projects to increase the supply of trained personnel.
National Association of the Deaf, Berkeley, Calif., $17,200 to inven-
tory the types of jobs performed by deaf persons throughout the Na-
tion, and to evaluate factors associated with occupational success or
failure; New York University—Bellevue Medical Center, New York,
N. Y., $11,340 to determine the extent to which a rehabilitation team
can return homebound disabled persons to employment outside the
home; Washburn University of Topeka, Topeka, Kansas., $31,877 to
study the responsibilities, knowledge, and skills required of the ad-
ministrator of the several therapies used in mental hospitals with a
view to increasing the effectiveness of those services in rehabilitating
the mentally ill.
MacDonald Training Center Foundation, Inc., Tampa, Fla., $40,000
to evaluate the potentials for rehabilitation of mentally retarded youths
with muscular, orthopedic, and emotional impairments; Robert Breck
Brigham Hospital, Boston, Mass., $38,138 to develop pre-employment
evaluation and work-hardening techniques for use with rheumatoid
arthritic patients as a basis for their return to remunerative employ-
ment; Our Lady of Fatima Hospital, North Providence, R. I., $30,000
to determine and demonstrate the services needed for rehabilitation of
chronically ill and disabled workers 45 years of age and older; Min-
neapolis Society for the Blind, Minneapolis, Minn., $142,365 to estab-
lish a regional facility to provide adjustment, training, and workshop
services to blind persons from a number of States; Crotched Mountain
Foundation, Greenfield, N. H., $22,913 to demonstrate the value of
the social group work method in the rehabilitation of severely disabled
persons in a rehabilitation center; Anderson Orthopedic Hospital and
Rehabilitation Center, Arlington, Va., $83,000 to develop a rehabili-
232 Department of Health, Education, and Welfare, 1956
tation center in the Washington metropolitan area as a guide for
rehabilitation centers established in other areas.
TRAINING OF REHABILITATION PERSONNEL
The Office’s training program, which completed its second year as of
June 1956, experienced considerable growth. The program is de-
signed to help overcome the shortage of professional personnel in the
rehabilitation field, improve the knowledge and skills of those already
in rehabilitation work and increase the awareness of rehabilitation
techniques, methods, and objectives among workers in related fields.
During the year, the Office made available to educational institutions
and individuals for training purposes, more than double the amount
granted in 1955. Of the total amount granted, $1.1 million went into
154 grants for teaching in such areas as rehabilitation counseling, re-
habilitation aspects of medicine, social work, occupational therapy and
physical therapy. The remainder went for traineeships to 2,070 stu-
dents in these and other areas.
In administering the training program, the Office has been aided by
an Advisory Committee on Training Policy. Composed of leaders in
the rehabilitation and education fields, it consults with and advises the
Office in the development of long-range training policies.
In addition, six ad hoc technical panels—composed of professional
personnel in the fields of medicine, rehabilitation counseling, nursing,
social work, occupational therapy and physical therapy—cooperated
with the Office in reviewing the individual teaching and traineeship
applications. ‘These panels materially assisted the Office in achieving
the most equitable and adequate geographical distribution of grants
within the overall framework of long-range training needs and
policies.
The Office greatly strengthened its liaison and informational ac-
tivities vis-4-vis cooperating educational institutions. A compre-
hensive informational bulletin, containing background data on the
training program along with specific details on grants and instruc-
tions for the preparation and submission of grant applications, was
distributed to these institutions and other interested organizations.
GUIDANCE AND SETTING OF REHABILITATION STANDARDS
During 1956, the Federal Office greatly emphasized guidance and
consultative services to State rehabilitation agencies and working
closely with State personnel in the solution of common problems.
The Ninth Annual Guidance, Training and Placement Workshop,
held in Washington, D. C., early in June, was among the major
Federal-State cooperative efforts in the guidance and standards fields.
The Workshop saw committees of State agency personnel, assisted by
Office of Vocational Rehabilitation 233
Office consultants, develop reports and recommendations in such areas
as counselor service utilization, use of occupational information, and
the use of community resources. Eighty-one representatives of 58
State agencies participated in the Workshop.
Among other significant developments in standards and procedures
was Office sponsorship of orientation training for 405 newly employed
State counselors through 17 regional institutes. The orientation pro-
gram was based upon a syllabus prepared by OVR in cooperation
with the States’ Vocational Rehabilitation Council.
Among the many specialized consultative efforts during the year
was one in which Federal Office personnel served in resource and con-
sultant capacities in a pioneering workshop conducted by the Amer-
ican Foundation for the Blind on competitive, sheltered, and home-
bound employment of sightless persons with hearing impairments.
Cooperative Relationships
In 1956, the Office effected an agreement with the Veterans Ad-
ministration for referral of disabled veterans from VA field stations
to State rehabilitation agencies. This cooperative agreement was
fully in keeping with a recommendation made by the President’s
Commission on Veterans’ Pensions that extended use be made of the
State-Federal program in the rehabilitation of handicapped veterans
with peace-time service or with non-service-connected disabilities.
Among other cooperative ventures in the guidance and standards
areas during the year was the Office’s participation in a conference
concerned with community planning for mental retardation and
jointly sponsored by several Federal Departments and the Josiah
Macy, Jr., Foundation, Princeton, N. J. As of the year’s end, the
Foundation was preparing a report on the conference which is ex-
pected to prove of considerable value to rehabilitation personnel and
other groups concerned with the problems of mental retardation.
During the year, the Federal Office cooperated with the American
Foundation for the Blind in sponsoring a 5-day seminar on Rehabili-
tation Centers for the Blind. The seminar, held in New Orleans, was
attended by representatives of full-time rehabilitation centers and
was directed to the development of principles and standards for the
operation of such centers. A report on the seminar, in process of
publication. at year’s end, is expected to have wide circulation.
Still another cooperative venture in 1956 was the joint development
and issuance by the Federal Office and the Bureau of Public Assistance
of a publication entitled “Working Together to Rehabilitate the
Needy Disabled.” The booklet is designed to foster State Rehabilita-
tion-Public Assistance agency cooperation at the community level in
rehabilitating persons on the public assistance rolls.
408691—57—_16
234 Department of Health, Education, and Welfare, 1956
pose ED a TR i eecce al a lb ake Binoche rte
STIMULATING EMPLOYMENT FOR THE DISABLED
The Office during 1956 stepped up its many direct activities de-
signed to stimulate employment of the handicapped. In doing so, it
encouraged research into such diverse areas as employer attitudes
toward the handicapped and the experience of college-level deaf per-
sons in taking examinations for Federal employment.
An employer attitudes survey is being conducted in the Boston area
and preliminary results are scheduled to be announced during fiscal
1957. The project involving the deaf is actually a pioneering or pilot
effort which was conducted by the Civil Service Commission in cooper-
ation with the Federal Office, the National Association of the Deaf,
and Gallaudet College.
Tentative recommendations based upon evaluation of the experience
of deaf examinees on civil service tests are expected to improve the
opportunities of the deaf for various types of Government jobs. An
important byproduct of the pilot project has been the revision. of an-
nouncement language for many civil service examinations so that
more deaf persons will be encouraged to apply for Federal posts.
Among specific placement activities of the Office during 1956 were
the issuance of two releases to Federal employing officers to encourage
Federal agency employment of the handicapped and the collection and
distribution to State rehabilitation agencies of data on employment
opportunities open to handicapped clients both in nationwide busi-
nesses such as Sears Roebuck and Company, and in public agencies
such as the U.S. Public Health Service. The release of these data and
follow-up efforts have resulted in the development of many jobs for
the handicapped in the Sears and U. S. PHS organizations.
The Vending Stand Program for the Blind
Considerable progress was made in fostering the employment of
blind persons through the Vending Stand Program for the Blind.
Administered by State agencies in partnership with the Federal Of-
fice, it was brought into being by the Randolph-Sheppard Act of 1936
and was strengthened by legislative amendments in 1954.
A record number of 1,804 blind vending stand operators was in
business under the program as of June 30, 1956. This figure com-
pares with the 1,721 operators as of the same period in 1955. The net
average income of the operators during 1956 was $2,532, an increase of
$232 over the preceding year.
The total earnings of the operators and their blind employees was
$5.1 million as compared to $4.5 million in 1955. Gross vending stand
sales totaled $25.9 million as compared to $23.5 million in 1955.
Office of Vocational Rehabilitation 235
The Randolph-Sheppard amendments of 1954 augmented the op-
portunities for the blind by providing for preference to blind individ-
uals in the operation of vending stands on Federal property and
stipulating that each agency having jurisdiction over such property
must prescribe regulations to assure such preference. Previously,
preference had been assured for blind persons in the operation of
stands in Federal buildings only.
As of June 30, 1956, preference regulations had been established,
after detailed consultation between Office specialists and the various
Agencies concerned, in eight major establishments. These are the
Departments of Health, Education, and Welfare; Treasury, Defense,
Commerce, and Post Office; and General Services Administration,
Atomic Energy Commission and Tennessee Valley Authority.
DEVELOPMENTS IN MEDICINE AND PHYSICAL RESTORATION
In 1956, significant advances were made both in developing of
medical techniques and treatment methods for rehabilitating the
severely disabled and in planning facilities to serve them. The
pioneering element, so basic to the research projects for which Federal
grants were made, was especially evident in the area of rehabilitation
medicine. Particularly was this the case in the field of mental health.
Rehabilitation Facility Construction
Cooperative efforts of the Office of Vocational Rehabilitation, the
U.S. Public Health Service and various State, and community groups
made possible the development of plans for construction of compre-
hensive rehabilitation centers for the severely handicapped. This
cooperative progress was made under the provisions of the Medical
Facilities Survey and Construction Act of 1954 (Public Law 482).
At the year’s end, the Office and the Public Health Service jointly
had approved the granting of Federal funds totaling $5,333,803 in
support of 42 comprehensive centers in 85 States. These grants were
being matched with more than $20 million from the State and com-
munity groups organizing and constructing the Centers.
Of the 42 projects, five will provide services to persons, all of whom
have the same type of disability. Thus, one project will concern itself
only with psychiatric cases, two with speech and hearing disorders,
one with dental problems, and one with cerebral palsy.
Mental Health: Plans and Progress
Rehabilitation of persons with mental handicaps received major
emphasis in 1956. In furtherance of a plan initiated during 1955, 3
regional conferences were held and attended by State Hospital and
236 Department of Health, Education, and Welfare, 1956
a i eee AN AON IAS SSGES aS
State rehabilitation agency personnel working with the mentally
handicapped. The meetings, jointly sponsored by the Federal Office
of Vocational Rehabilitation, the National Institute of Mental Health,
and a university in each of the areas involved, helped lay a broad
foundation for the rehabilitation of mental patients in need of vo-
cational adjustment when ready for discharge from the hospital.
Aided by Federal funds, 12 State agencies increased their staffs
and strengthened their programs of services to the mentally ill during
the year. As of the year’s end, 22 States had one or more rehabilita-
tion counselors assigned to work exclusively with the mentally 111.
During the year, Federal funds totaling $450,000 went to
State agencies and other public or private, nonprofit groups for the
development of specific projects concerned with the rehabilitation
of the mentally disturbed or the mentally deficient. Among the States
in which these projects are located are Maine, Vermont, New Hamp-
shire, Massachusetts, Connecticut, New York, New Jersey, Pennsyl-
vania, Tennessee, Florida, Kansas, Missouri, Wisconsin, [linois,
South Dakota, Nebraska, Colorado, Texas, and Puerto Rico.
Very encouraging progress in helping the mentally retarded was
made during 1956 at a work adjustment center operated jointly by the
State rehabilitation agency and the Council of Jewish Women in
Milwaukee, Wisconsin. Of 41 mentally retarded persons with IQ’s
ranging from 25 to 76 assisted at the Center in its first year of opera-
tion, 21 were returned to productive employment.
INFORMATIONAL AND EDUCATIONAL ACTIVITIES
In keeping with the mandate laid down by Public Law 565, the
Office greatly stepped up its efforts to inform the public as to the voca-
tional rehabilitation program and the problems of the disabled. The
Office Director delivered numerous addresses to national and statewide
audiences. Numerous special reports, publications and releases bear-
ing on specific rehabilitation developments were issued, among them
an illustrated pamphlet explaining the provisions of Public Law 565
in lay language and a flier designed to inform disability freeze appli-
cants of the nature and scope of vocational rehabilitation services.
During the year, the Office concentrated upon helping State rehabil-
itation agencies to develop sound public information programs and to
deal with specific informational problems. The Office prepared a com-
prehensive Public Information “how-to-do-it” kit for use of State
agency personnel, the kit containing both instructional materials and
samples of the various types of informational tools.
Office of Vocational Rehabilitation 237
Office Information Specialists also conducted three public informa-
tion training institutes for State agency personnel. The institutes,
held in Washington, D. C., were attended by State Agency Directors,
Informational Specialists and other personnel charged with infor-
mational or public relations responsibilities. Well over half the State
agencies had representatives at one or more of the sessions.
The year also saw the development of a number of cooperative ven-
tures in the public relations area involving both public and private
agencies. The Office, which cooperates with the Veterans’ Administra-
tion and the President’s Committee on Employment of the Physically
Handicapped on a year-round basis in promoting the employment and
rehabilitation of the handicapped, linked arms with these two agencies
and with a private, nonprofit foundation (The Morgenstern Founda-
tion of New York) in sponsoring the first nationwide contest for
handicapped amateur artists. Drawing more than 1,000 entries it
served to focus the Nation’s attention upon the creative abilities of the
handicapped and to illustrate their overall rehabilitation potential.
INTERNATIONAL COOPERATIVE EFFORTS
During 1956, the Office participated in the training of 107 persons
from abroad who had come to the United States to observe the rehabil-
itation program or to study rehabilitation subjects at educational
institutions. ‘The persons who received such training—nearly 50 per-
cent more than were trained in 1955—came from 30 different nations,
many of them in underdeveloped areas of the world.
In working with these people from abroad, Office personnel
cooperated with the International Cooperation Administration of the
Department of State, the United Nations, various other Federal De-
partments, and numerous American institutions of learning. Office
personnel also provided rehabilitation specialists in Mexico and India
with consultation and advice directed to the development of rehabil-
itation counselor training courses within these two countries.
The Office also helped to recruit American rehabilitation specialists
for service abroad in such countries as Brazil and Egypt and dis-
tributed informational materials bearing on rehabilitation develop-
ments to more than 50 countries on a regular basis.
2338 Department of Health, Education, and Welfare, 1956
Table 1.—Number of referrals and cases, by agency, fiscal year 1956
[Corrected to September 30, 1956]
Referrals Cases
During fiscal year During fiscal year
Agency ! Re- Total | Closed from active load Re-
main- | active main-
Ac- |Not ac-| ingat | load ing at
Total | cepted | cepted | end of | (receiv- After | Before | end of
for serv-|for serv-| year 3 ing Reha- |rehabil-|rehabil-| year 6
ices ices 2 serv- bili- | itation | tation
ices) tated |plan in-|plan in-
itiated 4\itiated 5
United States, total___|290, 398 | 93,917 | 95,705 |100, 776 |221,518 | 65,640 | 6,178 | 14,881 | 134, 819
INIA DATA eee ees ae ee 7,202 | 2,599 929 | 38,724] 7,011 1, 956 219 372 4, 464
NTASK aCe eu OO ck wee ee ee 719 123 164 432 185 38 2 15 135
Arizona:
Generale ae ee ees 1, 706 493 501 712 896 289 46 13 548
Blinds: ees ees eee ee 102 39 24 39 118 28 5 et 74
Arkansaqcs* Jie. 1 EM OOF es 3, 954 1, 526 1, 247 Til Keull 3, 590 1, 350 95 244 1, 901
(Californias oe Sees 16,390 | 3,220} 10,471 2,699 | 8,541 1, 724 640 1, 258 4,919
Colorado:
General = ae sean eee 2,114 882 586 646 | 1,784 570 213 97 904
Bilin de tees sere were 8 ek 261 49 87 5 Wee? 44 4 30 99
Connecticut:
Genera] eee ae eee eee 3, 079 1, 492 828 759 | 3,605 927 170 312 2,196
Blind). es sey es 186 66 83 37 168 50 17 6 95
Delaware:
General a3 with. ose. Oe 1 Pala 511 508 254 1, 202 480 24 97 601
IBlinget ALtry tas Beye 58 30 20 8 68 23 9 9 Diet
Te of Columbia______-_| 2, 248 642 802 804 | 1,423 320 111 142 850
orida:
General see. 25s sas 8,373 | 2,747) 3,042 | 2.5841 5,907 1, 837 Wz; 510 3, 388
(Bilinear Pee Pee ee 3, 050 299 1, 653 1,098 810 250 46 39 475
Georciguene wey eieek APs 19,627 | 5,337] 5,782 | 8,508 | 11,393 | 5,093 213 508 5, 579
Hawaii:
Genera lyted oe nobel ee 764 176 348 240 563 183 29 11 340
Side ee. Sa eee ee Tee 26 6 10 10 76 5 4 5 62
Idaho
Generals ae ¥ ee 2 ee ee 1, 382 224 576 582 501 156 12 9 324
Be ee eee ee 39 11 12 16 82 ‘65 5 0 22
TIN OISHNE Fe oe ha aS ee A 11,054 | 5,417 2,768 | 2,869 | 12,126 | 4,139 359 636 6, 992
Indiana
Generalirsosiee pas eee 2, 749 1, 519 621 609 | 4, 222 1, 067 109 380 2, 666
Bind se.) we eee ees 276 90 83 103 268 45 24 SP 167
Iowa:
Generales 43 te ee 4,801 | 1,658} 1,177] 1,966 | 3,484] 1,105 75 178 | °° 2426
‘Blii:: = eeek Coen wees 135 24 38 Hf 63 i il oe 49
Kansas
(FONCT A) 2554 exes s Se ee DPS 3, 404 737 1, 235 1, 432 1, 879 440 54 147 1, 238
IBS OT AG lag ch ae ae ermal rs 286 61 91 134 ine/ee 41 9 15 112
Ienitickvees = eon eee 6, 034 932515 2.550 DO OO2nl nae bbl 97 209 1, 584
Louisiana:
CLS be oee ete ar eee 4,605 | 2,261 875 | 1,469] 5,419 | 1,400 69 27354, pas0Cl
Blinder wan ses fee 601 167 188 246 518 105 16 iC 390
Maine
General aa sf er ee eee 2, 275 379 955 941 995 215 20 76 683
SB ittG Ae ae ae lee tome ye 176 48 78 50 88 aly 11 3 5¢
Mary land em eee eee eens 4,105 1, 873 822 1, 410 4, 507 1,174 98 415 2, 820
Massachusetts:
Generales: Saaetee ees 3, 710 ib PAS 1, 147 eek | OAS 794 72 163 1, 747
IB Linn Se re ee Rene a eee 308 90 169 283 54 5 23 201
Michigan:
General ress sea crak ses 8, 334 3, 441 1,779 3, 114 8, 498 2, 938 295 189 5, 076
: DS [i ee ae Rae te 316 180 7Al 65 420 130 24 33 230
Minnesota:
Generalsso: | itlew Rubee 5, 029 1,101 T2702 sGb8 lmao oud 679 43 89 2, 866
IB Lind Seen ere eas 329 114 91 124 Sie 65 33 34 241
Mississippi:
Generals... cee 2, 816 992 774 1,050 | 2,728 841 61 175 1, 651
Bind axe epee: Ota Ste 708 329 251 128 6 255 34 i, 562
Missouri:
General Se ee 3, 240 1, 702 764 774 | 3,288 1, 331 44 162 1, 751
IB in Cee oe eee 616 219 157 240 514 USO 20 18 341
Montana
Genera | esas ae 1, 464 426 470 568 1, 086 369 12 39 666
Ceres ae ea eas ire 16 124 ih 0 18 i 1 30
Nebraska:
(CENTS tee ene eae 1, 234 816 68 350 1, 817 584 ily) 11 1, 205
BNC ates se ee 199 81 78 40 140 58 1 0
INGVa dated si arate eee: 610 95 395 120 173 54 3 3 113
see footnotes at end of table.
. Office of Vocational Rehabilitation
239
Table 1.—Number of referrals and cases, by agency, fiscal year 1956—Con.
[Corrected to September 30, 1956]
Referrals
During fiscal year
Agency !
Aec- |Not ac-
Total | cepted | cepted
for serv-|for serv-
ices ices 2
New Hampshire:
Gemeriien eee 539 234 170
LSD. ae ee 56 45 i
New Jersey:
Lo Gl) ee 3, 301 984 992
TRING Skea 600 106 196
New Mexico:
emeraleys. oot). 8k 1, 089 257 476
SUTTON G! 2s eo Se rr 179 39 57
New York
Gi a 19,209 | 6,512 | 7,403
TRUE Gis Se i 956 312 192
North Carolina
(Generales kN et 7,770 | 4, 509 1, 915
IB UO US on eee 1, 224 466 473
Nanni Wakotasoo.c. 2.2... 1,273 353 225
Ohio:
Jo a i a 5,510 | 1,553 | 1,692
TB NUITAYG ts ee ee 434 194 74
Ch 0 5,619 | 2,314] 2,296
Oregon:
Generales) 7 ee 5,183 | 1,024 | 2,139
ISNA le 2 191 46 87
Pennsylvania:
Gronenaliee 2 te 21,081 | 7,587 | 6,914
JSUT a eS 3, 059 339 1, 534
(0G S02 5,168 | 1,152 802
Rhode Island:
Genmeraleos See os 894 305 204
TBSINTOX6 Lg os Be aa ee 58 ‘7 0
South Carolina
CoCr Ste ae 5, 734 | 1, 942 1, 664
JOINIGNG eae 379 121 176
South Dakota:
CHaVeidey ee Bet ee 909 287 91
Shien Be 117 22 56
Tennessee:
Generale ee ae 5,3298)) 2,145 | | 15025
IBN Ove IS 5 eS ee er 797 185 135
Texas:
@enerale oe. .-- 10,154 | 2,719 | 2,623
IEISNG |e tae eS 1, 290 364 475
Witineeweere ee 1, 295 372 374
Vermont:
Generale ee 907 265 525
iawn ere Fe? Ue 56 25 16
Virginia:
CONC?) Le er 11,259 | 3,193 | 4,738
TSG 2 Sa a 493 119 150
Washington:
CC 6,251 | 1,433] 2,654
TESST G| = 5 ee ee Oe 184 60 74
WiesteViroimia<. 9.2... ._- 13,1438 | 3, 861 3, 711
Wisconsin:
Genenge es. esas - 5,482 | 1,682] 2,274
JESU OC6 ba 148 72 45
\WWiiG@inniiet ae eee 984 207 409
Cases
During fiscal year
Re- Total
main- | active
ingat | load
end of | (receiv-
year 3 ing
serv-
ices)
135 480
4 92
iL, Bas 2, 460
298 423
356 604
83 93
5, 294 | 18, 302
452 764
1, 346 8, 961
285 1, 454
695 T47
2,265 | 3, 659
166 676
1, 009 6, 697
1, 970 2, 820
58 149
6, 580 | 14, 707
1, 186 1,176
3,214 | 2, 887
385 802
1 192
2,128 | 4, 687
82 248
531 828
39 bo
2,159 | 4,672
477 589
4, 812 9, 135
451 784
549 | 1,147
1D Ne/ 642
15 67
3, 328 6, 974
224 22h
2, 164 3, 591
50 157
5, 57 8, 190
1, 476 4, 789
31 193
368 470
Closed from active load
bili-
After
Before
Reha- |rehabil-|rehabil-
itation | itation
tated |plan in-|plan in-
itiated 4\itiated 5
Re-
main-
ing at
end of
year 6
1 In States which have 2 agencies, the agency under the State board of vocational education is designated
as “general,”’ and the agency under the State commission or other agency for the blind is designated as
“blind.’’
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 yet determined. Aye ; i ie
‘ Closed after rehabilitation plan was agreed upon and approved by supervising official; received rehabili-
tation service but never reached the point of employment because of personal factors, illness, aggravated
disability, etc.
§ 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, 1956.
240 Department of Health, Education, and Welfare, 1956
a
Table 2.—Vocational rehabilitation grants, 1956, State divisions of vocational
rehabilitation
Support Extension Expansion
State or Territory grants and improve- grants 1
ment grants
1 DG 3) Lee ite a I as ah RN $26, 250, 052 $870, 958 $997, 812
Allaah alee oe oye Ss ee De Peg Spee 962, 134 28, 196 44, 797
YASIZOTN GSE oe che eee ie ete Pee eee Re 185, 640 2, 097 6, 133
PA kgm agra eeba fol URS Blt Si Bat ities 601, 369 17, 255 26, 802
Californigg titel Lal ele eae Sok aah 1, 780, 220 118, 418 91, 476
Coloradowitegh): satiate). te" eS aes 196, 979 6, 512 24, 005
Connecticqubm@ane syataio Mater: bs fees 317, 053 16. 038 47, 307
Delaware ieee ete fee = oboe eee 137,688. 2 jo2 2. eed SL See eee
UDA LOy site Ee apn eenieew) SNe hes ay Pea et ee 756, 156 17, 870 28, 309
CE KC) eta te Hare SPE AS (ae pes Tee ee 1, 750, 735 17, 324 12, 762
TESTO kre er ee ay ar a Ee ey ce teh Be 66, 855. | oc cncos kee |e
WM OISe Ae Ser S.A Ba) Ree ae 1, 359, 118 18, 060 69, 637
neighia: Sa So ee Pah enh ee ae 3008738) 4.56052 te eee 5, 954
Baie ees Me DENS ORS eae Np Pa led eA 463, 703 21, 000 21, 870
WAmsgc! Te... (GEER hee one Cee 225, 199 9.336 W..2e ae ee
Mentueky. 2-2. 5UGe. sek eee eee eee 2 261, 482 25, 893 18, 768
TLOUIsiaM ance k. Fo see e. a he Se ee ee ed, 2 PSL AGAS) | Cope ee eee ae 19, 586
Via tive ete soe Neh Oe eae Fo Ley 137, 649 7, 722 5, 5383
Sd MeN casa OW a (6 beware RA ie 8 SSOHOZSs| [2 eee ae Ree 5, 500
INISSSaChUSettS a4 seme ob ee eee eee ee 353, 006 37, 439 23, 897
did Rges Gu pessh cB ee eee yas ee REN 2 BE | 0 he 1, 049, 513 30, 506 52, 017
INTIME SObal shoe Se eS ene ae 478, 453 22, 341 48, 000
INEISSISSID Dl ees cee ere een teen ee 265, 432):|e aoe. on S|
IVIGSSO UTR. os SEE) ee er Epa 501, 734 8, 411 58, 607
Monta Gites. / See eo eer eee 12882380) |. f24 Se. . 3 eee
INebraskaal se: hayeer sce eae, 62) ea 2 182, 357 5, 384 33, 284
INVA CINE zs eee 2s SCE ae Ea eee 30, 584 1, 716"...
INeweakiamipshire i. 2: bee we be hee 48, 240 5, 000 3, 563
ING Wis ORSON. oe Me 8 See Ee wh eee 550, 564 47,480 || 2.2: 2255 0e eee
NeW Viexicou oi fae, =e eR ee ae 110, 961 1,056 ‘|. 2 eS eee
INO WViORK = tae eel eo sen Seen cmb eee © 1, 762, 447 57, 811 15, 920
INortniGaroling: AO... Twin ee Oe 763, 640 38, 396 28, 467
NorthiDakota: ce 4.2 we Ce ese 168, 272 4, 211 4, 260
OPTOMA re er Bees See ee 460, 677 H6nol | S28 ss ee
Okdahom as. 22 252 Tee: AS he 633, 941 20, 490 13, 014
Oreconveen ac, WE So PS 331, 756 11, 886 15, 652
Penns yivallia. 2 een 22a) TE a 2 2, 055, 081 40, 378 101, 816
mhodetislanid 2363220 ul ke8 . Saha eo 112, 761 mar a era em
Sout Caro linge. =. -- sa bere oe eee 478, 943 12, 000 500
Southvpakotacl.. = =e ae 2 es 105, 422 2, 696 4, 100
Moennessee: twine 6 ei ee ee eo 613, 344 9, 600 17, 000
PRG RASH NDOT oh eee EN sha ee Be 816, 523 23, 480 52, 225
UDG se Uark palm.) (8 eeaaeee gem Cea Seen Pree 2a ke. ates 135, 294 6,(889 2 Eo eee
NVGrimon G22 Gat Sa= 226 ee ae el peek L1L5607 (2 Si Jo. BEE ee
WAT OUI ge la. - te See UE A 2 gee ee 757, 168 31, 077 22, 366
Wiashinstom. i. eo e ey se Ras 494, 420 10, 292 17, 014
iW OSTHNARSTIA Ce co a2. gale Eee eee 752, 869 17, 590 13, 040
IWiScOnSIneE: 525) OD Bale ee Sa oe 502, 057 23, 369 22, 800
VV V OID TT OSH 2 os sR, SO 895002) | eee 2 ee | ee
IA ais aerated an eae ee eee Ihe 76, 340 5, 000 1, 147
EVA Waa SSE ies ee Sn Sd a 151, 072 3, 000 2, 027
PST Ome ICOw. fae ee 5 ee UO Se a 249, 439 20, 065 12, 889
DistVomeolimiblates. sc. pie a eee ee ee 248, 209 6, 319 5, 768
Total
$28, 118, 822
1, 035, 127
193, 870
645, 426
1, 985, 114
227, 496
380, 398
137, 588
802, 335
1, 780, 821
66, 355
1, 446, 815
366, 692
506, 573
234, 535
306, 143
801, 234
150, 904
338, 528
414, 342
1, 132, 036
548, 794
265, 432
568, 752
128, 230
221, 025
32, 300
56, 803
597, 994
118, 017
1, 836, 178
830, 503
176, 743
517, 414
667, 445
359, 294
2, 197, 275
116, 479
1 Includes grants to non-profit agencies for projects developed in cooperation with State Divisions of
Vocational Rehabilitation.
Office of Vocational Rehabilitation
241
Table 3.—Vocational rehabilitation grants, 1956, State commissions or agencies
for the blind
State or Territory Support grants
REE ee cy os $3, 749, 948
I 36, 722
Pe 8 oS 37, 959
Merwe. 51, 061
UDG ray anOmeee ee ee 42, 273
os MC ee 286, 786
DS Ee 9,
i "a 49, 273
LENOIR) co ee 24, 949
LGMOE ae 5 Sea ee 87, 736
LUNN SERN) sg 138, 104
ila eee ee el ek 37, 702
WNNassaeiuUsetts.— =<. 02. sok 75, 881
OPTUS) (E00) oS 110, 528
0 as 124, 787
a ES Se gle 174, 733
IMS SEQNS TT es Bs 192, 850
Pyilomittie re WU ee 28, 649
Cp gS 59, 062
Puew pearmpenire... 2-2 ele 21; 212
DNewaversoyenoe 2 So ie bi 140, 140
ING weVWieGxiCO.. 222-2050. 8 ele 30, 487
ING 00 ae 2 270, 576
INOEEa @arolna: 2.3 450, 370
Oriigure emewee = Vise a ee 163, 645
GUAT 2 SE IE es a See 49, 462
Heenmisvavaniaes se 52.0. eee fe ek 284, 478
HUROGOMSIENO mss ce = ce 27, 936
mouGhe@arolingees sii euee oe eek 41, 719
BOULMEDOROtiee 2.2 ok 33, 019
LUSIOS ORNS cs 0 EI le ee ae 241, 555
(SSDS a ee eee eer 212, 068
GET OE GS cee eS ea Sn 18, 237
NW SEA TIN 8s Oe a pee 49, 123
ANYOSPIN 012 5(0)0 ea 41, 571
Wes SECO EGS EE | 2 eee 74, 706
OE OS ee eee ae ee oe 31, 043
Total
Extension and Expansion
improvement grants 1
grants
$132, 153 $67, 699
ae By OOOn Benches oe enenue
iy fet ps SRO ap Ad 10, 708
Cin 1 BOO*| Sar ume eee ne
DG DARN ie Baie se ces ee
4189 eeee eo eee
See wi a 600| ~~ «4,600.
Deed? d SGU phe merck Nts oe
Syne. 7RABA: | 2 OT pees
of lie 4 eae” ieee 23, 930.
25020 ul teccsee cele emer
DLs eA Se ee 21, 456
Sn - Re OST) kee re cat
Bi ae AB el ap 5, 000
2390 (8) | aera nae perenne
ERI NS We a bs 2, 005
yee 125076, | Aoee Specie:
LOO (See ee eee
$3, 949, 800
1 Includes grants to non-profit agencies for projects developed in cooperation with State Commissions or
Agencies for the Blind.
Labs : Ae ve ae Cispatedisenes. if Ht
4, j
ANTE Sy ONE eee te >
zebavida mente avitsins eis pate enn: pone ron
Fe alee iat Pao
ork teeter eid nce g
‘
4 » 5
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‘ he fr { H wean” 3 vin fang SO
Eechii ERIE se LOONIE, | STUAIE eet
bet ae }
e"
a ‘ ~ pastony _ ¢
wy, Aral 1. ree PRET Ba
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Seba : ee yy
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i E rs { yy
me + APPR : his os
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im 4 } Le)
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. i
y h
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3
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hk
i
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.
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,
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u
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7 ®
-
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7 ,
Saint Elizabeths Hospital
THE YEAR JUST CLOSED has been one of change and development. As
for the physical plant, two new buildings, the Dorothea Lynde Dix
Pavilion and the new Saint Elizabeths Chapel have been opened,
while plans have been proceeding apace for the new Maximum Se-
curity Building. The Men’s Receiving Building has become the
Wilham A. White Building and its function will be that of an inter-
mediate treatment building. The former Women’s Receiving Build-
ing, renamed the Charles H. Nichols Building, has become a part of
the Geriatric Service. The Oaks Building, formerly used for women,
has been vacated and will be demolished in the near future.
Perhaps even more important than the new buildings is the de-
velopment of new programs for the treatment and care of patients.
Throughout the hospital the use of administrative discussion groups
and an increasing degree of permissiveness allowed to the patient has
been developed. This program has been aided by the services of a
social scientist. In the Dix Pavilion the new development of non-
stratification of patients has taken place. The building is particularly
suitable for this, having no large dormitories, and the plan of ad-
mitting patients to the same ward whether they be disturbed, suicidal
or quiet has worked out very satisfactorily. The program of self-
government carried out in the Maximum Security Section has been
further developed and a considerable additional number of outside
groups of volunteer visitors have come to the hospital. These are but
a few of the changes of a progressive nature which have taken place
during the year.
The most significant event of the year was the dedication on
April 13 of the Dorothea Lynde Dix Pavilion by the Vice President
of the United States, The Honorable Richard M. Nixon. The hospital
was greatly honored on this occasion by the presence of Vice President
243
244. Department of Health, Education, and Welfare, 1956
Nixon, the Secretary of Health, Education, and Welfare, and a large
number of other distinguished citizens. Earlier, on December 5, the
date stone of the Chapel was set, in ceremonies participated in by
Chaplains of the three major faiths, the Superintendent, and two
patients—perhaps the first occasion on which patients (for whose
benefit the hospital is operated) took an official part in such a
ceremony.
The use of the tranquillizing drugs, noted in last year’s report, has
been extended with greatly beneficial effects in the general atmosphere
of the hospital and the comfort of the patients. The use of these
drugs has permitted the granting of ground privileges to a much
larger number of patients, and has to a very substantial extent in-
creased the return of patients to the community. The number of
patients in the hospital has shown an actual decrease during the
current year. The average number of patients in the hospital during
June 1955, for example, was 7,277, but one year later this number had
dropped to 7,010, a decline of 267. Careful studies are being made
by the hospital’s statistician to determine how lasting are the effects
of the drugs on the discharge rate.
Note should be made of the publication of “Centennial Papers”,
a volume made up of the addresses given at the Centennial Celebra-
tion of the hospital in 1955. During the year the hospital was honored
by the visits of physicians and others from 26 countries.
Division of Medical Services
CLINICAL BRANCHES
The psychiatric care of the patients is assigned to the three clinical
branches. The Medicine and Surgery Branch operates the Medical
and Surgical Building and the Tuberculosis Service, where the pa-
tients who are acutely physically ill are cared for. AJl of the other
activities of the hospital, such as Laboratory, Occupational Therapy,
Volunteer Services, Maintenance and Construction, are auxiliary to
the work of these four branches.
Once again emphasis is placed upon the ever present problem of
overcrowding. Even in spite of the fall in population the excess of
patients over proper bed capacity is 556 or approximately 814 percent.
It should be noted that the buildings which have been added in the
last 10 years have been replacements and have not resulted in any
increase of bed capacity. There are some indications that the popula-
tion may stabilize at the present level rather than showing a further
drop.
It still remains necessary to maintain a waiting list for prisoner
patients to be admitted to Howard Hall. So pressing has this matter
Saint Elizabeths Hospital 245
become that it has appeared necessary to make plans for remodeling
the so-called Pine Ward in the Center Building as a medium security
unit to accommodate the increasing number of prisoners. There is no
reason to think that the demands on the hospital for this type of ac-
commodations will decrease. With the increasing recognition by the
courts of the psychiatric factors in criminal behavior, indeed, it is
likely that the number of patients of this sort will increase. Even-
tually the new Howard Hall will remedy the problem, but that build-
ing is still several years in the offing.
Attention has been called repeatedly to the difficulty in filling senior
staff positions in the hospital. One great difficulty which operates
against us is that another agency of the Government is permitted to
pay a premium of 25 percent of salary to physicians who are diplo-
mates of specialty boards.
There is no change to report in the matter of the elderly patient.
Approximately 40 percent of the patients admitted are 60 years of age
or over. The program of admitting the patients over 64 years of
age to the Geriatric Building is working effectively, and an attempt
is being made constantly to return these elderly patients to their homes
or to other places (such as the District of Columbia Village) where
they may be adequately cared for.
In the line of treatment the so-called tranquillizing drugs appear to
be working very well. The hospital, as always in the past, attempts to
follow an eclectic approach to treatment. An active program of in-
dividual and group psychotherapy is carried on. Treatment and dis-
cussion groups of one sort or another are now widespread in the hos-
pital. The District of Columbia Rehabilitation Service and the
Board of Education have been very helpful. Recreational therapy
has been very considerably extended, while in selected cases electro-
shock, subshock insulin and hydrotherapy continue to be used. With
the new drugs, however, all of these methods, particularly electro-
shock, are showing a substantial drop. Hydrotherapy continues to
have a useful place. Prefrontal leucotomy, never done with any fre-
quency in this hospital, has not been performed at all during the
past year.
The activity of the patients in asking for writs of habeas corpus
has shown some increase. For example, there were 46 orders to show
cause why such a writ should not issue, as against only 15 in the pre-
ceding year. Thirty-seven of these orders, however, were dismissed.
The number of writs showed a slight decrease, only 20 being issued,
and only three of these resulting in the dismissal of the patient.
During the year 1,327 patients were admitted, while 884, or 66.61
percent, were discharged. This is the highest discharge rate since
1946, when acutely ill patients from the Navy were still being treated.
246 Department of Health, Education, and Welfare, 1956
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MEDICINE AND SURGERY BRANCH
The services of the Branch are available to the patients of the hos-
pital who are in need of medical or surgical attention of a specialized
nature and to those employees who become ill or injured while on duty.
During the year 2,762 patients were admitted to the wards of the
Branch and a total of 45,066 patients made visits to the clinics.
PSYCHOTHERAPY BRANCH
Psychodrama has continued active, with 345 sessions for patients
and 103 conferences. Dance therapy has been considerably expanded,
and several individuals have come to the hospital for training in this
new and promising field of therapy. The art therapy has also been
carried on successfully.
PSYCHOLOGY BRANCH
During the year the psychological activities, formerly carried on a
section basis, have been placed in the status of a branch. During
the year 2,785 tests were given to 807 subjects. Many of these sub-
jects were employees of the hospital in various grades. During the
year the Branch has been approved by the American Psychological
Association as an approved training center for clinical psychology.
It is one of the few centers to receive such approval. ~ > SS6I ‘0g PUNE ‘sT[O1 UO
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NEEDS OF THE HOSPITAL
TaBLE 1.—Movement of patient population, fiscal year 1956__.____-____-
TasBLEe 2.—Consolidated statement of movement of patients, by classifi-
cation; fiscal year 195602 2&5. 92.2 a2 SL Pe ee
AMERICAN PRINTING HOUSE FOR THE BLIND
Services to Schools and Classes for the Blind
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HOWARD UNIVERSITY
Enrollment of Stadents-2o 00. 8 ee ee
Geographical Distribution of Students
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The Building Program
Graduates
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U.S. GOVERNMENT PRINTING OFFICE: 1987
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