DATE DUE _ GAYLORD PRINTED IN L 111 .A3 1957-1959 United States. Dept, of Health, Education, and Annual report of the U.S Department of Health, VOLS. HEIGHT COLOR LIB IMPRINT NONE BOUND BEFORE SEE OLD COVER SEE RUB NO LETTERING SEE S. B. DO NOT COLLATE DO NOT REMOVE ADS OR COVERS CRITERION BINDING CHARGE HAND SEWING SHELF NOS. EXTRA THICKNESS STUBBING HINGING LETTERING IMPRINT EXTRA TIME PREPARING, ETC. 2 SEPARATE SET BY PEELING AT THIS SHEET AND BREAKING SPOT PASTING IN STUB 1957 U. S. DEPARTMENT OF 1 1 (3 HEALTH, EDUCATION, AND WELFARE T— - (p- ,51~ 5 k ( < DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE MAY 22 1958 LIBRARY EDUCATION COLLECTION. 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, 1957 Marion B. Folsom, Secretary John A. Perkins, Under Secretary OFFICE OF THE SECRETARY Elliot Lee Richardson Edward Foss Wilson . Aims C. McGuinness . John R. Mackenzie . . Willis D. Gradison, Jr. Charles F. Barrett . . Parke M. Banta . . . Rufus E. Miles, Jr. Chester B. Lund . . . Harvey A. Bush . . . Frederick H. Schmidt . Assistant Secretary for Program Analysis. Assistant Secretary for Federal-State Relations. Special Assistant for Health and Medical Affairs. Legislative Liaison Officer. 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 . . . Commissioner of Social Security. William L. Mitchell .... Deputy Commissioner of Social Security. Victor Christgau .... Director , Bureau of Old-Age and Survivors Insurance. Jay L. Roney . Director , Bureau of Public Assistance. J. Deane Gannon .... Director , Bureau of Federal Credit Unions. Katherine B. Oettinger . Chief , Children’s Bureau. PUBLIC HEALTH SERVICE Leroy E. Burney . Surgeon General. W. Palmer Dearing . Deputy Surgeon General. John W. Cronin .... Chief , Bureau of Medical Services. Charles E. Burb ridge . . Superintendent , Freedmen’s Hospital. Ons L. Anderson .... Chief, Bureau of State Services. James A. Shannon .... Director , National Institutes of Health. OFFICE OF EDUCATION Lawrence G. Derthick . . . Commissioner of Education. Wayne O. Reed . Deputy Commissioner of Education. 11 '3‘f'Y7 FOOD AND DRUG ADMINISTRATION George P. Larrick . Commissioner of Food and Drugs. John L. Harvey . Deputy Commissioner of Food and Drugs. OFFICE OF VOCATIONAL REHABILITATION Mary E. Switzer . Director of Vocational Rehabilitation. E. Emory Ferebee . Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL Winfred Overholser .... Superintendent. Addison M. Duval . Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Finis Davis . Superintendent, American Printing House for the Blind. Leonard M. Elstad . President , Gallaudet College. Mordecai W. Johnson .... President, Howard University. REGIONAL DIRECTORS Lawrence J. Bresnahan . . . Region I, Boston, Mass. Joseph B. O’Connor . Region II, New York, N. Y. Edmund W. Baxter . Region III, Charlottesville, Va. Richard H. Lyle . Region IV, Atlanta, Ga. Melville H. Hosch . Region V, Chicago, III. James W. Doarn . Region VI, Kansas City, Mo. James H. Bond . Region VII, Dallas, Tex. Albert H. Rosenthal .... Region VIII, Denver, Colo. Fay W. Hunter . Region IX, San Francisco, Calif. iii Letter of Transmittal Department of Health, Education, and Welfare, Washington , D. G.% December 1, 1957. Dear Mr. President: 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, 1957. Respectfully, lk'(h _ , The President, The White House, Washington , D. G. Secretary. VI Contents Page The Secretary’s Report . 1 Social Security Administration . 17 Public Health Service . 83 Office of Education . Food and Drug Administration . 193 Office of Vocational Rehabilitation . Saint Elizabeths Hospital . American Printing House for the Blind . 247 Gallaudet College . 249 Howard University . 251 {A detailed listing of the contents of this report, byl topic headings, will be found on pages 255—2630 J Vll The Secretary’s Report The concern of the Federal Government for the human problems of its citizens runs deep in the mainstream of American history. The Public Health Service began in 1798 to care for sick and in¬ jured merchant seamen. Today it is the principal health agency of the Federal Government and the largest sponsor of medical research in the United States. The Food and Drug Administration, origi¬ nating in 1906 as a bureau of the Department of Agriculture, now has heavy responsibilities for the safety and purity of more than $62 billion worth of foods, drugs, and cosmetics. The Office of Education, established in 1867, has grown with the in¬ creasing importance of education in the United States. Today it con¬ ducts research, provides educational information services, and admin¬ isters grants to improve the education of the American people. Social security, a product of the depression of the 1930’s, today is a key bulwark to a strong national economy. Under it : old-age, survivors, and disability insurance provides a base of protection for most Amer¬ icans ; public assistance provides financial help for millions of needy persons ; and the Children’s Bureau is a focus of national concern for the health and welfare of children. The Office of Vocational Rehabili¬ tation was created in 1920 and has steadily expanded its services to the disabled as new knowledge in its field has become available. When these agencies were brought together, and then in 1953 ele¬ vated to a Department of the President’s Cabinet, their well-estab¬ lished traditions were carried forward to provide better service to all Americans. This Government’s concern for human problems has its roots in America’s belief in the worth of the individual. This dedication, which was expressed by the Founding Fathers, has grown stronger 1 2 Department of Health , Education , and Welfare , 1957 with time as our way of life has successfully withstood attack from without and from within. It has taken on added meaning in recent years as the physical and social sciences have developed new means and methods for advancing human welfare. Today it is generally recognized that contributions to the betterment of the individual measureably increase the strength of the whole Nation. When people are healthy they produce more and buy more. Ed¬ ucated people increase not only their own earning potentials but they add to the cultural and material wealth of their communities. Work¬ ers whose retirement and dependents are protected by social security feel more secure in their work and are less likely to need tax- supported relief. All the activities of this Department in the past year were directed toward improving the health, education, and economic security of the American people. These remain our primary objectives. Health Americans are among the healthiest people in the world. A child born in the United States today can reasonably expect to live 21 years longer than if he had been born at the turn of the century. This year the Nation’s population grew by more than 2.6 million people — an increase of about 16 people out of each 1,000 — one of the highest rates of population increase in recent American history. This came about largely because the health sciences devised better ways both to prevent and to cure illnesses, and also because people knew more about keeping themselves well. While the Nation’s birthrate has remained high since the end of World War II, the rate of deaths has been declining. For instance, from 1946 to 1956 maternal death rates fell 76 percent and infant death rates dropped 23 percent. Sharp declines have taken place in the mortality rate for several diseases, most remarkable being that of tuberculosis, which dropped from about 36 deaths per 100,000 popula¬ tion in 1946 to about 8 in 1956. This year even polio, that dread de¬ stroyer of children, was receding dramatically in the wake of a frontal assault with the vaccine developed by Dr. Jonas E. Salk. But there were new health problems to be met and many old ones whose solution seemed long overdue. The chronic diseases accounted for an increasingly larger proportion of all ailments. The two major killers of all persons were heart disease and cancer. They were par¬ ticularly virulent among the aged, causing four-fifths of all deaths in persons 65 years of age or older. The Secretary’s Report 3 RESEARCH Research is the essential base for medical and public health prog¬ ress. Both direct research by the Public Health Service and the spon¬ sorship of research outside the Government have grown rapidly in recent years. In the past 10 years, research programs of the National Institutes of Health — the principal research arm of the Public Health Service — increased from $8 million to $183 million this year. More than two- thirds of this money went to sponsor research by scientists working in schools, hospitals, and other institutions outside the Federal Govern¬ ment. As research work expanded, it became clear that a balanced and effective program would require more emphasis on the training of personnel needed to conduct research. NIH support for the training of promising scientists has been increased from $2 million in 1953 to more than $5 million this year. More recently, when inadequate facilities threatened to interfere with the medical research effort, a new program was launched to pro¬ vide $90 million over 3 years for matching aid to build and equip health research facilities. A total of 109 grants to nonprofit institu¬ tions in 31 States was awarded under the first $30 million appropria¬ tion by the Congress. Before the close of the year, Congress appropriated another $30 million for this purpose. Some of the discoveries at the National Institutes of Health in the past year illustrate the extent to which it is developing new knowl¬ edge. Researchers reported several developments in the treatment of cancer with drugs. A rare type of malignant solid tumor apparently was entirely suppressed by treatment with a drug, methotrexate, a chemical originally developed for the treatment of leukemia. Second¬ ary cancers which had spread from the original also were healed. Other experiments with reserpine, known for its benefits as a tran¬ quilizer, suggested that it may also have application in treatment of leukemia. The Cancer Chemotherapy National Service Center, in its second year as headquarters for the nationwide cooperative research program, arranged for the testing of more than 24,000 compounds for their possible use as anticancer agents. Long research culminated in the development of an experimental vaccine against a number of respiratory disorders which cause wide¬ spread hardship among large numbers of Americans. Researchers on the treatment of burns discovered that an injection of human gamma globulin, a blood derivative, would reduce the possibility of death from infections which often follow severe burns. 4 Department of Health , Education, and Welfare, 1957 The Nation benefits from all research which helps to advance the body of scientific knowledge. Identifiable achievements in science in¬ variably come as the combination of many efforts. Since one dis¬ covery builds upon the foundation of another, the earlier work is just as important to the final result as those which eventually are recog¬ nized as helping to save lives and advance human welfare. MEDICAL SERVICES The Public Health Service provides medical services for merchant seamen, American Indians, and certain other designated groups, and it assists other Federal agencies in providing needed medical care. It also administers the local-State-Federal program of hospital con¬ struction, an example of how Federal assistance has encouraged greater initiative and enterprise by individuals, private agencies, local and State governments. When the Hospital and Medical Facilities Construction program was started in 1946, there were about 10 million people who lived in areas without acceptable hospitals. That number has been cut by more than two-thirds in the past 11 years as more than 3,000 medical and hospital facilities have been built under the program — including 1,100 completely new general hospitals. In 1954, the President requested and Congress enacted legislation expanding the program to include Federal aid for four new categories : nursing homes, chronic-disease hospitals, diagnostic and treatment centers, and rehabilitation facilities. Since then 344 such projects have been approved for construction. They will provide 7,186 beds for elderly and chronic patients and 193 centers for outpatient care and rehabilitation. One of the serious limiting factors that retards the expansion of health services is the shortage of trained professional workers. This is especially true of nurses who, although their number has increased, are still in very short supply. To meet the most severe shortage, the Congress enacted and the Department established a program of aid to educate professional nursing teachers and administrators. The $2 million appropriated for the first year started 587 traineeships. Other medical services by the Public Health Service played impor¬ tant roles this year in protecting health : The Nation was free from smallpox for the fourth straight year. Much of the credit must go to the Quarantine Service, which inspected planes and ships bringing a record number of passengers into the United States. Many of these people came from other areas of the world where smallpox was epidemic. There was a mass migration of Hungarian refugees to this country, which required that these people be examined in large numbers and in The Secretary’s Report 5 places where facilities had to be improvised. By the end of the year, 33,413 refugees had been examined for admission to the United States. Substantial progress has been made in improving health facilities and services provided for American Indians and Alaska natives since July 1, 1955, when the Public Health Service assumed responsibility for the Government’s Indian health program. Additional physicians and other health workers were brought into the program, services were expanded, and the physical plant was improved. Better health serv¬ ices and facilities for Indians are bringing about improvement in the unfavorable health conditions which are prevalent among them. Par¬ ticularly notable are downward trends in death rates from tuberculosis and childhood diseases. SERVICES TO THE STATES About one-third of the Public Health Service’s budget this year was spent in grants to States and Territories in support of public health programs. The primary objective of the Department’s assistance was to bring the benefits of the latest health knowledge to the maximum number of people. One of the most dramatic health stories of the year was the rallying of health forces to fight an epidemic of Asian influenza. On April 18, 1957, doctors at Walter Reed Army Institute of Re¬ search in Washington cabled its military medical laboratory in Japan requesting cultures of a flu virus that had reportedly struck 10 percent of the population of Hong Kong. J ust 25 days after the request, the cultures were flown into Washington. About a week later, Walter Reed scientists reported definitely that this was a new variant of in¬ fluenza virus. This meant that people had no natural immunity to the disease and that vaccines developed against flu in the past would not protect against the Asian strain. Walter Reed immediately gave the virus to the National Institutes of Health, which transmitted prototype strains to six licensed vaccine manufacturers. By J une 7 a manufacturer sub¬ mitted an experimental lot of vaccine to the Public Health Service for testing. The Nation had developed a vaccine of considerable effectiveness against Asian flu before a case of the disease was confirmed in the United States. A few days later, when the first confirmed outbreak of Asian flu was reported in Newport, Rhode Island, the Public Health Service was already moving fast. Consultations immediately began with manufacturers who went into full-scale production of the new vaccine and agreed to distribute it according to a voluntary allocation system. In cooperation with pro¬ fessional and voluntary health groups, the Service conducted a na- 6 Department of Health , Education , and Welfare, 1957 tional campaign of public information to encourage maximum use of the vaccine. Medical and hospital authorities organized their resources to care for large numbers of sick. Additional money appropriated by the Congress permitted more scientific and laboratory support of the fight against Asian flu. By the fall of 1957, the Nation had weathered the most widespread influenza epidemic in 40 years — one whose impact had been reduced by the extensive use of vaccine. The fast identification of the virus, quick action by the Public Health Service, and prompt cooperation of health groups and pharmaceutical manufacturers throughout the country made it possible for a nation to organize in advance of an oncoming epidemic for the first time in history. Another striking illustration of nationwide organization to battle a disease was the attack on poliomyelitis. Only a few years ago, despite the generous gifts of the public and the hard work of the scientists, victory over polio seemed only a distant hope. No one knew how to cure it; no one knew how to protect him¬ self against it. Polio was a mystery disease. And then, the Salk vaccine was developed. All the years of work, and the faith and hope that prompted them, were justified. The Na¬ tion had a vaccine which, in test after test, proved highly effective in preventing paralytic polio. To encourage widespread vaccination, Congress appropriated $53.6 million for the purchase of vaccine — a program that was administered by this Department. About 64 million Americans had been vaccinated by the fall of 1957, almost half of them with the federally purchased vaccine. As the supply of the vaccine increased and as it was ad¬ ministered to greater numbers of people, the polio rates went down. Paralytic polio cases in 1956 — a year after polio vaccine had been administered on a large scale — were about half of what they had been in 1955. By the fall of 1957, paralytic cases were 80 percent below what they had been in 1955 and victory over this terrible disease seemed to be within reach. But public apathy threatened to interfere with the knockout blow. About 45 million Americans under 40 had received no vaccine, and 30 million had taken only one or two doses and have yet to complete the full schedule of three doses. Millions of doses of polio vaccine were lying unused on the shelves of manufacturers and druggists. And millions of unvaccinated people ran the needless risk of being crippled or killed by polio. The Department continued a vigorous public information effect to encourage greater use of the polio vaccine. The Department was also engaged on several other health fronts. To estimate the extent to which the population is being exposed to The Secretary’ s Report 7 radiation, arrangements were made to take a number of air samples from 80 points around the country, water samples from 10 streams, and milk samples from 5 milk-producing areas. Air pollution of all kinds is now being measured in every State through a newly estab¬ lished National Network of Air Sampling Stations. During the first year that Federal funds were available for construction of sewage- treatment works to reduce water pollution, payments totaling $37.9 million were approved for 446 communities. An expanded accident-prevention program, in its first year of opera¬ tion, organized a National Clearing House for Poison Control Centers. These centers have been established by about 100 communities to give physicians fast advice on the emergency treatment of patients who have been poisoned. The most frequent victims are children. The National Clearing House keeps these centers informed on the toxic con¬ tents of products sold for household use, and it recommends the treatment for people who eat or drink the products. The Public Health Service was authorized a year ago to begin a continuing survey of the Nation’s health so that the extent of illness and disability in the country would be more clearly defined. After a year of operation, the U. S. National Health Survey was preparing to publish its first statistics collected from door-to-door interviews throughout the Nation. A next step was to be medical examinations of a sample of the population. This continuing study will provide a valid basis for appraising the health of the American people and for planning methods to meet the health needs of the Nation. There has been remarkable progress in improving the health of the American people, and it is worth noting. But the real value of noting progress lies, not in self-satisfaction over achievements but in charting what must yet be done. Medical science is changing rapidly, and its scope is broadening. Medical progress itself has not only created new problems ; it has sharpened our awareness of human needs still unmet. Every forward step rightfully serves as a reminder of the distance yet to go. Food and Drugs A century ago the American family bought a comparatively small number of items. Most of the foods that a family ate were either raised or processed at home. “Boughten” foods were suspect — and with good reason, because too often they were unclean or adulterated. Medicines were simpler and less effective. The wise person either took the mixture compounded by the family doctor or brewed up a home remedy, because those were a lot safer than the kind that came from stores. The few people who used cosmetics settled pretty much for cold cream, rice powder, and simple fragrances. 8 Department of Health , Education , and Welfare, 1957 Today the country is in the midst of a revolution in consumption. The homemaker’s chores of food preparation — washing, peeling, shell¬ ing, and plucking — are greatly reduced by a host of foods that are ready to eat or nearly so. Bulk foods have almost disappeared. The average food store today stocks more than 5,000 items of packaged, frozen or canned edibles. In the drug field, over half the medicine used today by physicians and hospitals were unknown 15 years ago. And the cosmetics industry is one of the Nation’s largest. Yet the housewife seldom worries about the wholesomeness of a can of food, the safety of a bottle of medicine or the purity of a tube of lipstick. Her confidence is based upon the consumer safeguards which began in 1906 with the passage of the original “Pure Food and Drug Law” and much subsequent legislation which provides her with protection by the Food and Drug Administration and the State and local enforcement agencies. The average family spends about one-quarter of its income on the foods, drugs, cosmetics and therapeutic devices which are subject to inspection by the Food and Drug Administration. While Food and Drug Administration enforcement is necessarily very selective, in the past year it made 20,241 establishment inspections, seized 809 shipments of products which did not comply with the law, and com¬ pleted 182 criminal actions against violators. But to protect the public adequately it is necessary to keep legisla¬ tion up to date and in line with the swift changes in science and tech¬ nology of recent years. For instance, producers now add to foods: artificial sweeteners, colors, flavorings, stabilizers, preservatives, anti¬ oxidants, tenderizers, and emulsifiers. And other chemicals find their way into the food supply as residues of fungicides, insecticides, de¬ foliants, herbicides, and growth promoters. Under present law, to prevent the use of a harmful chemical in a food the Government must prove that it is poisonous or deleterious. Yet little is known about the toxicology of many of the new com¬ pounds and long studies are required. Therefore, the Department has recommended to Congress a bill to require that the manufacturers concerned must furnish scientific evidence that chemical food additives are safe before they are used in foods. On another front, the promotion of quack medicines continues to be a serious public health problem. One can no longer buy Indian Swamp Root Oil at the corner store, with labeling that promises to cure diabetes, cancer, or heart disease. But last year people were still going to some “clinics” to get a worthless medicine for cancer. Because protracted litigation could not be relied on to protect cancer victims and their families adequately, the Department posted a public warning against the treatment in thousands of U. S. post The Secretary’s Report 9 offices and other public buildings. These warnings and subsequent tighter enforcement measures by State agencies markedly reduced the number of persons who risk their lives by going to these “clinics.” Many types of fraudulent practices are not only becoming more widespread but are taking on the trappings of national movements and are bidding for wider public support. Associations have been formed with names calculated to convey the impression of scientific, medical, and public health aims. Conventions are held with pseudo¬ scientific agenda. The roster of speakers includes numerous persons convicted of violating the Federal Food, Drug, and Cosmetic Act. They attack organized medicine and the Government, alleging that there is a medical trust which seeks to suppress lifesaving medicines and treatments. Many people are influenced by these views, with a resulting loss of confidence in the medical profession and in rational medical treatment. Effective administration of the food, drug, and cosmetic law in¬ volves not only enforcement activities but a substantial educational program. The Food and Drug Administration increasingly directed its public information activities to counteract the growing efforts to promote fads and nostrums among the American people in place of sound health practices. Education In the past century sweeping changes have come about in American education. Teaching, curricula, methods, and materials have been changing and growing to keep pace with the growing Nation, with new scientific development, with the expanding sum total of knowl¬ edge, and with our increasingly important world position. With some 41 million Americans — a fourth of our population — in school or college during the year, the serious problems facing our schools remained a major concern of the Department. Enrollments in all elementary and secondary schools reached 39.1 million pupils — a record high for the Nation — and seriously over¬ taxed the ability of many schools to educate their students. This problem shortly will be inherited by American higher education. The number of young people knocking at the doors of our colleges and universities will almost double by 1970. The measures of increasing enrollments have brought into sharp focus deficiencies in the supply of competent teachers and other school personnel as well as crowded and inadequate physical facilities for instruction. 448006—58 - 2 10 Department of Health , Education , and Welfare , 1957 The States built a record number of new classrooms last year and improved the operating efficiency of their school districts. Yet they reported in February 1957 that obsolescence and mounting enroll¬ ments created a total shortage of 159,000 classrooms. Proposed Fed¬ eral legislation to help ease the classroom shortage was defeated in Congress for the second successive year. But Federal assistance continued to go to communities where school enrollments had increased significantly as a result of Federal activi¬ ties in their areas. This year Congress provided about $223 million, for both the operation and construction of schools in these communities. The finest school — the most helpful curriculum — can impart little of value without good teaching. The States reported that, while 1.2 million public school teachers were employed in elementary and sec¬ ondary schools, there was a nationwide shortage of nearly 121,000 qualified teachers. This shortage was met by employing additional emergency teachers and by further increasing the size of classes. The shortage of teachers, which is present today when our schools and colleges have some 42.5 million students enrolled, threatens to worsen steadily as enrollment grows to an expected 65 million stu¬ dents by 1970. If this is allowed to happen, it will be a severe blow to our national strength and welfare. Americans should recognize one awesome fact: whatever coming generations think and do about law and government and the free way of life, about labor and in¬ dustry, about the quest for a durable world peace, about defense against aggressors will be determined to a substantial degree by the day-to-day influence of the teachers provided for them. Another problem of far-reaching significance to the Nation was the very large number of capable students who are unable or unwilling to continue their education to the limits of their intellectual abilities. This is a waste, not only of individual opportunity but of the most valuable resource of the Nation as a whole — the talents of its young people. This attrition works all through the school years. About 60,000 of the more talented students drop out of high school each year before graduation, according to some studies. But — and this may be even more important — of those who do graduate in the upper fourth of their class, more than 1 out of 3 do not go on to college. In all, more than 200,000 of the students who could profit most and make the best contribution to society end their education below the college level. While several major problems — buildings, teachers, and manpower needs — have been widely publicized, many others are important and are receiving the attention of the Office of Education and private agencies. It is encouraging that in the past year the Office of Edu- The Secretary’s Report 11 cation has been able to launch a promising new program of research in cooperation with colleges and universities and State educational agencies. As required by Congress, about half of the first year’s projects dealt with the important problem of education of mentally retarded children. The Office of Education has also been able to expand and improve its fact-finding and consultant services. These services are con¬ cerned with such matters of widespread concern as school finance, instructional programs, adult education, guidance, effective and eco¬ nomical design of classrooms, improvement of practical nurse train¬ ing, and other vocational education programs. The budget for the operations of this Office has been substantially increased in the past 2 years, but much remains to be done before the Office can make a maximum contribution to the cause of education throughout the country. If American education is to be improved significantly many matters must receive closer attention at the State and local levels. These in¬ volve such matters as the curriculum, the methods, and the philosophy of education. They touch on such questions as whether Americans are neglecting basic learning in such fields as the sciences, mathe¬ matics, English, foreign languages, and history, and whether some scholastic standards are failing to challenge the best in many young minds. One fact has been demonstrated so often and so clearly as to be beyond dispute: education is a keystone in the economic and social progress of the American people. At any time, to fall behind in edu¬ cation is short-sighted false economy. In today’s perilous world, to fail to invest enough of our expanding resources to support education on the scale that is necessary could be tragic. Old-Age , Survivors , and Disability Insurance This year the 10 millionth person began receiving social security (OASDI) benefit payments. At this milestone it is appropriate to restate some principles upon which this social insurance system is founded, to examine where it stands today, and to explore some of the results of this system after two decades of operation. One of the social security system’s most important principles is that benefits are earned through work — and the right to benefits is paid for by contributions from the worker’s own earnings and from his employer, as fixed by law. Another fundamental principle is that social security payments are not intended as a substitute for private initiative but, rather, are in¬ tended to provide a foundation upon which to build additional se¬ curity through private effort and individual thrift. 12 Department of Health , Education , and Welfare , 1957 A third important principle is that social security should be flexi¬ ble, keeping abreast of the times and utilizing new knowledge. De¬ spite a sharp growth in population, despite rapid economic change, and despite the shocks of war, the social security system has remained strong as its provisions have been adjusted in the light of changing conditions. Today — as the result of changes made in the law as recently as this year — more than 9 out of 10 workers, including self-employed persons, are covered under the OASDI program. They are earning protection for themselves and their families against the hazards of old age, disability, and death. And 73 million people, by their work now or in the past, are already insured under the system. Some 10.3 million former workers, their dependents, and their survivors were receiving $554.6 million in monthly benefit payments in June. About 8.5 million of these people were men aged 65 and over and women aged 62 and over, and the remaining 1.8 million were mothers and children. The first benefit checks were issued in July to more than 100,000 disabled workers aged 50 to 64 who were covered by the 1956 amendments to the Social Security Act. Many more applications had been filed and were being processed. The Federal old-age and survivors insurance trust fund totaled $23 billion at the close of the fiscal year, and the Federal disability insurance trust fund, created the previous year, totaled $337 million. The results of social security can be stated in two ways: what it did not do and what it did. Social security did not lower the standard of living or kill indi¬ vidual thrift, as was predicted by some critics of this system in its early years. But what did it do ? It has benefited millions of individuals and has had broad and profound effects on our society as a whole. Per¬ haps the finest thing about the program is that it removed the fear of a penniless old age from the minds of many people. The social security system also plays an important part in main¬ taining the Nation’s economic growth and stability by providing purchasing power for many persons who otherwise might be most in need. Finally, by providing for people at ages when they are least likely to have a source of income, it reduces the number of those who require public assistance. Public Assistance About 3.4 percent of our total civilian population receives some form of public assistance. Federal, State, and local governments this year paid almost $3 billion to assist some 6 million needy persons The Secretary’s Report 13 including dependent children, and aged, blind, or disabled adults. These programs were set up during the bleak days of the Great Depression. Why then, in the midst of prosperity and when in¬ come insurance programs are available, should the Nation be spending more than half again as much (in constant dollar terms) on public assistance as it did in 1938 ? One factor is the nature of the growth in our population. Our young and old — among whom dependency occurs most frequently — account for 80 percent of the persons receiving special types of assist¬ ance. And the young and old today represent a larger proportion of our total population than they did two decades ago. Secondly, many persons are receiving public assistance today be¬ cause the work they did in the past or the work of those who sup¬ ported them was not covered by social security. It has been only within the last few years that the social security system has covered nearly all the working population and thereby reduced the number of people who would be dependent upon public assistance in their later years. Furthermore, in aid to dependent children, the need for assistance arises from situations that are not covered by the old-age and sur¬ vivors insurance program. Most of the children have been deprived of parental support for reasons other than death — the only circum¬ stance under which children are eligible for survivors insurance benefits. Along with providing assistance, a primary objective of these Fed¬ eral programs is to develop services that will encourage self-care, self- support, and the strengthening of family ties. One of the by-products of such services should be the reduction of the number of those who are dependent on public assistance. Toward that end the Department proposed and the Congress au¬ thorized 2 programs : for more intensive research into the causes of dependency and for training social workers to help needy persons deal constructively with the complex problems contributing to their de¬ pendency. By the close of the year, however, funds to carry out these programs had not been made available. Services for Children The Children’s Bureau, which for 45 years has been the only Federal agency exclusively concerned with the welfare of America’s youth, this year gave special attention to two problems of great magnitude : juvenile delinquency and mental retardation. The adolescent today is under increased pressures. Although the vast majority grow up to be responsible adults, a sufficient number engage in delinquent behavior to cause concern all across the country. 14 Department of Health , Education, and Welfare, 1957 The Children’s Bureau continued its work on delinquency, concentrat¬ ing especially on developing standards for care and on training needed personnel. New emphasis was given to develop programs for a long-neglected segment of our child population — the mentally retarded. On the basis of the increased funds earmarked by Congress for this group of chil¬ dren, the Children’s Bureau approved 26 special demonstration proj¬ ects to be operated as part of State health department programs in maternal and child health. In addition, regular maternal and child health funds in many States went into programs for mentally retarded children. Vocational Rehabilitation Of the many handicapped and disabled people in America, there are many who — with some professional assistance — could become self- supporting. For the second consecutive year the State and private rehabilitation agencies, working with the support of the Federal Office of Vocational Rehabilitation, set a new record in the rehabilitation of handicapped persons. This year 71,570 handicapped persons were prepared for jobs and established in gainful employment, an increase of 8 percent over the previous year. The State-Federal programs cost $57.6 million to operate — $36 mil¬ lion in Federal grants and $21.6 million provided by the States. The men and women rehabilitated will increase their annual earnings from about $19 million to about $137 million in their first full year of em¬ ployment. It is estimated that during their average working life they will pay back in Federal income taxes a larger amount of money than the Federal grants used for their rehabilitation. Last year 14,000 of those rehabilitated were on public assistance rolls, receiving about $11 million each year. That same sum of money was spent once to rehabilitate these people and take them off public assistance. It is worth noting further that of the handicapped people rehabili¬ tated last year under the State-Federal programs, some 3,500 went into professions such as teaching, medicine, and engineering — all mak¬ ing important contributions to the Nation’s productivity. To alleviate the shortage of trained personnel, the Office of Voca¬ tional Rehabilitation allocated an additional $3 million in 200 awards for teaching grants and traineeships in rehabilitation. Ten medical schools received grants for training medical students in rehabilitation, and more than 100 doctors received stipends toward their training in physical medicine and rehabilitation. More than 2,000 persons al¬ ready in rehabilitation work studied in 80 short-term courses, financed The Secretary’s Report 15 in part by Federal grants. The Office also granted $1 million for the expansion of rehabilitation facilities or sheltered workshops, and an¬ other $2 million for research and demonstration projects. Special Planning for the Aged Since the turn of the century, our population has doubled. At the same time the number of those aged 65 and older has multipled 4 times. They represent more than 8 percent of our total population, and the proportion is expected to increase. If American society can better adjust to the needs of this growing number of older persons, it would both assist these people in living more meaningful lives and would enlarge the proportion of the popu¬ lation that is self-supporting and productive. Older persons — like everybody else — want and should have certain basic conditions of life. Chief among these is economic security — the financial ability on a continuing basis to maintain a level of living compatible with their standards and needs. But they should have more than financial security alone. Satisfac¬ tory living for older people would certainly include health services and housing suitable to their needs. Older people, like others, require opportunities for education, recreation, and full participation in community life. Many activities of the Department directly benefit the aged. Others assist them indirectly. Social security is one of the most important sources of income for retired workers and their survivors. Medical research is increasingly directed toward chronic and degenerative diseases. New grants are going for construction of chronic-disease hospitals and nursing homes. And the Office of Vocational Rehabili¬ tation, the Office of Education, and the Food and Drug Administra¬ tion pay special attention to the needs of older persons. To further strengthen this Department’s activities for the aged, a Special Staff on Aging was established this year in the Office of the Secretary. It provides consultation and information to States, communities, and voluntary agencies; serves as a clearinghouse for information and material on aging ; and issues a monthly news bulle¬ tin, Aging. It also serves as the secretariat for the Federal Council on Aging which was created by the President in 1956. The Council itself consists of representatives of 13 Federal departments and agencies. ***** * * The activities described here have not been the functions of a gov¬ ernment far removed from people. They are related intimately to human beings today. In the Nation’s efforts to improve health, education, and economic security, the goal is to develop opportunities for a better life for the 16 Department of Health , Education, and Welfare, 1957 individual. As the individual advances in these fields, not only is his own life enlarged but the Nation as a whole is enriched. This progress, therefore, is not the exclusive concern of private endeavor, of any one group of people, of any one administration, of any one level of government. Its fulfillment should be an aspiration of all men. Table 1. — Grants to States: Total grants under all Department of Health, Education , and Welfare programs, fiscal year 1957 [On checks-issued basis] States, Territories, and possessions Total Social Security Adminis¬ tration Public Health Service Office of Education Office of Vocational Rehabili¬ tation American Printing House for the Blind Total - $1, 963, 870, 093 $1, 594, 674, 421 $130, 390, 272 $204, 336, 577 $34, 228, 823 $240, 000 Alabama - 61, 212, 620 50, 593, 352 5, 087, 664 4, 440, 916 1, 085, 431 5,257 Arizona... . - 14, 730, 449 10, 933, 758 1, 217, 585 2, 312, 158 265, 206 1,742 Arkansas - 28, 475, 397 23, 350, 788 2, 052, 286 2, 337, 833 729, 323 5, 167 California - 214, 054, 627 171, 901, 675 6, 217, 198 33, 748, 271 2, 169, 849 17, 634 Colorado - 33, 686, 804 27, 608, 088 1, 413, 622 4, 428, 815 234, 386 1,893 Connecticut - - 16, 111, 563 11,998, 464 1, 575, 754 2, 175, 268 358, 292 3,785 Delaware.. . 2, 804, 930 2, 030, 261 178, 584 407, 328 188, 006 751 District of Columbia — 5, 766, 265 4, 993, 937 463, 490 79, 961 227, 826 1, 051 Florida... - 54, 651, 488 45, 333, 978 2, 859, 678 5, 429, 497 1, 122, 537 5,798 Georgia - 62, 878, 000 50, 153, 923 4, 682, 198 6, 118, 713 1, 915, 986 7, 180 Idaho _ 7, 578, 030 5, 631, 177 1, 011, 929 867, 535 66, 277 1,112 Illinois . . 69, 431, 797 59, 731, 222 3, 626, 024 4, 521, 467 1, 541, 428 11, 656 Indiana _ _ - - - 26, 066, 010 21, 315, 348 2, 335, 098 1, 928, 961 482, 487 4,116 Iowa _ _ _ 27, 914, 403 24, 039, 713 2, 029, 583 1, 315, 854 525, 257 3, 996 Kansas _ _ 27, 879, 787 21, 074, 145 2, 259, 607 4, 198, 327 345, 275 2, 433 Kentucky - - 41, 305, 703 36, 009, 394 2, 646, 689 2, 268, 184 377, 501 3, 935 Louisiana _ _ .. ... 87, 156, 376 80, 694, 527 3, 658, 481 1, 827, 217 972, 095 4,056 Maine _ 10, 705, 880 8, 336, 552 1, 046, 970 1, 107, 971 214, 387 Maryland - 24, 949, 435 12, 811, 218 2, 084, 390 9, 674, 701 374, 470 4,656 Massachusetts. _ 56, 697, 856 51, 144, 023 1,881,016 3, 049, 749 613,244 9,824 Michigan _ 58, 348, 681 44, 562, 897 5, 471, 029 7, 008, 278 1, 293, 769 12, 708 Minnesota . _ - 34, 873, 220 29,240,426 3, 236, 461 1, 594, 176 796, 509 5, 648 Mississippi - 31, 989, 934 26, 223, 936 3, 427, 081 1, 780, 390 554,682 3,845 Missouri _ 89, 295, 372 80, 276, 605 4, 587, 759 3, 717, 508 709, 234 4,266 Montana _ 8, 551, 118 6, 566, 056 549, 931 1, 263, 528 170, 642 961 Nebraska _ 14, 435,117 10, 822, 056 1, 407, 112 1, 970, 096 234, 411 1,442 Nevada _ _ 3, 258, 253 1, 856, 651 423, 909 944, 319 33, 374 New Hampshire .. . . 4, 594, 310 3, 273, 132 501, 224 732, 599 87, 355 New Jersey.. - 21, 622, 165 16, 020, 883 1, 727, 280 3, 215, 614 650, 697 7,691 New Mexico _ _ 16, 828, 501 10, 921, 606 1, 200, 375 4, 552, 144 151, 883 2,493 New York. - 135, 125, 027 119, 821, 080 6, 502, 991 6, 526, 311 2, 255, 028 19, 617 North Carolina. _ 49, 444, 674 38, 965, 494 6, 103, 765 3, 053, 848 1, 310, 422 11, 145 North Dakota - 7, 439, 843 5, 649, 843 994, 019 577, 236 217, 964 781 Ohio _ . - -- --- 68, 467, 207 57, 634, 310 3, 847, 831 6, 296, 978 677, 003 11, 085 Oklahoma. .. ... _ 63, 212, 680 51, 987, 194 3, 099, 316 7, 391, 471 732, 085 2,614 Oregon - - 15, 430, 630 11, 784, 367 1, 502, 763 1, 733, 154 407, 282 3,064 Pennsylvania - - 70, 170, 217 57, 890, 780 5, 309, 500 3, 904, 622 3, 049, 994 15, 321 Rhode Island _ _ 9, 790, 308 7, 071, 312 1, 018, 815 1, 475, 735 224, 446 South Carolina _ 27, 804, 266 21, 184, 730 2, 825, 206 3, 152, 164 639, 072 3, 094 South Dakota - 9, 730, 161 6, 771, 361 993, 034 1, 821, 457 143, 047 1,262 Tennessee _ . _ 42, 503, 932 35, 035, 802 3, 302, 210 3, 293, 230 867, 523 5, 167 Texas - 126, 575, 646 105, 403, 048 7, 777,958 12, 348, 662 1, 037, 236 8, 742 Utah _ 9, 735, 931 6, 833, 482 726, 911 1, 973, 903 200, 253 1, 382 Vermont _ 4, 610, 234 3, 601, 053 417, 125 330, 302 161, 754 Virginia . - 33,110, 928 14, 618, 186 3, 233, 589 14, 284, 826 968, 259 6,068 Washington ... _ 45, 545, 456 37, 066, 602 1, 264, 599 6, 633, 305 577, 135 3, 815 West Virginia _ . . 28, 658, 846 24, 390, 627 2, 540, 362 938, 918 785, 664 3,275 Wisconsin _ _ 26, 477, 413 21, 910, 172 2, 163, 733 1, 623, 066 774, 824 5, 618 Wyoming _ _ . ._ _ 3, 880, 686 2, 704, 242 404, 236 688, 791 83, 417 Alaska .. _ ... 6, 201, 251 2, 191, 025 435, 641 3, 478, 734 95, 851 Hawaii _ 7, 777, 305 4, 046, 214 661, 207 2, 889, 362 180, 131 391 Puerto Rico _ 13, 550, 510 8, 307, 848 4, 302, 303 595, 964 341, 932 2,463 Virgin Islands _ 429, 631 355, 858 47, 091 20, 000 6,682 Other possessions _ _ 343, 220 56, 060 287, 160 Social Security Administration Social Security in 1957 Program Emphasis Relationships between income-maintenance and service aspects of social security measures claimed special emphasis throughout the So¬ cial Security Administration. With the achievement of almost universal coverage under old-age, survivors, and disability insurance — about 92 out of every 100 jobs are now within the scope of the program — and as a result of the aging of the beneficiaries, questions relating to the need for certain kinds of services have come increasingly to the fore. The provision of dis¬ ability benefits through the 1956 amendments focused special attention on the relation between income-maintenance and rehabilitation services. Increased emphasis on medical and social services for public as¬ sistance recipients reflected the special impetus resulting from the 1956 amendments. The new provision for separate Federal matching to help States broaden medical care for public assistance recipients, while not effective until July 1, 1957, was already leading to the de¬ velopment of new medical care programs in several States where none previously existed and to planning for improvement or expansion of existing programs in other States. The 1956 amendment relating to the purpose of public assistance resulted in greater emphasis on social services leading to the strengthening of individual and family inde¬ pendence. During the year, the States took stock of the scope and level of services being provided and planned for their further devel¬ opment. With the focus on constructive and preventive approaches, the goals of public assistance as they relate to income-maintenance and other services were examined. 17 18 Department of Health , Education, and Welfare, 1957 The primary objective of the grant-in-aid programs of the Chil¬ dren’s Bureau is of course that of service. The amount and source of the income of families receiving these services is nevertheless also of concern. This focus on the relationships between maintenance and service aspects in each of the Social Security Administration programs in 1957 was extended also to interprogram activities. Continuing joint explorations by the Children’s Bureau and the Bureau of Public As¬ sistance of welfare services for aid to dependent children families provided further opportunity for a reevaluation of the interrelated¬ ness of income and other welfare service needs. The health needs and medical care problems of persons receiving insurance benefits or assistance received special attention. Stepped-up activities in the field of aging cut across program lines and took into consideration both service needs and income-maintenance aspects. Program Operations The number of beneficiaries of the old-age, survivors, and disability insurance program reached the 10-million mark in May 1957. At the end of the fiscal year, 10.3 million persons were receiving monthly benefits at an annual rate of $6.7 billion. This was an increase of nearly 2 million beneficiaries during the year and $1.4 billion in the annual rate. During the period between the 1956 amendments and the end of the fiscal year, 753,000 monthly benefit awards were made to women between 62 and 65 years of age. A total of 541,000 applications were received from persons having farm self-employment income, or their dependents or survivors. By the end of the fiscal year a period of disability had been established for 273,000 disabled workers. About 301,000 applications (including 86,000 from persons for whom a period of disability had already been established) had been received in district offices for the disability benefits provided under the 1956 amendments, first payable for the month of July 1957. Of the total of 10.3 million beneficiaries at the end of the year, 8.5 million or 82 percent were aged men and women, including 600,000 women aged 62-64. At the beginning of the year, aged bene¬ ficiaries — all of whom were 65 and over — made up 80 percent of the beneficiary rolls. In June 1957, more than half (52.4 percent) of the Nation’s 14% million people who had passed their 65th birthday were actually receiving benefit checks under the insurance program. Additional aged persons had their benefits withheld, generally because of em¬ ployment, and others had not yet retired and filed a claim. In all, Sociat Security Administration 19 more than three-fifths of the Nation’s aged men and women were eligible for benefits. Of the individuals who will reach age 65 in 1957, 3 out of 4 will be eligible. Old-age assistance caseloads declined by 20,000 over the year. The 2,504,000 receiving old-age assistance in June 1957 represented 17 percent of the total population 65 and over, a marked drop from the 23 percent who received assistance in the autumn of 1950 when old- age assistance caseloads first began to decline. Under each of the other three federally aided assistance programs, caseloads rose slightly. A total of 2.8 million recipients of aid to dependent children, aid to the blind, or aid to the permanently and totally disabled were receiving payments in June, 177,000 more than a year earlier. Payments under each of the programs averaged somewhat higher in June 1957 than in the same month last year. The aggregate of payments under the four programs rose 9 percent during the year to $233 million in June 1957. The higher expenditures, reflecting upward revisions in State standards of assistance to meet rising living costs, resulted in part from the 1956 amendments increasing the Federal share in State assistance payments. State maternal and child health agencies provided health super¬ vision in prenatal clinics for some 224,000 mothers in 1957. About 445,000 infants and 640,000 other children received health supervi¬ sion through well-child clinics. In addition, health departments provided nursing service for about 2,660,000 infants and other children. Crippled children’s services under federally aided programs reached some 290,000 children. A significant development during the past year is the trend toward the establishment of diagnostic and treatment centers in medical schools for children with handicaps. Efforts to strengthen and expand social services for children became increasingly difficult due to an insufficiency of qualified child welfare workers and to recruitment problems. State welfare agen¬ cies continued to use Federal funds for child welfare services primarily for personnel and professional education. The Congress, in appropriating $16 million for maternal and child health grants for the fiscal year 1957, earmarked $1 million for special projects for mentally retarded children and the House Committee on Appropriations recommended that approximately $1 million addi¬ tional also be used on the problems of mentally retarded children. By the end of the year projects had been approved in 26 States by the Children’s Bureau, with commitments totaling about $1,300,000. In addition, State health departments have reported budgeting over 20 Department of Health , Education , and Welfare, 1957 $500,000 of other Federal maternal and child health funds for children with mental retardation. Juvenile delinquency continues to increase. Provisional figures for 1956, based on juvenile court reports received thus far by the Children’s Bureau, 9how an increase of about 20 percent in juvenile delinquency cases over 1955. During the same period the child popu¬ lation in the age group 10-17 went up only about 3 percent. The lat¬ est annual bulletin of the Federal Bureau of Investigation’s Uniform Crime Reports shows an increase of 17.3 percent in police arrests of young persons under 18 in 1956 as compared with 1955. Reflecting this trend is the increasing volume of technical consultation and writ¬ ten guides for practice provided the State and local agencies work¬ ing to improve their programs to combat juvenile delinquency. Federal credit union operations continued upward during 1957 to new high levels. The number of operating Federal credit unions was 8,592 on June 30, 1957, a gain of 484. An 11-percent increase in membership brought the total to nearly 4.8 million. Members’ sav¬ ings in Federal credit unions rose 18 percent, to $1,464 million at the end of the fiscal year, while average shareholdings moved up from $288 to $307. Loans outstanding to members amounted to $1,157 mil¬ lion as the fiscal year ended, an increase of 22 percent. Aggregate assets of Federal credit unions exceeded $1.6 billion, 19 percent more than a year earlier. Program Administration in 1957 To carry out the tremendously expanded operations of its programs the Social Security Administration had 22,472 employees at the end of June, not quite 4,000 more than the total on the payroll a year earlier. The vast majority of these employees were in field, area, and regional offices. The Bureau of Old-Age and Survivors Insurance had to adopt emergency measures to meet the operating demands resulting from the 1956 amendments. Benefits became payable to two new categories of beneficiaries soon after the amendments were enacted: benefits to women between ages 62 and 65 were first payable for November 1956 and, for January 1957, benefits to disabled children aged 18 or over with a total disability that began before age 18. Applications based on farm self-employment swelled the workload during the spring of 1957. Intensive efforts were made during the last part of the fiscal year to publicize the deadline of June 30 for filing applications to establish a period of disability with a beginning date more than 1 year prior to filing and as early as the actual onset of disablement. (Legislation enacted just after the end of the fiscal year extended this deadline through June 30, 1958.) The Bureau gave top priority to Social Security Administration 21 processing as many disability claims as possible in preparation for the payment of benefits in August 1957. During the year, plans were developed for two beneficiary surveys to be conducted by the Bureau of Old-Age and Survivors Insurance in fiscal year 1958. One is designed to provide current data on the economic situation of beneficiaries. The other is a long-term sur¬ vey involving revisits at 1- or 2-year intervals and is focused on the gathering of information that will show how the situation of bene¬ ficiaries changes with the passage of time. In September 1956, procedures were established to combine monthly benefit checks to husband and wife beneficiaries. When these pro¬ cedures become fully operative, savings to the old-age and survivors insurance trust fund will approximate $1 million a year. In the Bureau of Public Assistance, priority was given to work necessary to implement the 1956 amendments to the public assistance titles. The amendments relating to medical care and increased em¬ phasis on services involved considerable preparation on the part of both Federal and State agencies and, in some instances, the enactment of new State legislation. The Bureau of Public Assistance issued policy and guide materials for use of the States in reexamining their provisions for medical care, welfare services, and staff training and in planning improvements. By the end of the fiscal year, all States had submitted descriptions of the services they make available, re¬ flecting in part the past year’s increased and expanded activities in this area. The Bureau of Public Assistance, in its continuing work with the States, placed emphasis on the development and maintenance of sound and efficient public assistance programs, including review of admin¬ istrative costs in relation to program objectives, and on cooperation with public and national voluntary agencies in areas of mutual concern and interest. The Children’s Bureau launched a large-scale study to examine the reasons for the large number of staff losses in child welfare and pri¬ vate family service agencies. The Interdepartmental Committee on Children and Youth, for which the Children’s Bureau furnishes the secretariat, was a co¬ sponsor of the Joint Conference on Children and Youth held in Washington in December 1956, at which over 200 representatives of State, national voluntary, and Federal agencies participated. Federal credit unions continue to increase in size as well as number, a trend having important implications for the program administra¬ tion responsibilities of the Bureau of Federal Credit Unions. To anticipate the need for changes in procedures, Bureau policies per¬ taining to chartering, examination, and supervision were studied. 22 Department of Health , Education , and Welfare, 1957 During the fiscal year, the Bureau of Federal Credit Unions com¬ pleted a special survey of the purposes for which loans were made to members during 1956. International Activities The Social Security Administration, through its various coopera¬ tive activities, had the benefit of exchange with the experts from pro¬ grams in 65 countries during 1957. Increased interest of governments in improving social conditions in their countries is reflected in the growing status of social work in the exchange programs in every geo¬ graphical area. The Social Security Administration continued to participate in policy development in the international social welfare field through representation at the United Nations meetings and those of the Or¬ ganization of American States. The Interdepartmental Committee on International Social Welfare Policy, under the chairmanship of the Director of the Bureau of Public Assistance, developed policy recommendations for meetings of the UN General Assembly, the Eco¬ nomic and Social Council, the Social Commission, and the Interna¬ tional Labor Organization. Papers were also prepared in connection with meetings of the United Nations Children’s Fund (UNICEF) and the Organization of American States. The largest international meeting during the year was the Eighth Session of the International Conference of Social Work, held in Munich, Germany, during the week of August 5. The Commissioner participated as a plenary speaker and Social Security Administra¬ tion staff participated in expert groups. A new activity that developed during the year was the implementa¬ tion of plans for the reciprocal exchange of social workers with five European countries — Austria, Belgium, Norway, Sweden, and Yugo¬ slavia. This program was undertaken in cooperation with the Inter¬ national Exchange Service of the Department of State. National Exchange Committees already established in the various countries in cooperation with the United Nations program are assisting with program and hospitality. During fiscal year 1957, the Social Security Administration offered training facilities to 770 persons, 10 percent more than in 1956. The trainees came from 65 different countries, representing every degree of development in social welfare and in maternal and child health. Of the 149 persons who were here as long-term trainees under the sponsorship of the International Cooperation Administration, or as scholars or fellows under the United Nations and the World Health Organization, slightly more than half were studying and observing Social Security Administration 23 aspects of child welfare services or of maternal and child health under the auspices of the Children’s Bureau. In contrast, almost 2 out of every 3 of the 621 persons who came to the Social Security Administration for a shorter time were interested in the social insur¬ ance and public assistance programs and administration. The in¬ crease in the number interested in social work education reflected the trend in other countries to develop their own social work training facilities. As in past years, the Social Security Administration cooperated with the International Cooperation Administration in the nomina¬ tion and technical support of experts in the fields of social welfare, social insurance, and maternal and child health, as required by the agreements between that organization and the Department. The total number of experts assigned this year was 25, compared to 23 in 1956. New assignments in Tunisia and Korea increased to 13 the number of countries in which assignments were made or continued. Old-Age, Survivors, and Disability Insurance In May 1957, the number of beneficiaries receiving old-age and survivors insurance benefits reached 10 million. Speaking on that occasion of the growth of the social security insurance system, the Secretary of Health, Education, and Welfare remarked: Truly this is a milestone in the progress of the American people toward freedom from the fear of want. . . . Few people now question whether we should have a basic social security system. . . . Rather, it is evident that as the produc¬ tivity of the people steadily increases, as more and more goods and services become available for all, there are still further opportunities for sound, forward-looking steps toward the prevention or elimination of want in this country. . . . Both political parties strongly support a sound social security system. Although long-range projections cannot be precise, the present sched¬ ule of taxes provided in the law and the present schedule of benefits are approximately in balance. The system is in very sound condition and should continue to be self-sustaining. . . . The social security system plays an important part in maintaining general economic growth and stability. It provides purchasing power for many persons who otherwise might be most in need. The benefits — some $7 billion this year — quickly enter the stream of commerce and help sustain business and industry against sudden troughs and down-turns. Among the most important activities of the Bureau of Old-Age and Survivors Insurance during fiscal year 1957 was the effectuation of the 1956 amendments. Coverage was effected for members of the uniformed services, almost all previously excluded professional self- employed groups, additional self-employed farmers, and certain 24 Department of Health. Education , and Welfare , 1957 other groups of workers. With these extensions of coverage, the pro¬ gram now provides protection for almost all American families. The only major groups that still remain excluded are Federal employees already under a retirement system, doctors of medicine, nonregularly employed farm and domestic workers, and low-income farm and nonfarm self-employed persons. During 1957 the Bureau faced the largest workload in its history. This was the first year in which a large number of farmers and their families became beneficiaries under the program. Lowering the re¬ tirement age for women to 62 also accounted for a substantial part of the great increase in the number of old-age and survivors insur¬ ance benefit awards. The payment of monthly benefits to disabled workers between the ages of 50 and 65, beginning for July 1957, added much to the volume of the Bureau’s work. Extensive admin¬ istrative adjustments were made necessary by the unprecedented volume and complexity of the Bureau workload. At the same time every effort was made to uphold the Bureau’s high standard of service to the public. Throughout the year the Bureau maintained as its primary objective the combination of efficiency in its mass operations and sympathetic treatment of the people that the program serves. A more detailed record of the year’s significant events and accom¬ plishments is given in the following sections. What the Program Is Doing BENEFICIARIES AND BENEFIT AMOUNTS Unprecedented increases occurred in fiscal year 1957 in the number and amount of monthly benefits being paid under the program. In June 1957, 10.3 million persons were receiving benefits at a monthly rate of $554.6 million — increases from June 1956 of almost 2.0 million , in number and $115.2 million in amount. About 8.5 million of the i beneficiaries were men aged 65 or over and women aged 62 or over — ! 5.8 million of them retired workers and 2.7 million the wives and de- I pendent husbands of retired workers and the widows, dependent widowers, and dependent parents of workers who had died. Of the remaining 1.8 million, about 400,000 were mothers and 1.4 million were children. The growth in the number of beneficiaries stemmed partly from the large number of benefit awards to women under the 1956 amend- ! ment that lowered to 62 the retirement age for women, effective in November 1956; about 600,000 women aged 62-64 were receiving j benefits at the end of June 1957. Contributing also to the increase j in the number of beneficiaries was the large number of awards flow¬ ing from the provision in the 1954 amendments to the Social Security Social Security Administration 25 Act that extended coverage to self-employed farm operators; appli¬ cations for benefits were received from more than half a million farmers and their dependents. The increase in the total amount of benefits payable monthly resulted from the marked growth in the total number of beneficiaries, the rising proportion of benefits com¬ puted on the basis of earnings after 1950, and the increasing number computed under the provision permitting up to 5 years of lowest earnings and periods of total and permanent disability to be dropped in the computation of the average monthly wage. In June 1957, the average old-age insurance benefit paid to a re¬ tired worker who had no dependents also receiving benefits was $59.90 a month. When the worker and his wife both received benefits, the average for the family was $107.80. Families consisting of a widowed mother and two children received on the average $144.60. Among beneficiaries on the rolls at the end of June 1957 whose bene¬ fits 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 $73.00, for an aged couple about $121.00, and for a widowed mother and two children about $182.00. DISABILITY PROVISIONS During the fiscal year, a period of disability was established for about 138,000 disabled workers; the total number established since the beginning of the program in July 1955 was 273,000. About 127,000 applications for a period of disability were denied during the fiscal year; the total number of denials since July 1955 was 234,000. A person for whom a period of disability has been established has his insurance rights preserved during the period in which permanent and total disability prevents him from performing any substantial gainful work. Thus, such periods will not count against the disabled person in determining whether he or his survivors are eligible for benefits or in calculating the amount of the benefits. By the end of December 1956 almost 40,300 persons were receiving old-age benefits that had been increased by an average of $9.76 a month as a result of having had a period of disability established. The higher benefits 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 13,000 wives and young children of retired workers and about 5,500 widows, children, and dependent parents of workers who had established a period of disability before death were also receiving larger monthly benefits because of the freeze. For the same reason, lump-sum death payments during the calendar year ended December 448006—58 - 3 26 Department of Health , Education , and Welfare, 1957 1956 based on the earnings records of 8,900 deceased workers were increased by an average amount of $21.66 per worker. The 1956 amendments to the Social Security Act provided for payment of monthly disability insurance benefits beginning July 1957 to workers aged 50-64 who are totally and permanently disabled. More than 300,000 persons (including 86,000 persons for whom a period of disability had already been established) had filed appli¬ cations for monthly disability benefits by the end of June 1957. Over 100,000 benefit checks were issued to disabled workers in August as payment for the month of July, the first month for which such benefits were payable. The applications not yet acted upon were being processed and benefits will be paid retroactively to July 1957 to those who meet the requirements. Monthly benefits became pay¬ able, beginning January 1957, to totally disabled persons aged 18 or over whose disability began before they reached age 18 and who were children of retired or deceased insured workers. By the end of June 1957, such monthly benefits were being paid to 10,000 per¬ sons. Many more applications had been filed and were being processed. THE PROTECTION PROVIDED Of the population under age 65, an estimated 65.8 million were insured at the beginning of the calendar year 1957. Some 28.2 mil¬ lion of these people were permanently insured — that is, whether or not they continued to work in covered jobs they will be eligible for benefits when they reach retirement age, and their families are as¬ sured of protection in the event of their death (included in this total were some 0.7 million women aged 62-64 who were already eligible* for old-age benefits). The remaining 37.6 million were insured but would have to continue in covered work for an additional period to make their insured status permanent. Nine out of ten of the mothers and young children in the Nation were assured that they would re¬ ceive monthly benefits in case of the death of the family earner. An estimated 36 million of the insured persons under age 65 also met the work requirements for protection against the risk of long¬ term and severe disability. Of the 14.7 million people aged 65 or over in the United States in December 1956, 62 percent were eligible for benefits under the pro¬ gram. Forty-seven percent were actually receiving benefits, and 15 percent were not receiving benefits because they or their husbands were receiving substantial income from work. The percentage of aged persons who are eligible is expected to rise to over 70 percent by 1960. Social Security Administration 27 THE COVERAGE OF THE PROGRAM Approximately 75 million workers were covered by old-age, sur¬ vivors, and disability insurance during the course of the calendar year 1957. An additional iy2 million people employed in the railroad industry were assured, through the close coordination of the railroad retirement and old-age, survivors, and disability insurance programs, benefits at least equal in amount to those that would have been pay¬ able if their railroad employment had been covered under the Social Security Act. Altogether, including State and local government and nonprofit employees for whom coverage is available on a group-elec¬ tion basis and members of the Armed Forces, nine-tenths of all per¬ sons in paid employment in the continental United States were covered or could have been covered by old-age, survivors, and disability insur¬ ance in June 1957. Of the workers not eligible for coverage, about one-third were covered by other public retirement programs — Federal, State, or local. The remaining two-thirds — 6 percent of the Nation's paid employ¬ ment — were not covered by any public retirement program. Those without retirement protection under a public system consisted prin¬ cipally of self-employed persons whose annual net earnings were less than $400 and of domestic and farm workers who did not earn suffi¬ cient wages from any one employer to meet the minimum coverage requirements of the law. INCOME AND DISBURSEMENTS Expenditures from the Federal old-age and survivors insurance trust fund during the fiscal year totaled $6,665 million, of which $6,515 million was for benefit payments and $150 million, including Treasury Department costs, for administrative expenses. Total re¬ ceipts were $7,100 million including $6,540 million in net contri¬ butions, $555 million in interest on investments, and $5 million in transfers from the railroad retirement account. Receipts exceeded disbursements by $436 million, the amount of the increase in the trust fund during the year. At the end of June 1957 this fund totaled $23.0 billion. Total assets of the old-age and survivors insurance trust fund, ex¬ cept for $766 million held in cash, were invested in United States Government securities as required by law; $2.8 billion were invested in public issues (identical with similar securities owned by private investors), and $19.5 billion were invested in securities of varying maturities issued for purchase by the trust fund. The average inter¬ est rate on all investments of this fund at the end of the fiscal year was 2.5 percent. 28 Department of Health , Education , and Welfare , 1957 The Federal disability insurance trust fund was created by the Social Security Amendments of 1956. Contributions to this fund became payable starting in January 1957. Benefit disbursements began in August 1957. Assets of the disability trust fund at the end of the fiscal year totaled $337 million, consisting of $12 million held in cash, and $325 million invested in 2.5-percent United States Gov¬ ernment securities of varying maturities issued for purchase by the trust fund. Administering the Program The 1956 amendments imposed the greatest management challenge in terms of volume and complexity of workload that the Bureau has ever faced in a single year. The need to develop methods for the administration of new program provisions was coupled with the necessity to gear the organization to handle large workload in¬ creases with dispatch and with the least possible diminution in qual¬ ity and service to the public. The recruitment and training of new staff were among the first problems to be met. Personnel requirements measured against esti¬ mated increased workloads alone would have required the addition of about 7,000 fully trained employees. These requirements, how¬ ever, had to be balanced against recruitment possibilities, capacities to train and absorb into production, overtime that could be used, and anticipated workload levels beyond 1957. By balancing these various factors, a recruitment objective of some 3,500 employees was established. This brought employment at the end of the fiscal year to approximately 21,560, a figure reasonably close to the staff needed for continuing Bureau operations in subsequent years. An accelerated training program was used throughout the Bureau. Experienced employees were given training immediately on the amendments, with particular attention to the disability provisions. Emphasis was placed on partial training to equip new employees to handle specialized areas of work, and thus get quickly into pro¬ duction. Three-week central-office courses were given in Baltimore to equip new field employees with the knowledge essential in the claims process. More than 1,400 new district office employees re¬ ceived this intensive training during the fiscal year. The Bureau took a number of other significant actions to gear its resources to the amendment requirements. Twenty new district offices were opened to provide more adequate facilities and better service to the public, bringing to 558 the number of full-time district offices in operation. The number of field contact stations was in¬ creased from 3,537 to 3,660, and additional space was acquired for Social Security Administration 29 each of the six area offices. Through the use of public informational devices, it was possible to strike some balance between the receipt of claims on which payment was scheduled to be made quickly and the receipt of disability insurance claims which could not be paid by law until August 1957. The Bureau also deferred or gave low pri¬ ority to certain areas of work. In the first 6 months of the year, the Bureau kept the workload situation within planned control limits despite the receipt of 1,500,000 retirement and survivor claims applications in the district offices, al¬ most twice as many as in the same period of the preceding year. The high point in the first 6 months, in the number of claims pending in the district offices (292,500) was reached in mid- October due mainly to the receipt of claims from women aged 62-64. At the end of De¬ cember, the pending load was down to 260,000. The most crucial period in the processing of retirement and sur¬ vivor claims under the amendments came in the second half of the fiscal year. The extent of filing of claims after January 1, 1957, rose considerably above expectations. In January and February, em¬ bracing a period of 9 weeks, over 750,000 claims applications were received in the district offices. These tremendous workloads resulted in the largest number of pending cases in Bureau history and a sub¬ stantial increase in processing times. The highpoint was reached in early February when 473,000 claims were on hand in the district offices. The Bureau brought all its administrative forces to bear to get this emergency situation under control as quickly as possible. Measures which were adopted included the shifting of workloads and personnel between offices to meet workload bulges in certain parts of the country ; the hiring of temporary and part-time clerical staff ; trans¬ ferring some of the adjudication activity normally performed in the district offices to the area offices; deferring certain types of district office nonclaims work to a later date; specialization in the use of personnel; and the extensive use of overtime. Through use of these emergency measures the district offices were able to reduce the pending load by the end of the year to about 200,000 claims, the operational goal established for that date. The following actions were taken to implement the disability in¬ surance benefit provisions of the 1956 amendments: renegotiation of State agency agreements; development of policies and procedures with the Office of Vocational Rehabilitation on provisions regarding acceptance of rehabilitation services; development of policies and procedures for disability benefit reductions for workmen’s compen¬ sation benefits and other Federal benefits based on disability; de¬ velopment of plans and procedures for determining continuance or 30 Department of Health , Education , and Welfare , 1957 cessation of disability ; and development of alternative procedures for determining charges to the disability trust fund. The first applications for disability insurance benefits and benefits for disabled children aged 18 and over were taken in district offices on October 1, 1956, with the first benefits for disabled children pay¬ able for the month of J anuary 1957 and the first disability insurance benefits payable for the month of July 1957. As mentioned earlier, by the end of the fiscal year district offices had received applications for more than 300,000 disability insurance benefits and 45,000 claims for benefits for disabled children aged 18 and over. In the last several months of the year emphasis in the public information pro¬ gram was turned to the disability benefit provisions, and processing procedures were streamlined and accelerated. Over 100,000 checks were issued to disabled beneficiaries in August as payment for the month of July. During the year the Bureau also issued about 744,000 original and duplicate account numbers to members of the Armed Forces covered for the first time by Public Law 881 (84th Congress). To achieve a balancing of work distribution, the job of issuing these accounts, normally done in the district offices, was transferred to the Division of Accounting Operations. The total number of original and dupli¬ cate account numbers issued during 1957 was 7,567,000. Along with the planning and actions to meet the impact of the 1956 amendments, attention was given during the year to management improvement undertakings of varying scope and significance. Large scale electronic processing equipment was used successfully during the year in operations dealing with the maintenance of earn¬ ings records, the reinstatement of incorrectly reported earnings items, and the computation of benefit amounts. In December, the Bureau reached a decision to secure an additional electronic data processing installation to be placed in operation early in fiscal year 1958. The additional machine will make it possible to eliminate existing elec¬ trical accounting machine listing and collating operations and punch- card file records of detailed and summary earnings. The earlier installation will reduce costs by about $1,000,000 a year beginning in fiscal year 1958; the second installation by an estimated $500,000, starting in fiscal year 1959. In September 1956, procedures were established to combine monthly benefit checks to a husband and wife where one is entitled to old-age insurance benefits and the other to wife’s insurance or dependent husband’s insurance benefits in cases in which (a) both parties reside at the same address; (b) neither is incompetent; (c) neither voices any objection to the combination; and (d) no other reason exists that would make the combination undesirable. The combination was made Social Security Administration 31 as new claims were awarded or as certain adjustment actions were taken for beneficiaries already on the rolls. Experience maintained to date indicates that public reaction to this combination is favorable and plans have now been made for the mass conversion of the separate payments remaining on the benefit rolls. These cases number 1,100,000. Savings to the trust fund resulting principally from re¬ ductions in the check writing and mailing costs of the Treasury Department will approximate $1,000,000 a year. Architectural planning for the new Bureau headquarters building on the outskirts of Baltimore has been completed. In addition to the amounts previously authorized, the Congress approved $5,710,000 in additional funds for the construction of the building. This makes a total of $31,080,000 which has been made available for this purpose. The new legislation contains an escalator clause to take care of changes in building costs after October 1, 1956. The contract for construction was signed on October 31, 1957. Arrangements were completed for a review of Bureau operations by a small group of business leaders. This review, to be made in the first part of fiscal year 1958, has among its specific objectives: a re¬ view of the broad aspects of the process by which the Bureau dis¬ charges its responsibilities; identification of specific operations where any new techniques or methods used by industry could be adopted with resultant improvements in efficiency and economy; and recom¬ mendations as to whether the Bureau should seek outside assistance in the development of any proposed studies. The results of this review are expected to furnish valuable perspective and guidance to the Bureau in its administration of the program. Total administrative costs for the program in fiscal year 1957 represented about 2 percent of contributions to the trust fund. The key to this low level of administrative cost is the fact that while the composite measurable workload of the Bureau has increased by 223 percent since 1950, personnel has increased by only 97 percent. Legislative Developments During the Year Even though major social security amendments had been enacted at the start of the fiscal year, wide public interest in the program was reflected in a continuance of legislative activity affecting the program. Six bills involving relatively small but important changes in the old-age, survivors, and disability insurance provisions re¬ ceived active congressional consideration during the last half of the fiscal year and were subsequently enacted into law by the Eighty- fifth Congress. 32 Department of Health , Education , and Welfare, 1957 PROVISIONS OF THE 1957 AMENDMENTS Changes in coverage of employees of State and local governments . — During 1957 three new laws (P. L. 85-226, P. L. 85-227, and P. L. 85-229) amended the coverage provisions as they apply to employees of States and localities. P. L. 85-226 provides a general extension of the time during which retroactive coverage for prior years may be arranged under the State and local coverage provisions. Under previous law, cover¬ age arranged before 1958 could begin as early as January 1, 1955; under the new provision, coverage arranged in 1958 or 1959 can be¬ gin as early as January 1, 1956. This law also permits old-age, survivors, and disability insurance coverage of policemen and fire¬ men under retirement systems in Alabama, Georgia, Maryland, Ten¬ nessee, and the Territory of Hawaii. (Coverage of policemen and firemen under public retirement systems had been authorized by the 1956 amendments for only Florida, North Carolina, South Carolina, and South Dakota.) Another provision of P. L. 85-226 extends to all interstate in¬ strumentalities a provision, enacted in 1956, under which specified States may divide retirement systems into two parts and provide coverage under the Social Security Act only for the part consisting of the positions of those employees who desire coverage. This pro¬ vision has made it possible for some members of retirement systems to obtain old-age, survivors, and disability insurance coverage even though a majority of the present members of their retirement system do not want such coverage. At the same time the old-age, survivors, and disability insurance system is protected against “adverse se¬ lection” in the long run because all new employees who enter positions originally covered by a “divided” retirement system must be covered under the Social Security Act. The changes made by the other two new laws were also concerned with the “divided retirement system” provision. Under P. L. 85- 227 the States of California, Connecticut, Minnesota, and Rhode Island were included with those previously authorized to divide re¬ tirement systems for purposes of securing coverage under the Social Security Act; this change increased to 13 the number of States (in¬ cluding Hawaii) that are named under the provision. P. L. 85-229 is designed to make it easier for retirement system groups to obtain old-age, survivors, and disability insurance coverage under the di¬ vided retirement system provision. It was formerly necessary to follow a procedure involving two separate polls of retirement system members where this provision was used. First, the members of the system expressed their desire for or against coverage under the Social Security Act. Then, after the required additional 90-day-notice Social Security Administration 33 period, a referendum was held among only those members of the system who had already expressed a desire for coverage. The amend¬ ment allows the affected States and interstate instrumentalities to combine these two polls into a single vote which retains the principal features of the referendum provision, such as the 90-day-notice period. Changes affecting disability provisions. — P. L. 85-109 made two changes in the disability provisions of the program. An amendment requested by the Department extends for 1 year — through June 30, 1958 — the time within which disabled workers may file applications which will permit the beginning of a period of disability to be established as early as the actual onset of disablement even though that date is more than 1 year prior to filing. Disabled workers who would otherwise have lost valuable social security protection because they failed to file applications before the June 30, 1957, deadline in prior law were thus given a further opportunity to assure themselves of that protection. P. L. 85-109 also modified the disability benefits offset provision. Under this provision, before it was amended, the disability insurance benefit under the Social Security Act had to be reduced by the amount of any periodic Federal benefit or Federal or State workmen’s com¬ pensation paid on account of disability. The amendment specifically excludes veterans’ compensation (compensation paid to a veteran by the Veterans Administration on account of a service-connected dis¬ ability) from the periodic Federal benefits that cause disability in¬ surance benefits under the Act to be reduced. The disability benefits offset provision continues to be applicable in cases involving veterans’ pensions, which are paid on account of non-service-connected dis¬ ability. There was no change in the offset provision as it applies to persons receiving benefits because of a disability that began in child¬ hood. Changes in coverage of ministers. — As a result of amendments made by P. L. 85-239, ministers who failed to file certificates to elect old-age, survivors, and disability insurance coverage under the self- employment provisions within the time prescribed by the prior law will have an extension of time (generally through April 15, 1959) within which to elect coverage. Under the amendments, ministers who elect coverage during the extended period will be covered retro¬ actively for taxable years ending after 1955 in which they have net earnings from self-employment of $400 or more, including earnings from the exercise of their ministry. Ministers (chiefly those newly ordained) who are eligible to elect coverage after April 15, 1959, will have retroactive coverage for only 1 year. P. L. 85-239 also provides that a minister who has elected coverage shall, in determining his net earnings from self-employment, include 34 Department of Health , Education, and Welfare, 1957 the rental value of a parsonage (or any allowance for the rental of a parsonage) and the value of meals and lodging furnished to him for the convenience of the employer. This provision recognizes that in many instances noncash remuneration received by ministers consti¬ tutes a significant portion of their total earnings ; also, it assures that, for old-age, survivors, and disability insurance purposes, the noncash remuneration of the ministers affected (who are actually employees) will be treated much like the noncash remuneration of employees gen¬ erally. For purposes of coverage, this provision applies to taxable years ending on or after December 31, 1957 ; for purposes of the retire¬ ment test under the program, however, the provision applies to tax¬ able years beginning after August 30, 1957 (the date of enactment). Another provision of this legislation relates to the crediting of re¬ muneration of ordained ministers who were excluded from coverage as employees because they were in the employ of nonprofit church- related organizations and were in the exercise of their ministry but whose remuneration was erroneously reported as wages in 1955 and 1956. It was found that these mistakes were usually the result of confusion as to whether certain of these ministers, usually performing teaching or administrative duties, were engaged in the exercise of their ministry. Under the newT provision the remuneration in ques¬ tion will be credited in the same manner as correctly reported wages for old-age, survivors, and disability insurance purposes to the extent that the employer or employee tax was not refunded before August 31, 1957. Bene jits for alien survivors of servicemen who died of service-con¬ nected disabilities. — P. L. 85-238 provides that the provision for sus¬ pending benefits of certain aliens outside the United States, enacted as part of the 1956 amendments, is not to apply to alien survivors where the individual on whose wages and self-employment income the benefits would be payable died while serving in the Armed Forces of the United States or died as a result of disease or injury incurred or aggravated in the service. The new provision applies only to sur¬ vivor benefits (monthly benefits and lump-sum death payments) and not to retirement or disability insurance benefits. Although P. L. 85-238 applies to nonresident alien survivors of all servicemen dying in service or from service-connected causes, under present practice relating to recruitment of aliens into the armed serv¬ ices it will affect primarily a small number of survivors of Filipinos who serve in the Navy and Coast Guard, mainly as messmen. The Department of Defense and the Department of Health, Edu¬ cation, and Welfare favored the enactment of the provision of P. L. 85-238 dealing with alien survivors of servicemen because it was nec¬ essary in order to coordinate the coverage of servicemen under old-age, survivors, and disability insurance with the Servicemen and Social Security Administration 35 Veterans’ Survivor Benefits Act. The latter act establishes depend¬ ency and indemnity compensation for survivors of servicemen and veterans at a level which presumes the concurrent payment of benefits under old-age, survivors, and disability insurance. Change in the requirements for entitlement to spouse’s benefits. — P. L. 85-238 also removes the requirement that for entitlement to wife’s, husband’s, widow’s, or widower’s insurance benefits the spouse must have been a member of the worker’s household or must have been receiving regular support payments from him or the worker must have been under order by a court to contribute to the spouse’s support. Monthly benefits will be paid to wives, widows, and young widows with children on the basis of legal relationship alone. This change will give the protection of the program to a wife who was deserted by her husband and who for some reason had not secured a court order requiring the deserting husband to contribute to her support. Under the change a spouse will meet the definition of wife, widow, husband, or widower (1) if the courts of the State of the worker’s domicile at the time of his death or (if he is alive) at the time of the spouse’s application for benefits would find that the spouse and the worker were validly married at such time, or, (2) if they would not so find, if the spouse would nevertheless have the right to share as a spouse in the intestate personal property of the worker under the law of such domicile. These changes are effective for monthly bene¬ fits payable beginning with September 1957. A saving clause was incorporated in the law so that parents of a deceased worker who had already filed proof that they were sup¬ ported by the worker would not be denied parent’s insurance benefits because a widow or widower became eligible as a result of the new provisions. (Parent’s insurance benefits cannot ordinarily be paid to a dependent parent of a worker who was survived by a child, a widow, or a dependent widower who might eventually qualify for benefits based on the worker’s earnings record.) Saving clauses were also incorporated which provide that neither a parent’s benefit nor the benefit of a spouse who becomes entitled to benefits as a result of these changes shall be reduced because of the entitlement of the other, even though the total benefits to the family exceed the maximum that could otherwise be paid. COMBINED REPORTING FOR SOCIAL SECURITY AND INCOME-TAX WITHHOLDING PURPOSES The plan for integrating old-age, survivors, and disability insurance wage reporting with annual reporting of income taxes withheld was resubmitted to the Eighty-Fifth Congress by the Department of Health, Education, and Welfare. The bill embodying the pro- 36 Department of Health , Education, and Welfare, 1957 posal (H. R. 8309) also contains the necessary provisions for putting the definitions of insured status and related provisions on an annual rather than a quarterly basis. The plan would make it possible to eliminate the detailed quarterly wage reports now filed by employers for social security purposes. The information needed would be obtained from the reports of each employee’s wages filed annually by employers on withholding-tax statements (Forms W-2). The Hoover Commission had estimated that elimination of the quarterly reports would save employers about $22 million a year. The substitution of annual for quarterly reports would also bring about substantial reductions in the workload of wage items to be processed by the Bureau of Old-Age and Survivors Insurance. It is estimated that in fiscal year 1960, nearly 262 million wage report items would have to be processed for social security purposes under the present quarterly reporting provisions. Under annual reporting, this number would be reduced by at least one half. (The reduction would not be three-fourths, as might be expected, because a large number of workers are not employed by the same employer in all 4 quarters of a year.) The plan also provides that the Treasury Department and the De¬ partment of Health, Education, and Welfare might enter into an agreement under which Forms W-2 filed by employees with their in¬ come-tax returns would be sent to the Bureau of Old-Age and Sur¬ vivors Insurance to be matched mechanically against the forms filed by employers. This matching process would improve tax admin¬ istration through the discovery of errors in reporting of wages for both income-tax and social security tax purposes. COORDINATION OF TV A RETIREMENT SYSTEM WITH OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE The Social Security Amendments of 1956 authorized the extension of the program’s coverage to members of the retirement systems of the Tennessee Valley Authority and the Federal Home Loan Banks, sub¬ ject, in each case, to approval by the Secretary of Health, Education, and Welfare of a plan for coordinating the existing staff retirement system with the Social Security Act system. The plan submitted to the Department by the Tennessee Valley Authority to modify its re¬ tirement system and provide an equitable basis, as required by the law, for coordinating the system with old-age, survivors, and disability insurance was approved by the Secretary on December 28, 1956. As a result of this legislation members of the Tennessee Valley Authority retirement system became the first group of civilian employees of the Federal Government to be covered by both old-age, survivors, and Social Security Administration 37 disability insurance and a supplementary Federal staff retirement system. RETIREMENT SYSTEM OF FEDERAL HOME LOAN BANKS The Secretary was unable to approve proposed coordination plans that were submitted to the Department by the Federal Home Loan Bank Board. Since the law specified June 30, 1957, as the deadline for an approved plan of coordination, some 200 members of the Banks’ retirement system continue to be excluded from coverage under the Social Security Act. SIMPLIFICATION STUDY The Bureau moved forward with its project of developing legisla¬ tive proposals to make the program easier for the public to understand and comply with, and easier for the Department to administer. The project also seeks to improve the program so that it will be more ac¬ ceptable to the public as fair and equitable. The initial phase of this study was to examine two areas which have considerable complexity and which have been of much interest to the public — the retirement test and the computation of benefits. Work groups of Bureau employees have been formed for each of these areas. These groups are staffed with people who have had firsthand experi¬ ence in the administration of the law, technicians skilled in the eval¬ uation of program matters, and employees with legal training. Because of the intricate and delicately balanced considerations in¬ volved, many months of concentrated study will be necessary before recommendations can be made to the Congress on how to simplify these two areas within the framework of the existing program. In the meantime, plans are being made for the examination of other complex phases of the law. Financing the Program In modifying the schedule of contributions under the old-age, sur¬ vivors, and disability insurance program at the time it enacted the amendments in 1956, Congress again made clear its intent that the program be self-supporting from contributions of covered workers and employers. The revision in the schedule was arrived at after careful review of long-range actuarial cost estimates prepared for use of the congressional committees in their legislative considerations. OLD-AGE AND SURVIVORS INSURANCE BENEFITS The level-premium cost of old-age and survivors benefits after 1955, on an intermediate basis, assuming interest at 2.6 percent and earnings 38 Department of Health , Education , and Welfare, 1957 at about the levels that prevailed during 1955, is estimated at 7.43 percent of payroll (after adjustments to allow for administrative expenses and interest earnings on the existing trust fund). The level contribution rate, equivalent to the graduated rates in the law, is estimated at 7.23 percent of payroll, leaving a small actuarial insuffi¬ ciency of 0.20 percent of payroll. The old-age and survivors insur¬ ance benefit system may for practical purposes therefore be said to be in actuarial balance. DISABILITY INSURANCE BENEFITS The Social Security Amendments of 1956 established a system for financing disability insurance benefits which is entirely separate from the financing of old-age and survivors insurance benefits. The level premium cost of the disability insurance benefits and the applicable administrative expenses 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 pay¬ roll, thereby producing an actuarial surplus of 0.07 percent of payroll. The difficulties involved in making exact predictions of the actu¬ arial status of a program that reaches into the distant future are widely recognized. If different assumptions as to, say, interest, mortality, retirement, disability, or earnings had been used, differ¬ ent results would have been obtained. Accordingly, no one set of estimates should be looked upon as final. The Department, in carrying out its policy of continually reexamining the long-range cost estimates of the program in the light of the latest information available, is now in process of a complete review and revision of its cost estimates. Public Assistance Effect of the 1956 Amendments The implementation of amendments to the public assistance titles of the Social Security Act passed in 1956, which included some of the most fundamental changes in the public assistance programs since their inception, provided a major focus of activities at both the Federal and State level during the year. The impact of in¬ creased program responsibility resulting from these legislative changes was immediate and substantial. The new provision to help States extend and broaden medical care for public assistance recipients through separate Federal sharing in costs paid directly to suppliers of medical care services required con- Social Security Administration 39 siderable preparation on the part of both Federal and State agencies. The clarification of the objective of public assistance as including both financial assistance and other welfare services to help recipients achieve increased self-care, self-support, and to strengthen family life, resulted in States’ taking stock of the scope and level of the services they were already providing and in planning for their further development. Similarly, a companion provision which authorized Federal grants to States for training public assistance personnel to deal construc¬ tively with complex problems involving dependency and seriously affecting family life resulted in stepped-up efforts by the States in their on-going training programs, and in the development of long¬ term plans for increasing the availability of qualified persons to work in the public assistance program. As a result of raising the Federal share of State public assistance payments and the maximum payment subject to participation, ef¬ fective October 1, 1956, through June 30, 1959, all but a few States increased individual payments by $3 to $4 a month for the needy aged, blind, and disabled; and by $1 to $2 per person receiving aid to dependent children. The availability of additional Federal funds thus made it possible for many States to make long-overdue adjust¬ ments in payments in relation to increased living costs. Amendments broadening the aid to dependent children program were implemented through legal or administrative actions taken by 42 states to add certain relatives (first cousins, nephews, and nieces) to those with whom the needy child may live and receive federally aided assistance and by 31 States to obtain Federal sharing in as¬ sistance expenditures for children aged 16 and 17 without regard to whether they are regularly attending school. Both provisions were effective July 1, 1957. Trends in Caseloads and Expenditures 1 In June 1957, 5.9 million persons, 3.4 percent of the total civilian population, received either federally aided categorical public assist¬ ance or State and/or locally financed general assistance. The total number of persons assisted increased 198,000 or 3.4 percent from June 1956 to June 1957. The greatest increase occurred in the number of persons receiving aid to dependent children (148,000). Smaller in¬ creases occurred in the number receiving general assistance (41,000), aid to the permanently and totally disabled (26,000), and aid to 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. 40 Department of Healthy Education , and Welfare , 1957 blind (2,600). In old-age assistance, the number of recipients de¬ creased by 20,000. Drought conditions in some sections of the country, a strike in the steel industry, and the largest increase in living costs in 6 years undoubtedly contributed to the need of some individuals for public assistance. Total expenditures for assistance payments from Federal, State, and local funds were $2,969 million during fiscal 1957, an increase of $187 million or 6.7 percent over expenditures in the preceding year. The rise was due in part to the availability of additional funds authorized by the 1956 amendments. The largest increases in pay¬ ments occurred in old-age assistance, $90 million; and aid to de¬ pendent children, $61 million. The Federal share of expenditures was $1,505 million. Assistance payments for the past year repre¬ sented about 0.9 percent of personal income payments in the Nation during 1956. Old-age assistance. — The number of persons receiving old-age as¬ sistance in June 1957 (2.5 million) was 0.8 percent lower than in June 1956, with a corresponding decline in the proportion of persons aged 65 or over in the country receiving old-age assistance — 168 per 1,000 in June 1957 compared with 173 per 1,000 a year earlier. Al¬ though caseloads were lower in 42 States, the national annual decrease of 20,000 was the smallest in 6 years. The national average monthly payment for old-age assistance was $58.66 in June 1957, an increase of $4.37 from the previous June. Average payments, exclusive of Puerto Kico ($7.99) and the Virgin Islands ($18.53), ranged from a low of $28.67 in Mississippi to a high of $94.15 in Washington. Aid to dependent children. — Increases during the year in the num¬ ber of families receiving aid to dependent children were fairly sub¬ stantial for the Nation and for a majority of the States. The 647,200 families receiving assistance in June 1957 represented a 5.5-percent increase; and the 1,831,900 children, a 7.3-percent in¬ crease over June 1956. Although there was a seasonal decline be¬ tween July and October, the national caseload increased in subsequent months of the fiscal year. The national average assistance payment in June 1957 was $96.52 per family ($26.04 per person), an increase of $7.25 per family ($1.69 per person) from the pre¬ vious June. Average payments per family, exclusive of Puerto Eico ($12.72), ranged from $28.18 in Mississippi to $150.12 in Wisconsin. Aid to the blind. — There was a small but steady rise (2.5 percent) in the total number of persons receiving aid to the blind (from 105,800 in June 1956 to 108,400 in June 1957), even though 27 States had lower caseloads at the end than at the beginning of the year. The average assistance payment for all States in June 1957 was Social Security Administration 41 $63.87, an increase of $3.45 from the previous June. Average pay¬ ments, exclusive of Puerto Rico ($7.91), ranged from $37.77 in West Virginia to $116.78 in Washington. Aid to the 'permanently and totally disabled . — Recipients of aid to the permanently and totally disabled numbered 283,900 in June 1957, compared with 258,300 in June 1956. The 9.9-percent increase was largely the result of the relative newness of the program and the initiation of a new federally aided State program in Kentucky, which brought to 46 the number of States administering such pro¬ grams. The national average payment per recipient in June 1957 was $59.10, an increase of $2.38 from the previous June. Average payments, exclusive of Puerto Rico ($8.68) and the Virgin Islands ($19.81), ranged from $24.60 in Mississippi to $116.91 in Connecticut. General assistance . — About 294,000 cases received State and/or locally financed general assistance in June 1957, an increase of 4,000, or 1.5 percent from the preceding June. Decreases and increases over the year were divided about equally among the States. The national average payment per case in June 1957 was $54.90, an increase of $2.83 from the previous June. Average payments for States reporting on a comparable basis ranged from $12.28 in Ala¬ bama to $78.29 in New York. OASI BENEFICIARIES RECEIVING SUPPLEMENTARY ASSISTANCE PAYMENTS The number of aged beneficiaries of old-age, survivors, and dis¬ ability insurance who receive old-age assistance to supplement their benefits continues to increase. In February 1957, nearly a fourth (22.2 percent) of the 2.5 million old-age assistance recipients were receiving such assistance to supplement their insurance benefits. The number (555,300) of recipients of old-age assistance also receiving insurance benefits in February 1957 represents an increase of 39,000 or 7.4 percent from the preceding F ebruary. The national average old-age assistance payment for recipients receiving both insurance and assistance in February continues to be less than for those receiving only assistance — $48 compared with $60.77. About 18 percent (a little over $26.6 million) of the total amount expended for old-age assistance was paid to the needy aged receiving both assistance and insurance benefits. In contrast to the increasing number of aged receiving both insur¬ ance benefits and assistance payments, the number of families receiving aid to dependent children to supplement insurance benefits showed a slight (2 percent) decline in February 1957 from the number in the preceding February. The 31,900 families receiving both insurance 448006—58 - 4 42 Department of Health , Education , and Welfare , 7957 benefits and assistance payments represented 5.1 percent of all families receiving aid to dependent children. As in old-age assistance, the average assistance payment to families receiving both types of pay¬ ments was less than to families receiving only assistance. The na¬ tional average assistance payment in February to families receiving both types of payment was $75.75 compared with $96.39 for families receiving only assistance. Major changes in old-age and survivors insurance made by the 1956 amendments to the Social Security Act will extend benefits to more people. These changes include reduction of the retirement age for women, extension of child’s benefits to disabled children aged 18 or over, and the addition of disability insurance benefits. The imme¬ diate effect of these amendments on the public assistance program, however, is not expected to be very great. Program and Administrative Developments During the year, priority was given by the Bureau of Public As¬ sistance to work necessary to implement the 1956 amendments to the public assistance titles of the Social Security Act. This included, for example, the issuance of information explaining the amendments to interested groups and individuals, consideration of their implications, exploration of problems that could be anticipated, identification of major policy issues that needed to be resolved, and the development of pertinent Federal policy and recommendations. In addition, fiscal and administrative procedures were developed to effect the necessary changes in grants to States, and technical assistance was provided to State agencies in carrying out the purposes of the new legislation. This work was carried on along with the Bureau’s continuing em¬ phasis on the development and maintenance of sound and efficient public assistance programs, including review of administrative costs in relation to program objectives, cooperation with national public and voluntary agencies in areas of mutual concern and interest, and improvement in internal Bureau management. Although the full effect of the potentials for significant develop¬ ments in the assistance and services available to needy persons made possible by these amendments will not be realized until the States have had more time to put the legislation into operation, substantial progress is already evident. Developments in some of the program areas, such as medical care, welfare services, and staff training, which involve Federal, State, and local cooperation and planning, are of special interest. Social Security Administration 43 IMPROVING MEDICAL CARE FOR PUBLIC ASSISTANCE RECIPIENTS Traditionally, public welfare agencies provided some medical care through staff physicians, by operating institutions giving medical care to the indigent, or by paying for the medical care given to needy persons. Under the Social Security Act as passed in 1935, Federal financial participation was available in the costs of medical care when included in the monthly payment to the recipient within the limits of the Federal maximum on the monthly assistance payment. How¬ ever, the amount of medical care that could be provided to assistance recipients under this provision was limited, and its nature and extent varied greatly between States, and often between localities in the same State. Yet the cause of dependency for many is directly related to dis¬ abling effects of illness. For example, of the 2% million persons over 65 years of age receiving old-age assistance, nearly half are 75 or over — an age group with a high incidence of chronic illness. Dis¬ ability itself is a basic eligibility condition for the nearly 284,000 needy persons receiving aid to the permanently and totally disabled, for the 108,000 receiving aid to the blind, and for the approximately 484,000 children and 125,000 adult caretakers receiving aid to de¬ pendent children whose need is due to the physical or mental in¬ capacity of a parent. It also plays a large part in the need of many of the 294,000 cases receiving State and/or locally financed general assistance. The increasing need for medical care and its higher cost resulted in an amendment to the Social Security Act in 1950 which broadened the definition of “assistance” to include payment for medical care or other remedial care made directly to the suppliers of such services. The amount allowed for medical care, however, still had to come within the specified individual matchable assistance payment maxi¬ mum, as previously. To provide greater flexibility in meeting high medical expenses in individual cases, some public assistance agencies used a pooled fund — a prepayment arrangement — into which a fixed monthly payment was made for each recipient, and from which was paid the costs of medical care for individual recipients. The averag¬ ing of costs through the pooled fund helped to some extent in meeting the higher medical care costs in individual instances. In fiscal year 1957, only about 10 percent ($288 million) of the total ($3 billion) expended for public assistance, including general as¬ sistance, was spent for medical care payments made directly to the suppliers of such services. Only about a fifth of this amount came from Federal funds; most of the vendor payments were made by States with the greatest resources, with a high concentration in only 44 Department of Health , Education , and Welfare , 1957 a few States. For example, a little more than half the vendor pay¬ ments made for the aged in June 1956 were in three States — New York, Illinois, and Massachusetts. A few States made vendor pay¬ ments financed entirely from State and local funds. To increase the availability of medical care for needy persons, the Social Security Act was amended again in 1956 (Public Law 880, 84th Congress) to permit Federal sharing in vendor payments for medical care separate from the money payment. This amend¬ ment provides for separate Federal sharing in a State’s total ex¬ penditures for medical care paid directly to suppliers of medical services in behalf of assistance recipients up to one-half of the sum of $6 times the number of adult recipients and $3 times the num¬ ber of child recipients per month. As a result, most States will be able to provide more medical care for the needy, and the use of an average in determining the amount of the Federal share will make it possible to meet larger medical care expenses in individual cases. The provision for additional Federal matching in medical care costs, beginning July 1, 1957, provided the stimulus for extensive planning and preparation on the part of both Federal and State agencies during the year. At the F ederal level, discussions were held with representatives of various groups to interpret the provisions of the amendment and to get the benefit of their specialized knowledge and suggestions for its implementation. These groups included the American Medical Association, American Dental Association, Ameri¬ can Pharmaceutical Association, American Hospital Association, the Christian Science Church, American Nursing Homes Association, and the National Social Welfare Assembly; medical staff in the De¬ partment of Health, Education, and Welfare; and State public wel¬ fare directors and other State staff. In June, representatives of interested national organizations and staff of State public assistance agencies came together in Washington to discuss the problems and questions which had arisen around the implementation of this amendment. The States reviewed existing medical care provisions to see how they could best be broadened and strengthened, and new provisions were planned. In 12 States, legislation was enacted to authorize making vendor payments for medical care ; and in six others, similar legislation was considered. Special interest was shown by States which previously had provided little or no medical care; many were interested in planning for payment of hospital care. Further legislation was enacted in 1957 because a few States which had been able to make substantial vendor payments for medical care within the Federal matching maximums on individual assistance payments would have been adversely affected by the limits of the new Social Security Administration 45 provision for separate Federal sharing in medical care expenditures. As a result, Public Law 85-110 was passed in July 1957 to give the States an option with respect to the basis for claiming Federal par¬ ticipation in their vendor payments for medical care. Before May 16 of each year or less often if desired, States can elect for the fol¬ lowing fiscal year to receive Federal financial participation for com¬ bined money and vendor payments within the specified individual matchable assistance payment maximum, as previously, rather than to claim separate Federal matching for vendor medical care pay¬ ments under the 1956 provision for separate matching of medical care expenditures. The new law amends section 305 of Public Law 880. Two States exercised this option for fiscal year 1958 for some of their programs. While the provision for separate Federal matching in medical care costs will not make it possible for States to finance a comprehensive program of medical service for assistance recipients, it has enabled States with no statewide provision for medical care to begin to pay the cost of some medical services, and others to expand their existing medical care provisions. Within several months after the effective date of the amendment, 35 States planned to use Federal funds in separate vendor payments for medical care. This includes 11 utiliz¬ ing Federal funds for the first time in providing medical care and 11 using the additional Federal money to extend their existing medical care programs. Six States have not yet taken action, although two are working on plans with their respective departments of health. The remaining 12 States have indicated that they cannot yet benefit by this amend¬ ment either because they lack enabling legislation or appropriations, or because of other problems which must be worked out first. How¬ ever, some of these States, as well as some others with vendor pay¬ ment plans limited in coverage, expect to continue to include an amount for certain kinds of medical services in the money payment. Sixteen States will use a pooled-fund arrangement (including 12 which had used this plan previously) ; 16 States will make direct payments to the suppliers of medical care services ; and 3 States will use prepayment arrangements such as a contract for service with a State health department, State medical association, or a hospital insurance plan. For example, one State is entering into contracts with Blue Cross-Blue Shield to provide hospitalization and physician’s services in the hospital for recipients of aid to the blind and aid to dependent children programs. Another State is contracting with the State medical society to provide physician’s services, drugs, and certain other items on a prepayment capitation basis. Some of these arrangements are being tried on an experimental basis. 46 Department of Health , Education, and Welfare, 1957 Some of the new plans are from States with limited funds and provide mainly for hospitalization for life-endangering illnesses. Where hospitalization is available through existing facilities or programs, some States are beginning with payments for doctors, drugs, and nursing-home care. As more experience is gained in determining cost figures and in handling other administrative aspects of this program, and as more State money becomes available, some of these States may be able to extend their coverage of services. STRENGTHENING SOCIAL SERVICES FOR NEEDY PEOPLE All those who come to the public assistance agency are struggling with problems of inadequate income. The definitions of the groups receiving federally aided assistance mean that, for many, this is fur¬ ther compounded by other serious personal problems such as those related to old age, illness, physical or mental handicap, or family disruption. Public assistance agencies have long recognized that without appropriate help such problems will often result in deterio¬ rating situations harmful to both the individual and the community. Within the limits of their capacity and availability of community resources, many public assistance workers have been assisting these needy individuals to find and use their own strengths and other availa¬ ble resources to develop their best potentials for more satisfying and independent living. For example, workers arrange for necessary medical care and other rehabilitation services within the public wel¬ fare agency or offered elsewhere. They provide services that enable the needy person to remain in his own home and with his family and friends as long as possible, plan other kinds of custodial care when necessary, and arrange for specialized services and home-helps that enable persons no longer in need of institutional care to return to normal living patterns in the community. Some workers also help with more intangible but equally serious emotional problems, such as a disturbed relationship between parent and child, tensions threatening family solidarity, or feelings of inadequacy blocking the way to independent activities. The extent to which these and other social welfare services are being provided, however, varies greatly across the country. Some agencies lack staff time and/or professional skill to provide many services, and supporting community resources are often missing or very limited. Yet heartening advances have been made in the num¬ ber of people helped to greater self-sufficiency ; some savings have also resulted through decreased assistance costs. Special projects have also demonstrated the benefits of cooperative effort between public and voluntary agencies and other groups in the community. Social Security Administration 47 For example, several projects were set up to relieve pressing prob¬ lems that stem from the increased number of aged people in nursing homes and mental hospitals. By providing outside living arrange¬ ments and such aids as homemaker service, visiting nurse services, and friendly visiting, some aged persons no longer in need of sheltered care were able to return to the community. In addition to greater personal satisfactions in home living for the individual and freeing institutional beds for those needing them, some savings also resulted through reduction in expenditures for costly institutional care. Other demonstration projects used a team of experts — often in¬ cluding doctors, rehabilitation and employment counselors, and so¬ cial workers — to consider latent capacities and resources of handi¬ capped individuals. This approach has shown substantial results especially with incapacitated parents of children receiving aid to dependent children. Some were helped to become self-supporting, while others embarked on plans for at least partial rehabilitation. The value of such services was recognized and affirmed in the 1956 amendment to the Social Security Act which endorsed Federal shar¬ ing in expenditures incurred by a State public assistance agency in providing, in addition to financial aid, other staff services to help assistance applicants or recipients achieve increased capacity for personal and economic independence and strengthen their family life. The passage of this amendment, in turn, provided the stimulus for renewed and strengthened activities on the part of the State agencies. Effective July 1, 1957, State plans were to describe the services made available by the State agency and the steps taken to assure maximum utilization of similar or related services furnished by other agencies. This requirement provided a focus for evaluating services already provided and planning for their extension and increasing effectiveness. It also resulted in clarification of the responsibility of staff at all levels for the provision of such services, more emphasis on effective cooperation with other agencies, and added emphasis on participation in community planning to develop new resources. In developing policy and guide materials to implement the “serv¬ ices” amendment, the Bureau enlisted the help of a National Ad¬ visory Committee including representatives from State and local public welfare agencies, national voluntary agencies, graduate schools of social work, and staff from other units of the Department. A policy statement on “Social Services in Public Assistance” was de¬ veloped; and a monograph on “The Role of the Caseworker” was prepared as Part I of a series on Services in Public Assistance , and Part II — “The Role of the Agency” — is in process. Similarly, a 2-day National Conference on Homemaker Service was held in June 1957 under the joint auspices of the Children’s Bureau, 48 Department of Health, Education, and Welfare, 1957 the Bureau of Public Assistance, and the Public Health Service, to stimulate the further development of homemaker service. Effective results have already been achieved in its use to release family mem¬ bers caring for assistance recipients to seek gainful employment; to permit the chronically ill, the emotionally handicapped, the physi¬ cally disabled, and the aged to remain in their own homes as long as possible ; or to maintain a home for dependent children where the mother is ill or otherwise temporarily unable to care for them. A monograph on “Homemaker Service in Public Assistance” was pre¬ pared discussing the problems best served by homemaker service, the other types of home-help needed, and the ways in which this special¬ ized agency resource might be made more widely available. In addition, under the auspices of the National Social Welfare Assembly, a meeting was held with representatives of national volun¬ tary agencies to consider how voluntary and public social welfare agencies can work together in developing and providing the services needed by children receiving aid to dependent children. A report on “Services in the ADC Program — Implications for Federal and State Administration” also was prepared, summarizing State com¬ ments on the earlier draft report on “Services in the ADC Program” prepared jointly by the Bureau of Public Assistance and the Child¬ ren’s Bureau. The States’ Vocational Rehabilitation Council Committee on Re¬ lationships with Public Assistance also met in Washington in April 1957 with representatives of both the Bureau of Public Assistance and the Office of Vocational Rehabilitation to explore ways in which State agencies of both programs can work more cooperatively and effectively. Similar discussions were held between State vocational rehabilitation and public assistance agencies. Planning for the most effective use of all these resources was re¬ flected in many State social services plans, along with clarification of the problems and needs for which the State offers casework and counseling services. Some State plans provide special help to the handicapped, homemaker service for the ill and aged, and/or foster care for ill or aged adults unable to live alone but not in need of custodial care. Although there is great variation in the range of problems identified on which States will offer services, certain com¬ mon areas were recognized by most States — the effects of financial need, illness, disturbed family relationships, and lack of education and training for employment. To insure the progressive develop¬ ment of their social services some States have also established methods to assess the range and nature of problems identified, and the ade¬ quacy of agency and community resources in meeting them. Social Security Administration 49 EFFORTS TO INCREASE AVAILABILITY OF QUALIFIED STAFF With increasing recognition of the need for social services has come greater awareness of the direct relationship between the quality of services provided and the skill of staff providing them. Yet only about 20 percent of staff in social work positions in public assistance agencies have any social work training, and only 4 percent have com¬ pleted professional training. To increase the number of qualified persons available to provide the quality of services needed in administering public assistance today, a 1956 amendment authorized the use of additional Federal funds, effective July 1, 1957, to assist the States in meeting the costs of train¬ ing personnel employed or preparing for employment in public as¬ sistance programs. This permits States to provide financial aid both to individuals and institutions for training in social work and other professional and technical fields related to public assistance administration. In anticipation of additional Federal funds for training purposes, intensive effort was made by the States during the year to expand and strengthen their training programs. Proposed policy for operat¬ ing under this amendment and principles underlying long-range staff development plans developed by the Bureau were also used by the States in developing their training plans. Many of the States requested Bureau consultation and written materials on staff development. Emphasis in all the States was placed on reevaluation of current staff development plans and development of long-range plans, includ¬ ing the use of funds for graduate social work education for current employees. Some of the States added training consultants to their staffs, and others increased the number of persons assigned to training jobs. Based on study of the education and experience of current staff, the minimum educational requirements for beginning positions were raised in some States, and recruitment plans were developed in others. Many of the States held short-term courses to strengthen the skill of administrative and supervisory staff in helping workers to administer medical care provisions and provide other social services. Some of the States increased the use of faculty from schools of social work to conduct short-term institutes within the agency. Most of the States increased the number of persons granted educa¬ tional leave for graduate professional training during the year and made plans for expanding this number in succeeding years. Legis¬ lation was passed in several States authorizing the use of funds for training purposes. Appropriations made specifically for training enabled a few States for the first time to develop plans for educational 50 Department of Health , Education, and Welfare, 1957 leave. Consideration was given also to the need for readjustment of salary scales in relation to increased competence of staff, in order to retain staff being given professional training. Closer working relations between State public welfare agencies and schools of social work resulted from the increasing use of faculty members in conducting institutes within the agency, and from the in¬ creasing number of staff attending schools of social work. For ex¬ ample, in the New England area, a committee of State agency staff and faculty from five professional schools are working toward im¬ proving the professional performance of public assistance and child welfare personnel and toward defining the level of performance expected. In addition to working directly with schools of social work, Bureau staff also worked with the Council on Social Work Education in de¬ veloping teaching materials for use in training for work in public welfare programs. They also participated in developing materials for the use of the Council in a curriculum study designed to improve the quality of training for social work positions in public welfare programs, including the development with the North Carolina De¬ partment of Public Welfare of a statement of problems in public assistance. Several institutes were held by the Bureau for State staff on the use of the group process in training programs. A seminar on this subject was held in June 1957 under the joint sponsorship of the Children’s Bureau and the Bureau of Public Assistance, with repre¬ sentation from 26 States; and a monograph on “Group Leadership in Staff Training” was also issued under their joint sponsorship. The momentum in staff development activities gathered during the year has been seriously hampered by the omission of funds for train¬ ing in the 1958 Federal appropriation. The States’ interest in mov¬ ing ahead in this area, however, is reflected in the plans of many States to carry through in the coming year some of the activities pre¬ viously considered, although necessarily on a much more limited scale. OTHER ADMINISTRATIVE DEVELOPMENTS Nationwide increases and variation among States in the cost of administering public assistance and congressional consideration of measures affecting the use of Federal funds in matching State and local expenditures pointed to the need for study of underlying factors. Since people receiving public assistance are dependent because of financial need compounded by other personal or social problems, the work of State and local agencies has been increasingly directed both Social Security Administration 51 toward dealing with problems which created the dependency and helping individuals move to a fuller use of their own strengths and capacities. In addition to determining initial and continuing eligi¬ bility for assistance and the extent of need for financial assistance, the worker also assesses the individual’s need for, and provides or arranges for the provision of, other services that will assist him to deal constructively with his economic and social problems. This broader concept of the purpose of public assistance, under which most States are operating even though in varying degrees, received con¬ gressional recognition and approval through the “services” amend¬ ment to the Social Security Act in 1956. This amendment also recognized that the costs of administration would include expendi¬ tures necessary in providing these services. During the year, therefore, intensive study was made of the component elements included in State and local expenditures for administering assistance to provide a basis for the development of proposals relating to administrative costs which would meet the reali¬ ties of current program objectives, as well as carry out responsibility for proper and efficient administration. Continuing efforts also have been made by regional and depart¬ mental staff in advancing more efficient and effective administration of public assistance programs through review of State plan and administrative practice, and providing technical assistance to the States. For example, during the year, administrative reviews were conducted in 23 States, covering 920 local agencies. Emphasis was placed on eligibility determination, with study in other program areas on a selected basis including the application process, appeals and hearings, rehabilitation and other welfare services, State super¬ vision of local agencies, and determining disability in the aid to the disabled program. Findings from these reviews were used in strengthening program operations both in the States and in the Bureau. Technical assistance and consultation also continued to be provided to the States on request in both program and administrative areas. In addition to the continuing help given by regional staff, during the year, for example, 104 consultations were provided by specialists in such areas as: implementation of new legislation on medical care, training, and social services ; team activities and other aspects of the aid to the disabled program; need determination and standards of assistance; administrative costs; staff training; various aspects of the aid to dependent children program; administrative and fiscal stand¬ ards; and methods for quality control and improvement of various aspects of public assistance administration. 52 Department of Health , Education , and Welfare , 1957 In addition to the issuance of reports mentioned above, other publi¬ cations processed for distribution during the year included : Illness and Disability — Selected References for Public Assistance Casework¬ ers; Digest of Special Studies Relating to Public Assistance; Trend Report — Graphic Presentation of Public Assistance and Related Data; and National Manual — Emergency Financial Assistance and Emergency Clothing. DEFENSE WELFARE SERVICES Under a delegation from the Federal Civil Defense Administration, the Bureau completed its second year of work in planning for emer¬ gency financial assistance and emergency clothing in the event of an enemy attack. The signing of agreements between the Social Se¬ curity Administration and 43 State departments of public welfare during the year provided a firm base for establishing a nationwide organization through which welfare needs of people could be met promptly during an emergency. The issuance of a national manual for emergency financial assistance and emergency clothing provided the guideposts for continuing State and local civil defense welfare activities. A national advisory committee broadly representative of the retail clothing industry, national clothing trade associations, and public and voluntary social agencies helped in planning this aspect of the program. Working relationships with other governmental agencies having delegations from the FCDA, particularly the Department of Labor and the Business and Defense Services Administration of the Department of Commerce, contributed to the better coordination of civil defense welfare activities. Termination of the appropriation to the FCDA for delegated civil defense activities necessitated the discontinuance as of June 30 of the Bureau’s planning activities in relation to the emergency financial assistance and clothing programs. However, with the Department’s willingness to consider resumption of these activities if funds again become available, the Bureau is maintaining liaison with the FCDA and is continuing staff work involved in planning for the continuity of essential functions required by the Office of Defense Mobilization. SERVICES FOR REPATRIATED AMERICANS Since World War II the Bureau has been cooperating with the Department of State in the repatriation of American citizens. Al¬ though relatively few become stranded in foreign countries in peace¬ time, the hardships of some are great. The Department of State makes loans to pay for return transportation but not for emergency medical care or maintenance abroad, nor for aid after reaching this Social Security Administration 53 country. Yet many of these individuals no longer can claim resi¬ dence in any State and are not eligible for public aid or public hospitalization. During the calendar year 1956, 42 cases from 22 countries were re¬ ferred to the Bureau by the Department of State for help in meeting individual or family problems. Since Federal funds are not avail¬ able for this purpose, the Bureau, through its regional offices, tried to locate other available resources to provide the assistance and services needed. These include, for example, reception services at the port of entry, making contacts with relatives and friends, arranging for medical or hospital care, providing temporary income main¬ tenance, or providing help with family relationship problems. In the fall of 1957 when a small group of Americans were evacu¬ ated from trouble areas in the Middle East, the Bureau was given a special allocation from the President’s Emergency Fund and re¬ quested by the Department of State to meet the evacuees at the air¬ port and help them on to their destinations. Recognizing that prob¬ lems relating to repatriation of Americans will become more acute in a period of international tensions, the Bureau has been working with the Department of State and the Department of Defense in develop¬ ing plans and legislative proposals for more adequate meeting of peacetime repatriation needs and for prompt activation of stand-by plans for reception and provision of services to evacuees during an emergency. Children’s Bureau A broad mandate to “investigate and report upon all matters per¬ taining to the welfare of children and child life” was given the Children’s Bureau in the act of 1912 creating the Bureau. To its investigative and reporting functions was added an additional responsibility under title V of the Social Security Act of 1935, as amended — that of administering grants to States to assist them in extending and improving their health and welfare services to chil¬ dren, especially in rural areas and areas of special need. Improving the conditions under which children are born and grow up has been the concern of the Children’s Bureau through 45 years of service. To this end it makes studies and reports, works with public and voluntary agencies in an advisory capacity, develops guides and standards for service, and administers the grants for maternal and child health, crippled children’s services, and child welfare services. 54 Department of Health , Education , and Welfare , 1957 Some Facts and Figures About Mothers and Children For the third consecutive year, the number of live births in 1956 exceeded 4 million. Crude birth rates have stabilized since 1950 at about 25 per 1,000 total population but fertility rates in relation to women of child-bearing age continue to increase, and birth rates for third and fourth children indicate the possibility of larger families. The United States child population under age 18 increased from 47 million in 1950 to an estimated 57 million in 1956. By 1965, the number is expected to rise to about 70 million. Infant mortality is reported provisionally for 1956 at 26 deaths per 1,000 live births, the lowest rate ever recorded, but many States still have relatively high rates, particularly for nonwhite infants. About 320,000 infants were born prematurely in 1956. Sixty per¬ cent of neonatal deaths and 44 percent of all infant deaths in 1955 were reported as associated with prematurity. In 1955, almost 4 percent of reported pregnancies that reached 20 weeks or more in duration resulted in a stillborn infant or death in the neonatal period. Maternal mortality has declined steadily since 1929, from a rate of 69.5 maternal deaths per 10,000 live births to an estimated 3.8 in 1956. In 1955 in 17 percent of the births to nonwhite mothers and in over 8 percent of the births to mothers in rural nonmetropolitan counties no medical attendant was present at delivery. These pro¬ portions, however, are lower than in previous years. Accidents are the leading cause of death for children. They took the lives of 16,707 children aged 1 to 19 in 1955 and accounted for 40 percent of the mortality in this age group. Among other deaths, cancer has become the leading cause for death of children 5 to 19 years of age, while influenza and pneumonia lead in the preschool group. Next in importance among all deaths of children 1 to 19 years old are congenital malformations and dis¬ eases of the heart, including acute rheumatic fever. The number of children born out of wedlock during 1955 was esti¬ mated at 183,300, a 4-percent increase over 1954. Of these, 64,200 were white children and 119,200 nonwhite. About 73,000 unmarried mothers were under 20 years of age. Juvenile delinquency continues its upswing. Police arrest data reported by the Federal Bureau of Investigation for 1,160 cities show that arrests of juveniles under 18 increased 17.3 percent from 1955 to 1956. In 1956, juveniles represented 66.4 percent of all persons arrested for auto theft, 53.9 percent for burglaries, 50.4 percent for larcenies. Preliminary juvenile court data, too, show a rise in delin¬ quency cases between 1955 and 1956, possibly by as much as 20 per- Social Security Administration 55 cent. This is the eighth consecutive year of increase. Roughly 2 percent of the child population aged 10 through 17 are estimated to be involved each year in delinquency cases that reach court. Family income in the United States reached an all-time high in 1955, with a median money income of $4,421 per family. But fami¬ lies with four children had a median money income of $4,360; families with five children, $3,622; and families with six or more children, $3,434. In 1955 families with four or more children con¬ stituted only 9 percent of all families, but they contained 31 percent of the country’s children. The mother’s work outside the home has been one of the major factors in rising family income in recent years. Between 1948 and 1953 the proportion of married women living with their husbands and with preschool age children increased from 11 to 16 percent. In March 1956 more than two million such mothers with children under age 6 were in the labor force. Children With Special Needs Though all children are its concern, the Children’s Bureau continues to recognize certain groups as being under special handicap and in special need. The adolescent in contemporary society is under increased pressures and though the vast majority grow up to be responsible adults, a suffi¬ cient number engage in delinquent behavior to cause concern all across the country. The Children’s Bureau has continued through 1957 its drive on delinquency, concentrating especially on developing stand¬ ards for care and on training needed personnel. The children of migrant agricultural workers continue to be a con¬ cern of the Children’s Bureau though progress in improving their lot has been made. A study in Florida made possible through a spe¬ cial grant has borne fruit in a service project in two counties. Colo¬ rado, also, with the stimulus of a special grant, has gradually ex¬ tended and improved its program. In Pennsylvania child welfare services to migrant children have been considerably expanded. In a number of other States there is evidence of increased awareness of the problem and of willingness to accept more responsibility for these children. In appropriating $16 million for maternal and child health grants for the fiscal year 1957, the Congress earmarked $1 million for special projects for mentally retarded children and the House Committee on Appropriations recommended that approximately $1 million addi¬ tional also be used on the problems of mentally retarded children. By the end of the year projects had been approved in 26 States by the 56 Department of Health , Education, and Welfare, 1957 Children’s Bureau, with commitments totaling about $1,300,000. In addition, State health departments have reported budgeting over $500,000 of other Federal maternal and child health funds for chil¬ dren with mental retardation. Adoptive placement of children without benefit of prior social agency services has received special attention. Emphasis is being given to the social, medical and legal protections needed by natural parents, the child and adoptive parents. Social workers from various States attended a Children’s Bureau sponsored meeting to consider “The Bole of the Social Agency in Adoption.” Federal Interdepartmental Committee on Children and Youth The Congress places responsibility upon a number of the agencies of the U. S. Government for programs which contribute in varying degrees to the social well-being of children and youth. In 1948 the President requested these agencies to form an Interdepartmental Committee on Children and Youth to assist each other in keeping informed about program developments, to work together for greater effectiveness in program planning, and to strengthen working rela¬ tionships between the Federal Government and the States. This triple assignment has been carried out during fiscal year 1957 by the regular monthly meetings of the full Committee, the work of its subcommittees, and an informational exchange with the State and Territorial Committees on Children and Youth. Thirty-four Fed¬ eral agencies are represented on the Committee which meets monthly from September to June. The Children’s Bureau furnishes the secre¬ tariat for the Interdepartmental Committee on Children and Youth. The Interdepartmental Committee was a cosponsor of the Joint Conference on Children and Youth held in Washington, D. C., in December 1956 at which over 200 representatives of State, national voluntary, and Federal agencies participated. Programs of the Bureau RESEARCH IN CHILD LIFE The Bureau’s small research staff has the chief responsibility of carrying out the legislative mandate “to investigate and report upon all matters pertaining to the welfare of children.” In addition to its own studies and those conducted jointly with others, the Bureau seeks to stimulate research in child life by other agencies by formulating the questions requiring study and by developing research methods and by advising agencies engaged in such research. Social Security Administration 57 Technical research under way during the year included develop¬ ment of a method for determining unit costs in institutional care of children and analysis of methods and findings of evaluative research. Two large-scale studies were launched to examine, respectively, the outcome of independent adoptions and the reasons for the large number of staff losses in child welfare and private family service agencies. Work continued on assembling information about pro¬ grams and services for mentally retarded children. Improvement in hospital statistics on maternity and newborn infant care was stressed in the development of a joint research study of the American College of Obstetricians and Gynecologists, the American Academy of Pedi¬ atrics, the Connecticut State Department of Health, and the Chil¬ dren’s Bureau. Throughout the country juvenile delinquency is being studied from both psychological and sociological perspectives — the former focusing primarily on the inner personality dynamics of individual children, the latter directing attention to the effects of situational or environ¬ mental social and cultural factors. In an attempt to bridge the gap between these two approaches, the Bureau published a report of a conference of experts from both fields. The Bureau receives annual statistical reports from official State agencies regarding State and local health and welfare services for children. It also receives certain statistical information on voluntary child welfare services, on the work of juvenile courts and public training schools for juvenile delinquents, and on adoption. These reports are occasionally supplemented by special statistical inquiries. During 1957 the following publications based on such statistical data were published : Some Facts About Public State Training Schools for Juvenile Delinquents , Training Under the Maternal and Child Health and Crippled Children's Programs , Crippled Children's Serv¬ ices at the Mid-Decade , Selected Child Welfare Expenditures of State and Local Public Welfare Agencies , Juvenile Court Statistics , Maternal a/nd Child Health Services , Adoption in the United States and Its Territories , and Public Programs for Crippled Children. As a part of its research interpretation activities, the Bureau has been reviewing its role in parent education as an interdisciplinary movement, with special reference to current issues and problems requiring new approaches. Three issues of Research Relating to Children under a new plan of coverage were published. This series is an inventory of current research to help investigators in the field of child life keep informed about studies being conducted in their areas of special interest. The research staff worked with or provided technical consultation requested by State health departments and other health agencies on 448006—58 - 5 58 Department of Health , Education , and Welfare, 1957 studies concerning subjects such as prematurity, emotionally dis¬ turbed children, mental retardation, neurological defects of infancy and childhood, and attitudes of professional health workers. State welfare departments and other welfare agencies were assisted in studies on such problems as family life education, value of a central register for juvenile delinquents, optimum caseload for child welfare workers, administrative uses of child welfare reports, and evaluation of juvenile delinquency control measures. MATERNAL AND CHILD HEALTH SERVICES All of the States, the District of Columbia, Alaska, Hawaii, Puerto Rico, and the Virgin Islands receive Federal fluids to extend and improve services for promoting the health of mothers and children. The Congress for the year 1957 increased the appropriation for maternal and child health to $16,000,000 and earmarked $1,000,000 to be used only for special projects for mentally retarded children. The ongoing programs of the State maternal and child health agencies continue to make a major contribution to the health of the Nation. Preliminary and incomplete figures from State maternal and child health reports show that about 224,000 mothers received services at maternity medical clinics in 1956. In addition, health nurses served some 430,000 mothers before or after delivery. About 445,000 infants and 640,000 other children received health supervision through well-child clinics. In addition, health depart¬ ment programs provided nursing service for about 2,660,000 infants and other children. Almost 1,248,000 children were vaccinated for smallpox and nearly the same number were immunized for diphtheria by State and local health departments through grants provided by the maternal and child health programs. Polio immunization through these pro¬ grams reached ten and a half million children. To better prepare personnel for maternal and child health pro¬ grams a number of States carried out institutes and special training projects. Of unusual significance is the First Illinois Congress on Maternal Care sponsored by the new Illinois Committee on Maternal Welfare, held in February 1957. The Illinois Committee on Maternal Welfare was a pilot project of the American Committee on Maternal Welfare designed to invite the active participation of the several profes¬ sions concerned with achieving optimum maternal and newborn care. The Illinois Department of Health played an active role in the plan¬ ning and execution of this program. An institute attended by 150 physicians and nurses on Maternity Newborn Care sponsored by the Montana State Health Department, Montana State Medical Society, and the Montana State Nurses Asso- Social Security Administration 59 ciation was held June 9-12, 1957. The focus of the institute was on the medical and nursing clinical aspects of obstetrical and newborn care in respect to complications in pregnancy, abnormal labor, and conditions causing stress in the newborn. Representatives from 17 schools of nursing with degree programs met in Atlanta, Georgia, for a workshop on The Maternal and Child Health Component of the Basic Curriculum for Nurses. This work¬ shop was sponsored by the Southern Regional Education Board, the Georgia State Department of Public Health, and the Children’s Bureau. The Utah State Health Department with the University of Utah sponsored an institute for nurses on child growth and development in June as a follow-up of the Regional Institute held at the Uni¬ versity of Wyoming, June 1956. Special emphasis has been given to the development of programs to a long-neglected segment of our child population — the mentally retarded. On the basis of the increased maternal and child health funds earmarked by Congress for this group of children, the Chil¬ dren’s Bureau approved 26 special demonstration projects to be op¬ erated as part of State health department programs in maternal and child health. These are designed to: 1. Provide early easefinding, evaluation, diagnosis and treatment, planning, and follow-up care, particularly for preschool mentally retarded children and their families. 2. Evolve patterns of service and methods of providing services which State health departments can utilize. 3. Provide training and orientation for a variety of professional personnel In addition to special project funds, regular maternal and child health funds in many States have gone into programs for mentally retarded children. Through regional and State conferences on mental retardation professional personnel, official State agencies and representative parents’ groups in at least 28 States were involved in institutes on this problem. During the year the Denver and Dallas Regions each had conferences on mental retardation, and the Charlottesville and At¬ lanta Regions held one jointly. Among the States which had State meetings were: Arkansas, Colorado, Iowa, Kentucky, Minnesota, Mississippi, Virginia, and Washington. In addition, an institute on mental retardation for public health nurses at Boston University and one for social workers at Tulane University were utilized to evolve patterns for similar institutes being planned and geared to a variety of professional disciplines. Most States having special projects have provided for orientation of project personnel and maternal and child health staff through visits in existing special facilities serving the mentally retarded. 60 Department of Healthy Education , and Welfare , 1957 There has been renewed interest by maternal and child health directors in programs for the improvement of hospital care of ma¬ ternity patients and their newborn infants. The planning in most instances is a cooperative venture with the appropriate committees of the State medical societies, State chapters of the Academy of Pediatrics, the official State agency responsible for hospital licensing, the State hospital association, and, in some instances, the staffs of individual or local groups of hospitals. With an increasing number of births occurring in hospitals, and most of the prenatal care pro¬ vided by private physicians or hospital clinics, this is a logical focus of emphasis in any efforts to improve the quality of care and to lower the morbidity and mortality rates. The intensification of interest at the State level is in part a result of the cooperative efforts at the national level. The Children’s Bureau has had a representative on the American Academy of Pedi¬ atrics Committee which, with the cooperation of the American Col¬ lege of Obstetricians and Gynecologists, the American Public Health Association, the American Hospital Association, and the National League for Nursing, developed “Standards and Recommendations for Hospital Care of Newborn Infants — Full Term and Premature,” and this year revised it. The Children’s Bureau has also been rep¬ resented on a committee of the American Committee on Maternal Welfare (now the American Association for Maternal and Infant Health), which with a number of professional organizations is in the process of developing a “Guide to Hospital Care of Maternity Patients.” Eighty-three public health nurses in North Carolina have com¬ pleted short courses in home and farm accident prevention over the past 3 years. These courses have been sponsored jointly by the State Board of Health and the University of North Carolina. This is considered a significant accomplishment within the State since acci¬ dents, particularly those of home and farm, are one of the leading causes of death in North Carolina children. CRIPPLED CHILDREN’S SERVICES All of the 53 States and Territories, with the exception of Arizona, are participating in the crippled children’s program. Though the State agency auspices vary, the objective is uniform, namely : to locate children who require care, and to provide restoration through diag¬ nosis, medical and surgical treatment, and alleviation of unfavorable social and psj^chological influences which adversely affect the degree and duration of the disability. The appropriation for crippled chil¬ dren’s services is $15,000,000, the amount authorized. Preliminary figures from State reports indicate that a new peak was reached in 1956 in the number of handicapped children served Social Security Administration 61 under federally aided programs. Some 290,000 children were cared for during the year. Most of the children (232,000) were seen in clinics; about 60,000 received physician’s services through home or office visits. Children who were hospitalized numbered approxi¬ mately 52,000. Convalescent home care was given to the smallest group, around 3,800. A significant development during the past year is the trend toward the establishment of diagnostic and treatment centers for children — children with all kinds of handicaps — in medical schools. These cen¬ ters are based in the pediatric department but available to the centers are all medical specialties; medical social work; nursing; psychology; physical, occupational, and speech therapy; and a variety of other disciplines, including special education. Both the Arkansas and Louisiana maternal and child health divi¬ sions employed consultants in safety and accident prevention, and the Poison Control Center in Oklahoma is continuing to develop its service. The Michigan Child Amputee Program has established a training- course for physicians, occupational therapists, physical therapists, and medical social workers. This is the first child amputee course to be offered in the country. As a result there is awakened interest in this group of handicapped children on the part of other State agencies. While the Grand Rapids Center is accepting many severely handicapped children, including a number of quadruple amputees, the crippled children’s agencies in other States are gradually assuming more responsibility for the less severely handicapped amputees as knowledge from the Grand Rapids Center is being disseminated to professional personnel in other States and countries. Washington is one of the States which has established a special crippled children’s clinic for amputees during the year. Several States are beginning to develop services for children with nephrosis, cystic fibrosis, and other selected metabolic and degen¬ erative diseases in which the prognosis can be materially improved through early recognition and continuous and proper medical treat¬ ment and follow-up. Such services have been initiated in Connecticut, Massachusetts, New Hampshire, New Jersey, and Pennsylvania. During the past year the number of States accepting children with congenital heart disease under their crippled children’s program has continued to increase, and the number of States which have their own centers which have been approved for cardiac surgery has also in¬ creased. Some States use the State center for cases requiring simpler cardiac surgery and the Regional Cardiac Centers for the more com¬ plicated cases. Children of the Territory of Guam are now served through the Regional Cardiac Center in California. Among the States which have initiated programs for children with congenital heart disease this year are Alabama, Missouri, and Kansas. 62 Department of Health , Education, and Welfare, 1957 A few centers which have been approved for cardiac surgery by their respective States are: Vanderbilt University Hospital, University of Tennessee Hospital, St. Louis University Hospital, and University of Missouri Hospital. In addition to the University Hospitals in Minneapolis, Minnesota, two other centers were added to the Minnesota Regional Heart Center program — the Mayo Clinic, Rochester, Minn., and Mt. Sinai Hos¬ pital, Minneapolis, Minn. A major problem which arose in these cen¬ ters was that of obtaining a large amount of fresh blood on the day of the operation. There were not enough paid donors available and the lack of donors was holding up operations. Largely as a result of newspaper publicity plans were worked out for obtaining voluntary donors from Minnesota State Prison, St. Cloud Reformatory, and other correctional institutions. Increased activity in development of services for children with rheu¬ matic fever and congenital heart conditions has been a marked trend in crippled children’s programs in Alabama, Florida, Georgia, North Carolina and Tennessee. Because of mutual interest of the Children’s Bureau and of the Public Health Service, there have been joint activi¬ ties with State heart programs. A symposium on rheumatic fever sponsored by the maternal and child health and crippled children’s divisions of the North Carolina State Health Department was held at Chapel Hill during the year. State health departments and crippled children’s agencies continue to show extension and improvement of speech and hearing programs. The program in Arkansas is now to be housed in the Children’s Hos¬ pital and is thereby established as part of a general children’s medical service. A new program is being developed by the Texas maternal and child health division, and the New Mexico program is being reorganized following the return from training of their audiologist. The Tennessee Conference on Handicapped Children highlighted the speech and hearing program in that State, and the audiology training program of the Bill Wilkerson Speech and Hearing Center which is affiliated with Vanderbilt University is being expanded, aided by a grant from the Children’s Bureau, through the State health depart¬ ment, California, with a special project grant, has started a program at the John Tracy Clinic which is devoting particular attention to the problems of central nerve deafness in children. Indiana, Wis¬ consin, and Ohio are States which provided fellowships for training in audiology. The Colorado special project in hearing conservation started last spring. The program is emphasizing the development of preventive and treatment services in rural parts of the State and is making a particular effort at the casefinding of preschool children. In several States cognizance has been taken of the radiation hazard to public health. In Connecticut enabling legislation for control of Social Security Administration 63 sources of ionizing radiation by the State Health Department was passed. New York has a new regulation prohibiting the use of radioactive materials, X-ray machines, and similar radiation-produc¬ ing equipment on human beings by anyone not licensed to practice medicine, osteopathy, dentistry, or podiatry. In North Dakota, also, the Health Department was given responsibility for the control of radioactive developments in the State. CHILD WELFARE SERVICES The Children's Bureau has continued to work with public and vol¬ untary, national, State, and local welfare agencies in planning for better social services for children. One part of this work is the joint planning with welfare agencies in the 48 States, Alaska, Hawaii, Puerto Bico, Virgin Islands, and the District of Columbia for the most effective use of Federal grant-in-aid funds for strengthening and extending child welfare services. The method for providing social services for all children in need of them in all geographical areas continues to be a major concern of the Bureau. The importance of structure, organization, and administra¬ tion in the provision of public social services for children is increas¬ ingly recognized. State child welfare advisory committees, planning commissions, and youth councils are taking a broader look at the total framework within which services are provided and are asking for help in relation to principles of organization and administration and in effective planning for the coordination of services. State welfare agencies continue to use Federal funds for child wel¬ fare services available under the grant-in-aid program primarily for personnel and professional education. Still, the lack of a sufficient number of qualified child welfare staff and difficulties in recruitment present increasing problems in strengthening and expanding social services for children. In spite of salary increases in many States, sal¬ aries for social workers generally seem to be too low to compete with industry, education, and other fields. Some States are facing the fact that fully trained and competent staff in adequate supply will not be available for many years to come and are developing long-range recruitment methods. Arkansas, Louisiana, and Maine are employ¬ ing college juniors during the summer months. This is in effect a paid orientation to the public social services with the hope that upon graduation from college such students may be interested in further training and employment in the social work field. In Florida, a special committee on recruitment has been appointed with representatives from the departments of education and welfare and from the fields of public relations, counseling, youth guidance, and industry. The personnel officers of the State department of public welfare have been working with high schools in the prepara- 64 Department of Health , Education, and Welfare, 1957 tion of material on social work to be included in textbooks. They have also been developing a rating scale for high school senior apti¬ tude tests to indicate the potential aptitude for social work. This recruitment project involves long-range plans beginning with the eighth grade social study textbooks. In an attempt to improve the quality of services provided to chil¬ dren, many States are providing special workshops for supervisory staff. A seminar on “Group Leadership in Staff Training” in public welfare agencies sponsored jointly by the Children’s Bureau and the Bureau of Public Assistance was held in June 1957. Thirty-six State supervisors and consultants carrying responsibility for staff development in 26 States attended. State public welfare departments are giving increasing consider¬ ation to the kinds of services needed in strengthening the child’s own home. Interest in the development of programs of services to children in their own homes, particularly protective services, has continued with even greater momentum this year than last year on national, State, and local levels. Several sessions at the National Conference on Social Welfare were devoted to services to children in their own homes and to protective services. State conferences of social work have increasingly included institutes on services to chil¬ dren in their own homes. The requests to the Children’s Bureau for special consultation in this area have greatly increased. More and more, State and local welfare agencies are interested in developing homemaker services as a way of keeping children in their own homes. During the year, the Children’s Bureau issued a new Directory of Agencies Providing Homemaker Services in the United States and Canada which included 128 agencies in 89 cities and 31 States. A small meeting on homemaker service under the auspices of the Children’s Bureau, the Bureau of Public Assistance, and the Public Health Service was called on June 17-18, 1957. Nurses, doctors, and social workers discussed how to stimulate an expansion of homemaker services throughout the country ; considered the kind of situations that require help in the home by an outside person ; defined the types of home helps needed ; specified some of the knowledge and skills involved; and outlined steps to be taken in planning for a national conference on homemaker and related services. In considering how to assure the best possible care to children of unmarried mothers, child welfare staffs in the States have been faced with a dilemma. On the one hand they recognize that the continuation of independent placement of babies for adoption re¬ sults, to a great extent, from the lack of services for unmarried mothers. On the other hand, great expansion of such services with- Social Security Administration 65 out good public understanding of the needs of these children fre¬ quently produces public reaction against all unmarried mothers. Considerable progress is being made in getting social workers, doctors, lawyers, nurses, and other professional groups to consider together their reponsibilities in providing services to unmarried mothers and services in adoption. Connecticut, Maine, Rhode Island, and Vermont have ongoing committees with broad representation of physicians, lawyers, clergymen, social workers, and others including adoptive parents studying the need for more adequate State and local community adoption programs. A conference in Estes Park, Colo¬ rado, in September 1956, sponsored by the Colorado Medical School, the State health and welfare departments in the surrounding region, and the Children’s Bureau, brought together about 90 representatives of the medical, legal, and social work professions to consider how the knowledge and skills of each could be brought to bear in protecting children placed for adoption. Statistical reports on adoptions (covering the calendar year 1955) show that of the children adopted by nonrelatives, 56 percent were placed by social agencies and 44 percent were placed independently. Public interest in adoptions and in practices of social agencies has continued with an increase in the number of articles in popular maga¬ zines and number of programs on adoptions on television and radio. Interest in the foster-care needs of children of minority groups has increased. The project called MARCH in San Francisco for re¬ cruitment of adoptive homes for children in minority groups has continued. A number of States, including the Middle Atlantic and Middle Western, have been giving special attention to the needs of Negro children. In South Carolina the State Department of Wel¬ fare has developed a new adoptive service for hard-to-place children. Colorado, Montana, and Wyoming have continued their efforts to find adoptive homes for handicapped children, older children, and children from mixed races or minority groups. In Colorado a series of newspaper articles about 51 of these children brought immediate and warm response from the public in the form of over 100 letters and 300 telephone calls from interested families in Colorado and sur¬ rounding States. In addition to these many problems in regard to adoptions, State and local communities are requesting help and advice in regard to adoption legislation, fee charging in adoption service, and the estab¬ lishment of a State adoption resource exchange. In nonadoptive full-time foster-care programs, child welfare staffs are being encouraged to use foster care as a temporary arrangement until the child can be returned to his own family or placed in an adoptive home. The recruitment, selection, and development of fos- 66 Department of Health , Education , and Welfare, 1957 ter family homes for children with special needs such as disturbed children and children who are physically handicapped are of major concern. Many agencies are looking carefully at the size of caseloads and board rates and are attempting to identify and measure the costs of foster-care services. An examination of the nature of “purchase of care” from voluntary agencies by public agencies and the responsi¬ bilities involved for both the public and voluntary agencies is the cen¬ ter of a great deal of attention. Increase in commercial day-care facilities is reported in certain sections of the country, especially in the Southeastern States where rapid industrialization has occurred. Here the need for day-care services is the most outstanding gap in services. The welfare depart¬ ments have struggled to meet this need and have taken considerable initiative through their child welfare licensing responsibility to raise the standards of day-care services. Three of the Southeastern States have two or more State staff members who are devoting full time to this service. Tennessee has six staff members giving full time to the development of day-care services. In North Carolina, Maryland, and Virginia work on licensing day¬ care facilities is beginning. In Arizona and Louisiana the State wel¬ fare departments have been given new responsibility for licensing group day-care facilities. Minnesota and Missouri have issued up-to- date standards for day-care centers. In institutional care of children, the progress varies. In most States there is real concern not only for improving the quality of in¬ stitutional care but also for providing small specialized institutions for certain groups, such as emotionally disturbed, delinquent, and re¬ tarded children. By and large, however, plants are being improved, standards are being adhered to, and emphasis is gradually being placed on program and special services for children, such as psychi¬ atric care and specialized medical care. The limited usefulness of traditional institutions and foster-family homes for adolescents has prompted increasing experimentation with agency purchased or rented group homes. Recent ventures of this kind have been introduced or considered in California, Connecticut, New York, North Carolina, and Tennessee and in a number of other States. Schools of Social Work are providing help in the improvement of institutional programs. The University of North Carolina School of Social Work has established a three-fold program of consultation, in-service training, and research for child-caring institutions in the Southeastern States. St. Louis University School of Social Service established in June 1957 a combined field and classroom curriculum for house parents employed in institutions in the St. Louis area. Social Security Administration 67 During the year real progress has been noted in the way States are moving ahead in taking responsibility for consultation to and li¬ censing of voluntary agencies and institutions. A number of States have issued new standards for child-placing agencies, institutions, maternity homes, day-care centers, and foster homes. Three work¬ shops on licensing were conducted under the leadership of the Chil¬ dren^ Bureau. In all the New England States, public and voluntary health, edu¬ cation, and welfare agencies and organizations are working with organized parent groups in the interest of better health, education, and welfare programs for the mentally retarded child. In some States this cooperative effort has been focused on the need for im¬ proved institutional services and facilities ; in others on family coun¬ seling and the development of camps and day-care services, and in still others, on special classes and vocational training and employment. Colorado, Utah, and Wyoming participated in the regional work¬ shop on services to mentally retarded children held in February under the sponsorship of the Colorado State Health and Welfare Depart¬ ments, the Colorado Medical School, and the Children’s Bureau. A similar regional conference was held in Dallas. Child welfare staff in these States are particularly desirous of incorporating modern concepts in the field of mental retardation into their in-service train¬ ing for social workers and to develop joint efforts between physicians, educators, and social workers in meeting the needs of mentally re¬ tarded children and their parents. Definite and continuing progress is evident in States in cooperative efforts among public and voluntary agencies. For example, in both Connecticut and New Hampshire, State-wide voluntary associations have spearheaded moves for better legislation, for foster-home find¬ ing, and for general interpretation of the needs of children. Publications completed during 1957 were: Child Welfare Serv¬ ices — How They Help Children and Their Parents ; Meeting Family Need Through Homemaker Service ; Homemaker Service , 1956 — A Directory of Agencies in the United States and Canada; Educa¬ tional Leave in Public Child Welfare Programs (Child Welfare Re¬ ports, No. 6) ; Child Welfare in Wisconsin : A Picture of a Program (Child Welfare Reports, No. 7) ; Foster Care , 1956 (Child Welfare Reports, No. 8) ; Group Leadership in Staff Training (Children’s Bureau and the Bureau of Public Assistance) ; and Proposals for Drafting Principles and Suggested Language for Legislation on Public ,< Child W elf are and Youth Services. 68 Department of Health , Education , and Welfare , 1957 JUVENILE DELINQUENCY SERVICES For the eighth consecutive year reports show a rise in juvenile delinquency — percentagewise faster than our juvenile population. The Children’s Bureau is giving consultative service to States and communities in relation to juvenile and family courts, probation serv¬ ices, police work, training of personnel in the law enforcement and correctional fields, social group work, and community organization ac¬ tivities in relation to juvenile delinquency. Interest in State and local programs for the control and treatment of juvenile delinquency continues at a high level. In a number of States legislation has been proposed or passed which provided for separate agencies or for units within established agencies to admin¬ ister services for delinquent children. A number of States have revised their juvenile court laws. Other States have added consult¬ ants to staffs of State agencies in areas such as probation services, institutional care, and community organization. There is also considerable activity in the establishment of new or reactivation of old State and local committees or commissions for communication, joint planning and coordination of services and ac¬ tivities in relation to juvenile delinquency. The use of forestry camps as treatment facilities is increasing. Camps have been established in at least 10 States, with five others planning such facilities. New construction is underway with six States building new training schools and a number of others ex¬ panding and renovating existing facilities. The emphasis on the training of staff continues to be great in the probation, institutional, and police fields. Bureau consultants were involved in joint planning and leadership in various training institutes. A workshop for staff responsible for training personnel in correc¬ tional institutions for juvenile delinquents, supported by a grant from the American Legion Child Welfare Foundation, was held at Rutgers University in April. J oining with the Bureau as cosponsors were the National Association of Training Schools and Juvenile Agencies, the National Probation and Parole Association, the Coun¬ cil on Social Work Education, and Rutgers University. The report of the workshop will include a formulation of new ideas regarding in- service training in correctional schools. A 4-day national conference on Youth Groups in Conflict held in May attracted over 200 persons from 22 States. The National Social Welfare Assembly, United Community Funds and Councils of America, and the National Association of Social Workers joined with the Children’s Bureau in sponsoring this conference. In recent years, programs to reach and help the members of hostile, antisocial youth Social Security Administration 60 gangs have multiplied rapidly across the country. An increasing amount of agency time, money, and personnel has been going into these programs. There has not yet been much formulation of theory, practice, or built-in research to guide programs or to measure effec¬ tiveness. The conference proceedings will be published. The Children’s Bureau continued to work closely with the Bureau of Indian Affairs in relation to law enforcement activities and to care of Indian children in correctional institutions. Discussions were held with representatives of the Bureau of Old-Age and Survivors Insur¬ ance in relation to the use of benefits for support of children in cor¬ rectional institutions and with representatives of the American In¬ stitute of Architects concerning developments relating to the con¬ struction of correctional schools. Cooperative work with the National Council of Juvenile Court Judges in the development of standard juvenile court and family court acts has continued. Institutions Serving Delinquent Children — Guides and Goals was published this year, as were articles written by staff members. INTERNATIONAL COOPERATION The cooperative program with the International Cooperation Ad¬ ministration of the State Department is continuing, with a moderate increase in persons sent to this country for training by that organiza¬ tion. The World Health Organization and the United Nations con¬ tinue to refer people from other countries to us for observation and training. During the year the international staff of the Bureau has planned and arranged training programs for 78 long-term trainees and ob¬ servers and 156 short-term visitors. The trainees were in programs 12 months or more, the observers 2 to 6 months, and the short-term visitors a few hours to 2 months. Of the 78 long-term trainees and observers, 51 were in the health field and 27 in the welfare field. In the health field, 21 physicians took courses in public health with a specialty in maternal and child health, nine physicians took gradu¬ ate work in pediatrics, and two took graduate work in child psychia¬ try. Seventeen nurses were trained in pediatric, maternity, or ortho¬ pedic nursing. Two dentists had graduate training in pedodontics. In the field of child and youth welfare there were 13 trainees in child welfare, three in group work, and seven in juvenile delinquency pre¬ vention and treatment. Four social workers received training in medical social work. Of the 78 trainees and observers, 53 came through the International Cooperation Administration, 11 through the World Health Organiza¬ tion, 13 through the United Nations, and one on her own. The long¬ term trainees came from 34 countries, the short-termers from 53. 70 Department of Health , Education, and Welfare , 1057 The maternal and child health and child welfare specialists re¬ cruited and backstopped by the Bureau contributed to programs in nine countries. During the year two pediatric nurse educators, a nurse midwife, and a maternal and child health physician left for assignments to Latin American countries. At the end of the year two specialists returned from Latin America after very successful ex¬ periences — one a nurse midwife in Mexico, and one a medical social worker in Panama. Both made a great contribution to the develop¬ ment of their respective professions in these countries, and both have left behind them an organized program with trained, competent native persons in charge. The Chief of the Bureau served as United States representative on the Executive Board of the United Nations Children’s Fund (UNICEF) . Also, the Assistant to the Chief for Program Develop¬ ment visited eight countries in the Eastern Mediterranean and South East Asian areas to see maternal and child health services aided by UNICEF. For one part of the trip she was loaned to ICA to take part in a conference on nursing education in Iran, and at another point was a Special Adviser to the United States Delegation at the meeting of the Western Pacific Kegion of WHO in Manila. Federal Credit Unions As general business activity continued upward throughout the fiscal year, Federal credit union operations advanced to new high levels in savings, membership, loans to members, assets, and number of active units. On June 30, 1957, outstanding charters totaled 9,022; of this number, there were 8,592 credit unions actually in operation,, 343 in process of liquidation, and 87 which had received a Federal! charter but had not yet commenced operations. The 8,592 operating Federal credit unions reported aggregate assets of more than $1.6; billion, or 19 percent more than the total a year earlier. Member¬ ship increased from 4.3 million in mid-1956 to almost 4.8 million on June 30, 1957, a gain of 11 percent. Members’ savings (shares) in Federal credit unions rose 18 percent, from $1,239 million on June 30, 1956, to $1,464 million at the end of the current fiscal year, while average shareholdings moved up from $288 to $307 on June 30, 1957. Loans outstanding to members of Federal credit unions stood at $1,- 157 million as the fiscal year ended, an increase of $211 million, or 22 percent, over the amount a year earlier. Although inflationary pressures on the Nation’s economy have been in evidence for some time, prompting measures by the Federal govern¬ ment to combat the trend, Federal credit union activities cannot be characterized as inflationary. Savings have always outpaced loans Social Security Administration 71 to members. The $1,157 million in loans outstanding on June 30, 1957, represented 79 percent of shares and 71 percent of total assets of Federal credit unions. By encouraging borrowers to continue to save while they are still repaying their loans from the credit union, and by stimulating saving by nonborrowers as well, the thrift aspect of credit union operations is emphasized. As a consequence, money taken out of circulation in the form of savings has exceeded the money put into circulation in the form of borrowing in every year since the inception of the Federal credit union program. Encouragement of thrift has always been a major function of credit union operations. The habit of saving is instilled in the members by the educational efforts of the officials in the form of personal contact and distribution of literature explaining the func¬ tions and objectives of the credit union. While some individuals un¬ doubtedly join the credit union only when they need a loan, many others have developed the habit of saving through the credit union, and many of them would very likely have accumulated no savings whatsoever were it not for the accessibility of the credit union at their place of employment, church or fraternal group, or in their own community. In the 23 years since passage of the Federal Credit Union Act on June 26, 1934, Federal credit unions have weathered periods of reces¬ sion and war and have emerged today in a period of unprecedented business activity in a stronger position than they were when the need was believed greatest. Arising out of the ashes of one of the worst depressions in the Nation’s history, the credit union movement con¬ tinues to serve a need for provident and productive loans at reason¬ able rates of interest, a need which has not diminished over the span from depression to prosperity. Another major function of credit unions — promotion of thrift — is just as important today as it was in the earliest days of our history when our forefathers so assiduously followed the principle of “waste not, want not.” Research and Development The Bureau of Federal Credit Unions is responsible for the charter¬ ing, examination, and overall supervision of all Federal credit unions, and for examination of credit unions chartered under the District of Columbia credit union law. During fiscal year 1957, the Bureau issued 692 charters to newly organized groups, and conducted 7,115, examinations among established groups. On June 30, 1957, Federal: credit unions were in operation in all 48 States, the District of Colum¬ bia, Alaska, Hawaii, Canal Zone, Puerto Rico, and the Virgin Islands.. 72 Department of Health , Education , and Welfare, 1957 Dissemination of information about credit union operations is achieved through issuance of periodic special reports to credit union officials and Bureau staff, and through distribution of the Bureau’s annual Report of Operations. Instructional materials for use of the officials and others are prepared and distributed by the Bureau from time to time. Noteworthy examples of this latter type are the Super¬ visory Committee Manual , Credit Committee Handbook , Federal Credit Union Handbook , and the Accounting Manual for Federal Credit Unions. A special questionnaire survey, designed to ascertain the purposes for which loans were made to members during 1956, was completed during fiscal year 1957. On the basis of reports from nearly a fourth of the Federal credit unions in operation at the end of 1956, a trend was indicated toward purchase of consumer durables, particularly automobiles. Despite this trend, however, the remedial type of loan still predominated in 1956, and the majority of loans made by Federal credit unions were relatively small in amount, ranging between $200 and $500. Table 1. — Social Security Administration: Funds available and obligations incurred, fiscal years 1957 and 1956 1 [In thousands; data as of June 30, 1957] Item Funds available 1 2 * Obligations incurred 1957 1956 1957 1956 Total _ $1, 741, 948 $1, 578, 038 $1, 751, 994 $1, 576, 272 Grants to States - - - - - 1, 614, 361 1, 481, 157 1, 624, 613 1, 479, 736 Public assistance - - — 2 1, 575, 000 1, 447, 000 1, 586, 361 1, 446, 116 Old-age assistance _ _ . . Aid to the blind _ _ - _ — _ Aid to dependent children _ _ Js 1, 575, 000 1, 447, 000 f 993, 284 I 41, 361 1 443, 210 922, 539 37, 618 395, 290 Aid to the permanently and totally disabled _ Maternal and child health and welfare services. 39, 361 34, 157 [ 108, 506 38, 252 90, 669 33, 620 Maternal and child health services _ .. 16, 000 11, 928 15, 497 11, 922 Services for crippled children... . 15, 000 15, 000 14, 835 14, 803 Child welfare services _ _ . 8, 361 7, 229 7, 920 6,895 Administrative expenses 4 5 ...... . 127, 587 96, 881 127, 381 96, 536 Office of the Commissioner «... _ 372 323 361 320 Bureau of Old-Age and Survivors Insurance 6 _ 121, 500 91, 229 121, 412 91, 067 Bureau of Public Assistance _ ... 1,748 1, 636 1,729 1,621 Children’s Bureau 7_. .. ... _ 1,822 1, 740 1,811 1,731 Bureau of Federal Credit Unions _ ..... 2, 145 1, 953 2, 068 1, 797 1 Funds available and obligations reported by administrative agencies. 2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. 2 Excludes approximately $11.4 million spent from 1958 appropriation for 1957 requirements. 4 Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and reimbursement items for services rendered to other Government agencies. 5 Appropriations by Congress from general revenues accounted for approximately 57 percent of the ad¬ ministrative expenses of the Office of the Commissioner in 1956 and in 1957; balance from old-age and sur¬ vivors insurance trust fund. 8 For administration of the old-age and survivors insurance program, which iuvolved benefit payments of $5,361,000,000 in 1956 and $6,515,000,000 in 1957. 7 Includes expenses for investigating and reporting on matters pertaining to the welfare of children author¬ ized by the act of 1912, as well as expenses for administration of grants to States. Social Security Administration 73 Table 2. — Financing social insurance under the Social Security Act: Contribu¬ tions collected and trust fund operations , fiscal years 1955—57 [In millions] Item 1957 1956 1955 Contributions collected under — 2 $6, 877 $6, 442 325 $5, 087 Federal Unemployment Tax Act 3 _ ... .. _. 330 280 State unemployment insurance laws 45 . _ 1, 537 1, 329 6,937 6, 442 495 1, 142 Old-age and survivors insurance trust fund: Receipts, total . __ . ._ . ... _ .. _ 7, 100 5, 535 5, 087 Net appropriations and deposits. . 6, 540 Interest and profits on investments 6 561 448 Expenditures, total. .. . .. .. _ _ ...... . _ 6, 665 6,515 150 5, 485 5, 361 124 4, 436 4, 333 Monthlv benefits and lump-sum payments 7 . Administration. _ _ _ .... _ .... _ 103 Assets, end of year _ _ 23, 029 338 22, 593 21, 141 Disability insurance trust fund: Receipts, total _ .... _ . _ ... .. Net appropriations and deposits.... 337 Interest _ .. .. . _ _ _ _ _ . .. _ _ 1 Expenditures (administration) _ 1 Assets, end of year . ...... . . . . . . . 337 State accounts in unemployment trust fund: Receipts, total _ _ _ _ _ . _ . 1,790 1, 520 1,333 1, 333 Deposits 8 _ _ _ _ _ _ _ _ 1, 578 212 1, 146 187 Interest . 187 Withdrawals for benefit payments _ _ _ _ .. 1, 514 8, 492 1, 287 8, 216 1,760 7, 983 Assets, end of year. 1 Contributions on earnings up to and including $3,600 a year in 1954 and $4,200 a year beginning Jan. 1, 1955. Contribution rate paid by employers and employees: 2 percent each through Dec. 31, 1956, 214 per¬ cent beginning Jan. 1, 1957. Corresponding rates for the self-employed: 3 percent and 3H percent. In¬ cludes deposits by States under voluntary agreements for coverage of State and local employees. Include? deductions to adjust for reimbursements to general funds of the Treasury of the estimated amount oi taxes subject to refund on wages in excess of wage base. 2 Contributions for old-age and survivors insurance and, beginning Jan. 1, 1957, disability insurance. 3 Before 1957, tax could be paid in quarterly installments by employers of 8 or more; beginning Jan. 31, 1957, tax payable annually on preceding year’s wages by employers of 4 or more. Rate is 3 percent on first $3,000 a year of wages paid to each employee by subject employer. Because of credit offset (up to 90 percent of amount assessed is offset by State unemployment insurance contributions paid or payable except for State experience-rating reductions), effective rate is 0.3 percent of such wages. * Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 5 Contributions and deposits by States usually differ slightly, primarily because of time lag in making deposits. 6 Includes interest transferred from the railroad retirement account under the financial interchange pro¬ visions of the Railroad Retirement Act, as amended in 1951. 7 Represents checks issued. Source: Compiled from Final Statement of Receip's and Expenditures of the United States Government, other Treasury reports, and State agency reports. 448006 58- 6 74 Department of Health , Education , and Welfare, 1957 Table 3. — Old-age, survivors, and disability insurance: Estimated number of families and beneficiaries receiving benefits and average monthly benefit in current-payment status , by family group, end of June 1957 and 1956 [In thousands, except for average benefit; data corrected to Nov. 21, 1957] June 30, 1957 June 30, 1956 Family classification of beneficiaries Total _ Retired worker families _ Worker only - - - Male _ Female _ Worker and aged wife _ Worker and young wife 1 _ Worker and aged dependent husband - Worker and 1 or more children _ Worker, wife aged 65 or over, and 1 or more children _ Worker, young wife, and 1 or more children. Survivor families _ Aged widow _ Aged dependent widower _ Widowed mother only i _ Widowed mother and 1 child _ Widowed mother and 2 children _ Widowed mother and 3 or more children _ Divorced wife and 1 or more children _ 1 child only _ 2 children _ 3 children _ 4 or more children _ 1 aged dependent parent _ 2 aged dependent parents _ Num¬ ber of families Num¬ ber of benefi¬ ciaries Average monthly amount per family Num¬ ber of families Num¬ ber of benefi¬ ciaries 7, 581. 8 10, 342. 1 6, 160. 2 8, 374. 5 5, 832. 3 7, 710. 1 4, 731. 9 6, 114. 4 4, 091. 9 4, 091. 9 $59. 90 3, 460. 3 3, 460. 3 2, 271. 8 2, 271. 8 67. 70 2, 148. 4 2, 148. 4 1, 820. 1 1, 820. 1 52. 30 1,311.8 1,311.8 1, 630. 2 3, 260. 4 107. 80 1, 182. 6 2, 365. 2 .5 1.0 101. 10 .3 .6 12.8 25.6 92. 80 10.7 21.4 21.3 54.4 104. 40 16.6 42.7 1.2 3.6 135. 90 1.3 4.0 74.3 273.0 129. 30 60.1 220.1 1, 749. 6 2, 632. 0 1, 428. 3 2,260.1 1, 019. 0 1, 019. 0 50.70 746.3 746.3 1.4 1.4 47. 60 1.1 1.1 1.9 1.9 59. 90 .8 .8 132.9 265.8 112. 20 128.4 256.8 92.5 277.5 144. 60 85.7 257.2 87.3 413.5 142. 20 82.4 389.8 .3 .7 136. 50 .3 .7 238.2 238.2 49. 80 217.0 217.0 94.8 189. 5 85. 60 90.0 179.9 34.0 102. 1 109. 00 31.8 95.3 21.0 94.3 116. 70 20.2 89.3 24.6 24.6 51.60 22.8 22.8 1.8 3.6 98. 30 1.5 2.9 Average monthly amount per family $60.00 65. 60 50. 70 104. 80 113. 30 88. 20 101. 00 132. 30 121. 10 49. 48. 51. 108.50 137. 80 136. 40 135. 70 48.50 83. 80 105. 20 112. 20 50.50 95. 30 1 Benefits of children were being withheld. Social Security Administration 75 Table 4. — Old-age , survivors , and disability insurance : Selected data on benefits , employers , workers , a/id taxable earnings , by State, for specified periods, 1954, 1956, and 1957 [In thousands, except for average taxable earnings; data corrected to Nov. 21, 1957] State Monthly bene¬ fits in current- payment status, end of fiscal year 1957 1 Num¬ ber Amount Total _ 10, 342. 1 $554, 637 Alabama _ . 152.9 6,583 Alaska _ __ ... 4.9 238 Arizona _ _ 49.2 2, 544 Arkansas __ _ 102.0 4, 390 California _ 808.7 45, 001 Colorado _ 85.9 4, 510 Connecticut. . . 166.9 10, 125 Delaware _ 23.5 1,292 District of Columbia 37.2 1,967 Florida _ _ 295.0 15, 884 Georgia _ 160. 1 6,912 Hawaii _ 22. 1 1,074 Idaho.. _ _ _ 37.0 1,839 Illinois _ ... 609.2 34, 939 Indiana.. . . . _ 300. 2 16, 196 Iowa . . ... 177.7 9.170 Kansas . . 130.6 6, 624 Kentucky _ ... 179.4 8,200 Louisiana.. _ _ 119.5 5, 491 Maine . . . 79.4 4, 035 Maryland _ 140.8 7, 486 Massachusetts- .. 397.6 23, 054 Michigan . _ 441.1 25, 735 Minnesota.. . _ 199.9 10. 684 Mississippi _ 90.2 3,612 Missouri _ _ _ 283. 1 14, 980 Montana _ .. 39.0 2,039 Nebraska.. . ... 87.1 4, 428 Nevada... ... _. . 10.3 570 New Hampshire. .. 48.5 2,609 New Jersey.. . ... 389.4 23, 181 New Mexico. _ __ 28.8 1,264 New York _ 1, 116.0 64, 350 North Carolina _ 185.0 8, 124 North Dakota. .. _ 28.2 1.318 Ohio _ 583.5 33, 240 Oklahoma _ _ .. 119.8 5, 762 Oregon _ ... 126.2 6, 928 Pennsylvania _ 789.4 44, 664 Puerto Rico _ 48.3 1.449 Rhode Island. ... 67.3 3, 840 South Carolina _ 91.7 3, 877 South Dakota _ 37. 1 1,814 Tennessee _ _ 169.8 7, 467 Texas _ 380.5 18, 059 Utah _ 39.2 2, 058 Vermont _ 29.0 1,476 Virgin Islands _ 0.6 19 Virginia _ 178.7 8, 367 Washington _ .. 183.4 10, 185 West Virginia _ . 134.0 6, 541 Wisconsin. .. 259.5 14, 264 Wyoming _ 15.2 804 Foreign 6 _ 62.7 3, 374 Maritime 7 . Benefit payments fiscal year 1957 1 Em¬ ployers report¬ ing tax¬ able wages, July- Sep- tember 1956 2 Ca Work¬ ers with taxable earn¬ ings 3 lendar year 1954 Amount of taxable earnings 4 * Total Monthly benefits Lump¬ sum pay¬ ments Total Average per worker 514, 580 $6, 391, 689 $122,891 4, 070 59, 700 $133, 800, 000 $2, 240 76, 600 75, 021 1, 579 59 880 1, 539, 000 1,740 2, 854 2, 807 47 3 70 128, 000 1,920 29, 688 29, 064 624 22 320 585, 000 1,820 49, 296 48, 512 784 34 490 768, 000 1,570 533, 981 524, 418 9,563 338 4, 940 11,437, 000 2, 320 52, 795 51,971 824 39 560 1, 040, 000 1,860 121, 544 119, 162 2, 382 65 1,070 2, 634, 000 2, 450 15, 338 15, 003 335 12 180 383, 000 2, 150 23, 597 23, 055 542 30 480 941,000 1,950 183, 065 180, 341 2, 724 108 1,310 2, 108, 000 1. 600 80, 381 78, 404 1,977 77 1,210 2, 022, 000 1,670 12, 561 12,415 146 11 170 355, 000 2, 050 20, 907 20, 576 331 14 210 358, 000 1,720 414, 387 405, 343 9, 044 236 4, 140 9, 727, 000 2, 350 188, 509 184,973 3, 536 96 1,750 3,851,000 2, 200 102, 713 101, 144 1,569 69 900 1, 781, 000 1,990 73, 865 72, 612 1,253 50 720 1,368, 000 1,890 93, 306 91, 672 1,634 57 830 1. 503, 000 1,820 64, 539 63, 015 1,524 61 860 1, 626, 000 1,880 48, 839 47, 906 933 26 380 652, 000 1,730 89, 208 87, 149 2, 059 69 1,010 2, 046, 000 2, 020 278, 953 274, 116 4,837 127 2, 130 4, 565, 000 2, 140 301,814 296, 003 5, 811 159 2,960 7,117,000 2, 400 121,467 119,514 1,953 73 1,050 2, 092, 000 1,990 40, 025 39, 234 791 34 500 779, 000 1,540 171, 428 168, 506 2, 922 103 1,620 3, 318, 000 2, 040 23, 052 22, 642 410 16 220 410, 000 1,820 48, 508 47, 808 700 35 480 861, 000 1,800 6, 750 6, 586 164 7 120 185, 000 1,540 31, 522 30, 916 606 17 270 504, 000 1,840 274, 414 268, 828 5,586 151 2, 340 5, 363, 000 2, 300 14,616 14, 256 360 17 220 338, 000 1, 540 76S.091 753, 148 15, 543 502 7, 550 17, 238, 000 2, 280 92, 204 90, 242 1,962 86 1,380 2, 261,000 1,630 13, 622 13, 452 170 13 150 216, 000 1,420 394, 827 387, 317 7,510 205 3,760 8, 808, 000 2, 340 66, 004 64, 927 1,077 51 770 1, 374, 000 1,770 81,948 80, 754 1, 194 49 670 1, 463, 000 2, 190 537, 455 527, 316 10. 139 255 4.530 10, 092, 000 2, 230> 15, 913 15, 713 200 16 350 301, 000 860* 46, 326 45, 450 876 21 380 771, 000 2, 010 44, 848 43, 721 1, 127 44 630 1, 056, 000 1,680 19, 304 19, 069 235 16 180 286. 000 1,630 84, 730 82, 994 1,736 70 1,040 1, 804, 000 1,740 205, 927 201, 554 4, 373 216 2, 940 5, 648, 000 1,920 23, 786 23, 371 415 16 310 568, 000 1,840 17, 555 17, 248 307 11 160 314, 000 1,960 226 217 9 (*) 10 5, 000 450 97, 793 95, 750 2, 043 82 1,210 2, 180, 000 1,810 120, 904 118, 954 1, 950 66 930 2, 038, 000 2, 180 77, 760 76, 540 1,220 37 560 1, 081, 000 1,930 165, 353 162, 610 2, 743 90 1,400 3, 231, 000 2, 310 9, 272 9, 101 171 9 130 222, 0C9 1,660 39, 610 39, 269 341 50 126, 000 2, 580 130 334, 000 2, 510 1 Distribution by beneficiary’s 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 State data represent workers employed in the State at some time during the year. Workers employed in more than 1 State are counted once in each of the States in which emDloyed. 4 State data represent taxable earnings distributed according to the State in which earned. Averages, based on unrounded estimates of workers and earnings, are rounded to nearest $10. 6 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. 76 Department of Health , Education, and Welfare, 1957 Table 5. — Old-age, survivors, and disability insurance : Selected data on benefits, employers , workers, and taxable earnings for specified periods, 1955—57 [In thousands, except for average monthly benefit and average taxable earnings; corrected to Nov. 21, 1957] Item 1957 1956 1955 Fiscal year Benefits in current-payment status (pnd of period): Number . . ... - - . . . . . 10, 242. 1 8, 374. 5 7, 563. 5 Old-age _ _ _ _ 5, 832. 3 4.731.9 4. 214. 8 Wife’s or husband’s _ _ _ _ . _ _ _ 1,719.0 1, 255. 0 1, 131.3 Child’s i _ 1. 427. 4 1, 316. 7 1,220.9 Widow’s or widower’s... . . _ . . 1, 020. 5 747.8 689.8 Mother’s.. _ 314.9 297.3 281.2 Parent’s _ 28. 1 25.7 25.6 Total monthly amount. _ _ $554, 637 $439, 424 $384, 025 Old-age _ $373, 230 $296, 976 $257, 230 Wife’s or husband’s.. .... .. _ .. $58, 749 $41, 968 $37. 011 Child’s i _ $54, 283 $48, 662 $13, 730 Widow’s or widower’s .. . . . . $51, 707 $36, 648 $32. 150 Mother’s _ _ _ _ $15, 224 $13, 876 $12, 677 Parent’s. -. . _ _ _ $1, 445 $1. 293 $1, 226 Average monthly amount: Old-age _ _ _ $63. 99 $62. 76 $61. 03 Wife’s or husband’s. .. _ ... _ _ $34, 18 $33.44 $32. 72 Child’s i _ _ _ $38.03 $36. 96 $35. 82 Widow’s or widower’s .. $50. 67 $49. 01 $46. 61 Mother’s ... _ ... . ... . $48. 35 $46. 67 $45. 08 Parent’s _ _ .. .... $51.38 $50. 31 $47. 86 Benefit payments during period; Monthly benefits. ...... . $6, 391, 689 $5, 245, 476 $4, 232, 609 Old-age. . . .... . $4, 340, 270 $3, 531, 824 $2, 802, 967 Supplementary. . . $679, 289 $531, 831 $428, 847 Survivor _ ... $1, 372, 130 $1, 181, 821 $1, 000, 795 Lump-sum payments $122, 891 $115, 337 $100, 539 Insured workers (midpoint of period— Jan. IP 1 2 3__ . 72, 500 70, 900 70, 700 Fully insured ... . _ _ .... 72, 200 70, 100 70, 300 Currently but not fully insured.. ........ 300 800 400 Estimated number of employers reporting taxable wages, 1st quarter of fiscal year.. .. ... ... _ _ _ 3 4, 070 3 3, 910 3,715 Calendar year Estimated number of workers with taxable earnings. 0) 68, 000 66, 000 Estimated amount of taxable earnings _ .. ... ... (*) $170, 000, 000 $158, 000, 000 Average taxable earnings 5 _ . . _ . ... (4) $2, 500 $2, 390 1 Data for 1957 include benefits payable to disabled persons aged 18 or over, whose disability began before age 18 and who are the children of a retired or deceased insured worker. 2 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. 3 Excludes agricultural employers. 4 Not available. 6 Rounded to nearest $10. Table 6.— Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average payment, June 1957, and total payments to recipients, by program and State, fiscal year 1957 [Includes vendor payments for medical care and caces receiving only such payments; data to Oct. 16, 1957] Social Security Administration 77 53 3s si Ilf tig If! o g. m ' 131 sss zss SSI 1 !83S§3 issa i illll ISIsaS of :«» -re* S S S s? 38583 888SS loof 0 05M00^05 g i is igjgfess I issss zsisztz Amount $164, 342 185, 237 211, 170 s 1 is jssggg mm | ieiH ssggiii ic i iff !>#« — i i co ® Aid to the blind Percent from Federal funds 49.0 47.8 47.6 OO kO O* 00 1-H kO WNONOOH Amount $75, 009 79, 110 87, 293 FlsisSIIS §"§2!SSsiS IIS1SII r-Tjo -7 ef co-r-T nw Aid to dependent children Percent from Federal funds 56.6 56.0 58.0 CSNkOOOOO^fH CcDkOOOONOOOOJ Amount $683, 907 708, 289 776, 477 liSSSIssla SSISSglKlI 8188833 oT i-i co io gs oc os ^ so V'-** ei" or-Tce us oo" gs co o po Old-age assistance Percent from Federal funds ®OrtU5T(ilOOeNN t-MOllOlO^lOMOO Amount $1,686, 441 1,735, 436 1,831,263 sSseiisiis isigiss s '“'Casas's*-' o"g8's‘ss" Federal grants to States 1 Aid to the per¬ manent¬ ly and totally disabled mi gss g ; if :|§*=S Bl;s i iliss SIsllSI co : : 7 the aid of a grant from the Institute, investigated psychological stress as a possible factor in infection processes. Mice subjected to such stress were shown to be more susceptible to infection than other laboratory animals. In another of many promising studies supported by NIAID grants, research scientists at Children’s Hospital in Philadelphia are devel¬ oping uses for a blood fractionating machine that greatly increases potentialities for stockpiling vital plasma. Donors may give as often as once a week by this method, which returns red blood cells to the donor in a single operation. An acute streptococcal infection protected guinea pigs against asthmatic attacks induced in normal animals by egg white aerosols during research by a grantee at Northwestern University. The reason for this interesting and possibly significant phenomenon is unknown. The grantee plans further studies of the allergic mecha¬ nisms involved and will investigate other infectious organisms and noninfectious derivatives for their value as protective agents. Institute of Arthritis and Metabolic Diseases More than 12 million people in the United States are afflicted with various forms of arthritis, diabetes, and other metabolic disorders. Although the ultimate means for prevention and cure are still remote, several developments toward control of these diseases are under way. Clinical trials with more than 200 patients have proved the effective¬ ness of a simple treatment for the shock so often fatal to victims of severe burns. Scientists in the National Institute of Arthritis and Metabolic Diseases have found that a solution of table salt and baking soda dissolved in tap water and administered by mouth is especially valuable in an emergency. No injection, whole blood, or plasma is required. The same scientists have developed a treatment for a type of infec¬ tion which causes many late deaths among those who have been severely burned and have successfully passed through the early shock period. Although the antibiotic and sulfa drugs failed, human gamma globulin, a blood derivative, was successful in subduing this infection, which was found to be caused by bacteria known as pseu¬ domonas. Clinical trials in progress may prove that the treatment is another life-saving advance. A new pain-killing drug developed by chemists in NIAMD labora¬ tories is as potent, measure for measure, as morphine and three to four time as potent as Demerol, but has less addiction liability than either. Much more potent than codeine, it has only slightly more addiction potential. 98 Department of Health , Education , and Welfare , 1957 Institute clinicians have devised a method for the detection and measurement of blood loss from the intestines that is much more effective and precise than older procedures, including X-ray. Searching for a better diagnostic test for rheumatoid arthritis, NIAMD scientists collaborated with colleagues in the National In¬ stitute of Allergy and Infectious Diseases in developing the bentonite flocculation test. Much more simple and rapid than present methods, BFT provides accurate answers in minutes rather than hours or days. A major scientific achievement was the discovery by an NIAMD investigator and his collaborator, an Institute grantee, of the manner in which nucleic acids are synthesized. The scientists were successful in synthesizing these important substances with enzymes isolated from living cells. Nucleic acids of the body control, among other things, the ability of a cell to generate without variation identical molecules of a protein such as insulin. Nucleic acids are also believed to be responsible for the genetic transmission of inherited character¬ istics and defects, among which is diabetes. GRANT-SUPPORTED RESEARCH In a project aided by a grant from the NIAMD, the prevalence of rheumatoid arthritis, as distinguished from other forms of rheumatic disease, was determined by intensive study of a selected sample of a local population. Preliminary results indicate that 2.7 percent of those examined had rheumatoid arthritis, that the disease strikes 3 times as many women as men, that married persons are affected more often than single, and that persons who have been separated, divorced, or widowed are more often affected than those who remain married. Growth hormone, one of the endocrine substances produced by the anterior pituitary gland, is of particular importance to the under¬ standing of diabetes, since it acts to cancel out the effect of insulin. Growth hormone obtained from cattle has been shown to cause dia¬ betes in dogs but to have no effect on humans. Growth hormone from monkeys, isolated by scientists at the University of California, has been found to be active in man. It is so rare, however, that not enough can be supplied for clinical experiments. Hope for a larger supply of growth hormone is high because the grantees have isolated the substance from whales. Extensive clinical trials of a new oral antidiabetic drug, tolbuta¬ mide, have demonstrated its effectiveness in reducing the blood-sugar level in certain types of diabetes, though the manner in which the drug acts on the body is still undetermined. Scientists supported by Institute grants participated in the laboratory and clinical testing. Relatively nontoxic and safe, tolbutamide (Orinase) is on the market, available for prescription. Public Health Service 99 Cancer Institute Cancer, the Nation’s second leading cause of death, takes about 250,000 lives annually. The goal of cancer research is control through cure and prevention. Scientists of many disciplines are working toward this end in studies of the causation, diagnosis, and treatment of the disease. Research carried out in the National Cancer Institute produced an advance that may be the first real breakthrough in treatment of cancer with drugs. Choriocarcinoma, a rare type of cancer occurring in the uterus of women after pregnancy, was apparently suppressed by the use of methotrexate. Even metastatic lesions in the lungs healed in several patients. Promising results were obtained with a new drug, 6-azauracil, which produced temporary improvement in patients with acute leukemia, most of whom were children. Studies with many people have indicated that routine removal of moles on the soles and palms, which has been suggested in some investigations in the past years, should not be recommended. Moles of this type occur more often than is generally believed, and identi¬ fication of the rare mole that may become malignant is impossible. A basic research observation, which may lead to a new diagnostic technique for cancer, was that the antibiotic tetracycline accumulates in tumor tissue and can be detected by a bright yellow fluorescence under ultraviolet light. In a collaborative project with the Tissue Bank of the Naval Medical School, two clones — pure strains of cells grown from single cells — of human skin epithelium were successfully established. This achieve¬ ment is a step toward the production of epithelial cells for reparative surgery required in such conditions as burns. A single treatment with reserpine, the tranquilizing drug, produced a threefold increase in the remaining lifetime of mice in advanced stages of induced leukemia. This observation may open up a new group of possible antileukemic agents. A new television camera tube used with a high-power microscope and an electronic oscilloscope permits study of chemical activity within live normal and cancerous mouse cells. Using ultraviolet light, the apparatus enlarges live cells 2,000 times normal size and projects the image on a TV monitor screen. Investigators can then take motion pictures of cell activities or directly observe hitherto hidden changes. NATIONAL CHEMOTHERAPY PROGRAM In its second year the Cancer Chemotherapy National Service Center initiated a hormone assay program to evaluate the endocrine 100 Department of Health , Education , and Welfare , 1957 activity of compounds for possible use as anticancer agents, and a major screening program in the antibiotic field. It awarded training grants in clinical investigation, pharmacology, steroid biology, and biochemistry. The pharmaceutical industry will submit annually more than 30,000 chemical compounds for screening. About 11,400 synthetic chemicals and 12,700 antibiotic culture filtrates were obtained for screening in 6 contract laboratories during 1957. The Food and Drug Administration continued preclinical pharma¬ cological testing of drugs. Two university laboratories will study the physiological disposition of drugs. The Chemotherapy Center simulated the establishment of a number of cooperative clinical study groups, representing some 75 medical schools and hospitals, for evaluating anticancer compounds in human patients. GRANT-SUPPORTED RESEARCH A grantee reported the development and successful use of a “midget” version of a billion-volt linear electron accelerator for ra¬ diation treatment of cancer patients. A 6,000,000-volt electron beam is converted into a high energy X-ray beam, which is adjustable to a pinpoint or to a spread of 400 square inches. Eighty percent of its output penetrates the body’s deepest point, yet the rays are less dam¬ aging to intervening tissues than standard “softer” X-rays. New studies with the anticancer drug Myleran were reported. Treatment of chronic leukemia produced significant remissions for periods up to 48 months in 14 out of 21 patients, with restoration of the white blood-cell count to normal. About a year ago a grantee discovered a new virus that in 14 to 21 days caused a leukemia-like disease in almost all the mice inocu¬ lated. Previously reported viruses induced a similar disease in adult mice that had been inoculated at birth. The grantee recently de¬ veloped a vaccine that rendered 80 percent of the animals immune to the new virus as long as 4 weeks after vaccination. Quantitative determination of 17 amino acids in normal and tumor tissues of tumor-bearing mice showed significant differences in the amounts of one amino acid. Aspartic acid was present in a lower amount in tumor tissue than in other tissues. This difference may make the tumor susceptible to drug attack. BIOSTATISTICAL AND FIELD INVESTIGATION STUDIES As a possible means of curbing the sharp rise in lung cancer — particularly serious among men over 45 — the Institute cosponsored a study group on smoking and health. As a result of the group’s findings and other evidence, the Public Health Service issued a state- Public Health Service 101 ment calling attention to the fact that excessive cigarette smoking is one of the causative factors in lung cancer. For 3 years NIII has collaborated with the Veterans’ Adminis¬ tration on a followup study of more than 200,000 World War I vet¬ erans. Information compiled from replies to a questionnaire on smoking habits, from accurate medical records in veterans’ hospitals, and from autopsy data made available when veterans die will pro¬ vide data on the relation of smoking and various diseases, including lung cancer. Results of a large-scale study of cytology as an aid to early de¬ tection of uterine cancer were summarized. The first examination of 108,000 women in the cervical cytology project in Memphis, Tenn., disclosed about 800 cases of cancer equally divided between intra¬ epithelial and early invasive cervical cancer. Fully 90 percent of the intraepithelial cancers and 30 percent of the early invasive can¬ cers were unsuspected. The case-finding rate in the second screen¬ ing of 33,000 women was significantly lower than in the first screening. To obtain additional data, NCI is operating eight cervical cytology projects and is establishing four projects to develop the use of cy¬ tology in diagnosing cancer of other sites — the lung, large intestine, urinary tract, and stomach. Studies of environmental factors that may cause cancer include a long-range project to determine the incidence of cancer in uranium miners of the Colorado Plateau and to assess the effects of lengthy exposure to radiation from uranium. CANCER CONTROL AND RESEARCH TRAINING Health agencies in 47 States, 4 Territories, and the District of Columbia received grants of $2,250,000 for support of their cancer control programs. New training programs to increase manpower resources include research grants to institutions that select and appoint individual scientists for training; biometry and epidemiology training grants; and training of cytology technicians. Institute of Dental Research Oral diseases and abnormalities affect hundreds of thousands of people in this country. The degree of severity ranges from relatively minor afflictions to oral cancer and major systemic disturbances re¬ sulting from malformations and infections. The program of the National Institute of Dental Research covers a broad area of basic and clinical research to attain more effective 102 Department of Health , Education, and Welfare, 1957 control of dental caries and periodontal disease and to increase our knowledge of the causes of oral disease and its relation to general health. Periodontal disease, an involvement of the supporting structures of the teeth, is found with increasing frequency among older people but may have its beginning earlier in life. Evidence for this is pro¬ vided by recent epidemiological studies which show that children of high school age exhibit the initial stages of periodontal disease, often with a degree of severity usually considered to occur only in the later years of life. In the younger ages, girls are more severely affected than boys, but this situation is reversed beyond the teen age. The role of inflammation in periodontal disease is being further elucidated by basic chemical studies. Investigations particularly related to various chemical aspects have shown that fluorides in the water supply do not adversely affect periodontal tissues. Newly devised methods of isolation and identification of microbes to detect infection of the blood stream indicate that present estimates of the frequency of bacteremias following tooth extractions and peri¬ odontal treatment may be far too low. This finding emphasizes the need for better operative techniques to reduce the risk to patients with rheumatic fever and other heart disorders. Other programs in the field of bacteriology will permit the study of oral diseases in experimental animals under germ-free conditions as well as in controlled conditions of exposure to selected microorgan¬ isms. Much progress can thus be made in discovering bacteria that are specifically implicated. Biochemical approaches are being uti¬ lized in other studies of dental caries in order to explore the role of proteins and minerals, basic enzyme reactions, and the application of heat to certain foods. The field of clinical investigations is concerned particularly with general anesthesia, high-speed instrumentation, oral manifestations of endocrine and other systemic dysfunctions, etiology and treatment of oral and facial abnormalities, and genetic factors in oral and other diseases. The Institute’s study of some 5,000 persons in Maryland is yielding important information on dental diseases and their rela¬ tion to genetically determined pathologic conditions. Histochemical, electron microscope, and X-ray studies of oral and related tissues are also contributing to a better understanding of tooth and bone formation. During the year, the research grants program in dental health was substantially expanded. More than 90 percent of the Nation’s dental schools are now receiving dental research grants from the National Institute of Dental Besearch. There were 265 dental research proj¬ ects under way with the aid of grant funds in 1957, a fivefold in- Public Health Service 103 crease over 1956. A graduate training grant program was initiated in 15 dental schools in the various fields of clinical and basic science related to oral disease. Heart Institute Heart disease, which includes some 20 heart and blood vessel dis¬ orders, is the leading cause of death in the United States. Heart disease is also a major cause of disability, exacting a heavy toll in suffering and economic loss. The National Heart Institute, with a much expanded program in 1957, is enlarging the Nation’s capacity to deal with the problem. It conducts research in its own laboratories, supports research in institutions throughout the country, administers training programs to increase the skills of professional personnel in the field of cardio¬ vascular disease, and helps develop community heart disease control programs. To stimulate research activities in the field of aging, a Center for Aging Research was established in the Institute. Atherosclerosis, the form of hardening of the arteries that leads to heart attacks, is characterized by deposits of fatty materials in the walls of the blood vessels and is frequently associated with excesses of certain fatty substances in the blood. Hence, fuller understanding of normal and abnormal fat metabolism is a major research objective. Fats absorbed from the intestines are transported to the tissues in the form of large molecular aggregates of fat and protein. NHI studies have shown that a lipoprotein lipase system is responsible for removal of the fat and its deposit in the tissues of the body. They have also shown that the unjoined fatty acids released from the body’s fat depots by the action of a specific enzyme constitute a major resource in meeting the caloric requirements of tissues. The regula¬ tion of release and uptake of these fatty acids has been under study since it was found that interference in this process can lead to the appearance in blood of large fatty aggregates of the type most often associated with atherosclerosis. Research in blood pressure has revealed a factor present in the plasma of patients with hypertension, but not in patients with other diseases or in normal persons. Studies are under way to determine the nature and significance of this material, which was recognized through its capacity to modify the contraction of the isolated heart. Research on the chemistry of brain centers which control blood pressure and other automatic body functions had led to the theory that the stimulating and moderating functions are mediated by centers controlled by different chemical substances, known respectively as serotonin and norepinephrine. Drugs act on the brain centers by caus- 104 Department of Health , Education , and Welfare , 1957 ing the release or preventing the action of those substances, suggesting new approaches to the central control of blood pressure. Other re¬ search indicates that serotonin may also play a role in allergic respiratory reactions. Further progress has been made in defining the chain of events that lead from failure of the heart muscle to perform its work adequately to the eventual formation of edema (dropsy) as a result of the body’s retention of excesses of salt and water. Previously, there was only inferential evidence that the last link in the chain is excessive secre¬ tion of certain hormones by the adrenal glands. This has now been demonstrated by the collection of blood directly from the adrenal veins in dogs with congestive heart failure. In another study, a sub¬ stance present in normal blood, similar to digitalis in its effect on heart muscle contraction, has been isolated in pure form and its chemical structure identified. Improvements in diagnostic and operative techniques are making possible the wider application of heart surgery, decreasing the risk, and improving results in heart disorders in which surgery has become standard treatment. Catheterization of the left side of the heart, which is reached by puncture through a bronchoscope, has proved a safe procedure. The technique, developed by the Institute, makes it possible to measure the gradients of pressure across heart valves sus¬ pected of deformity and thus to evaluate the extent of disease and, after operation, the adequacy of the corrective measure. Also, new methods have been devised to determine accurately the location of abnormal openings between heart chambers and to assess the func¬ tioning of heart valves. The use of hypothermia has become a safe technique in heart sur¬ gery. The body is cooled to about 86 degrees so that circulation can be interrupted for six to eight minutes without damage to the brain. Resistant abnormalities in the rhythm of the heart have been virtually abolished by a novocain injection procedure devised in NHI labora¬ tories. Other research has demonstrated that an injection of strophanthidin, a digitalis preparation, can avert heart muscle failure. Preliminary findings of the Institute’s study at Framingham, Mass., indicate that men aged 45 to 62 with any two of these three condi¬ tions — hypertension, overweight, high serum cholesterol — are about nine times as likely to develop coronary heart disease as men free of these conditions. The risk of developing coronary disease for men with hypertension is four times that of men with normal blood pres¬ sure. Men who were either greatly overweight or who had a high serum cholesterol count appeared to develop coronary disease three time as frequently as those who did not have these conditions. Public Health Service 105 GRANT-SUPPORTED RESEARCH Significant accomplishments have been made through research grants, particularly in arteriosclerosis, hypertension, cerebral vascular disease, chronic pulmonary disease, and rheumatic fever. A cooperative study on lipoproteins, begun in 1950, was completed during the year. This research, carried on in four institutions, in¬ volved 15,000 subjects with intensive study of about 5,000 men. It has provided information on the relation of cholesterol and fat-protein levels in the blood to the appearance of cardiovascular disease in pre¬ viously well persons. Results have led to a national and international revaluation of these measurements as indicators of the probable de¬ velopment of coronary disease. Grantees in several institutions continued intensive investigations of the relation of dietary factors to the production of atherosclerosis and high serum cholesterol. A number of studies have substantiated the theory that saturated fats tend to raise blood cholesterol and that unsaturated fats tend to lower the level. Other research indicates that the cholesterol level in the blood varies from one individual to another, and may be related to age, sex, diet, physical activity, and functioning of the liver and of endocrine glands such as the thyroid and the adrenals. In high blood pressure research, studies of several pressure-lowering drugs, used either alone or in combination, have determined more specifically the relation of their action to heart, blood vessel, and kidney function. This has led to techniques which increase the effectiveness of these drugs and minimize the undesirable side effects of prolonged administration. The number and diversity of new drugs being devel¬ oped by research and proving useful in the treatment of heart and blood vessel diseases have given rise to a great need for evaluation of drug therapy, particularly in the management of hypertension. A 5-year broad-scale study initiated in 1957 represents a step toward this goal. The manner in which group A streptococcal infections bring about rheumatic fever and heart damage is still obscure. A number of investigators are attempting to determine the mechanism of bacterial action. At two institutions, methods were established for the isola¬ tion and identification of the antigens produced by the streptococci and for study of their physical and chemical properties. Other research groups are investigating products elaborated by the micro¬ organism, of which two — crystalline streptococcal proteinase and streptolysin O — are known to have an effect on the heart. Grant studies have shown that crystalline streptococcal proteinase may de¬ stroy heart muscle. Streptolysin O reduces its oxygen consumption, causing a reduction in the amplitude of its contraction. 448006—58 - 8 106 Department of Health , Education , and Welfare , 1957 Institute of Mental Health New vigor and new measures hold promise for alleviation and eventual solution of mental illness and emotional disorders. Over a million persons are treated annually in mental hospitals, and thousands more are treated as outpatients. But the gains made last year in research and practice brought encouraging signs of progress. There was a substantial increase in State ond community mental health services. The National Institute of Mental Health met in¬ creasing requests for consultative services by : ( 1 ) providing special consultants in such fields as mental health in the schools, alcoholism, drug addiction, and industrial psychiatry; (2) conducting demon¬ stration projects to identify school children having mental health problems, to improve mental health education, and to provide followup assistance for discharged narcotic addicts; and (3) making available technical assistance and resource personnel on specific problems. Title V of the Health Amendments Act of i956 (Public Law 911) authorized mental health project grants for the development of im¬ proved methods of care, treatment, and rehabilitation of the mentally ill. Institute staff participated in a survey of the need for construc¬ tion of psychiatric facilities in Alaska to implement provisions of the Alaska Mental Health Act (Public Law 830) . On recommendations of the National Advisory Mental Health Coun¬ cil, the Institute increased its support of training for social workers, psychologists, and research workers in mental health. Pilot training projects were planned to improve methods of instruction for pro¬ fessional personnel who work with the mentally retarded, the aged, and juvenile delinquents. The Judge Baker Guidance Center of Bos¬ ton, for example, will develop a training program in the field of juvenile delinquency. NIMH also continued its support of training for career teachers in mental health, of graduate training for mental health personnel, of improved psychiatric instruction for medical students, and of mental health courses for professional personnel in the fields of law and education. The establishment of a joint research facility at Saint Elizabeths Hospital in Washington, D. C., provided the Institute with a hitherto unavailable research setting, that of the large mental hospital. Studies are planned of patients under combined pharmacological and psychotherapeutic regimens. PSYCHOPHARMACOLOGY During the year, the Institute carried on a $1.5 million psycho- pharmacological program aimed at evaluation of the tranquilizing and other centrally acting drugs and broad implementation and Public Health Service 107 stimulation of basic and clinical drug research. Several activities were undertaken to provide greater understanding of the effectiveness and limitations of drugs in the treatment of mental illness, including a number of intensive laboratory and clinical studies. A Psycho¬ pharmacology Service Center was established as a clearinghouse on information relating to drug investigations and as a focal point for the administration of grants in this field. NIMH cooperated in the large scale, continuing clinical evaluation of psychopharmacological agents by the Veterans’ Administration. MENTAL HEALTH RESEARCH In the field of clinical research, special “therapeutic communities” were organized and studied. In such communities, the patient lives in an environment geared to meet his special needs and designed to bring about a favorable change in his condition. F amily relationships as factors in the origin and remission of emo¬ tional and mental disorders were a focal interest of grant-supported projects and program development activities in the Institute. Ex¬ amples are studies of young schizophrenic patients and immediate family members, of a group of liyperaggressive children and their families, of the effects of family relationships on posthospital re¬ habilitation, and of the adaptations of both patients and their fam¬ ilies to mental illness. Researchers representing various scientific disciplines contributed their skills and knowledge to an integrated effort by the Institute to obtain basic data on the psychological and physiological processes of aging and on the relation of the older person to his environment. Institute staff also cooperated in the work of the National Heart In¬ stitute’s Center for Aging Research. Scientists at NIMH and at the Public Health Service Hospital in Lexington, Ky., continued their research into the action and effects of LSD (lysergic acid diethylamide) , a drug capable of inducing tem¬ porary states resembling psychoses. Studies of the drug’s effect on normal individuals who volunteered for such experiments have pro¬ vided important information on the enzyme systems involved in the metabolism of LSD within the human body. Moreover, they have demonstrated that the drug’s metabolic end product fails to produce LSD’s characteristic effects in man or animals — a finding related to the theory of enzyme disorder in the tissues of patients with certain types of psychoses. NIMH biostatisticians began studies to provide a base for assessing the effect of the tranquilizing drugs on patients in mental institutions through analysis of long-term trends of resident population, admis¬ sions, releases, and deaths in the hospitals of certain States. Con- 08 Department of Health , Education, and Welfare, 1957 tinuing collection and examination of data on characteristics of pa¬ tients served by these institutions will supplement a comprehensive study on the geographic distribution of outpatient psychiatric facilities. GRANT-SUPPORTED RESEARCH With Institute support, numerous investigators throughout the Na¬ tion are conducting broad-scale research into mental health and men¬ tal illness. Grants for research in mental health increased in num¬ ber and scope. A new type of grant was awarded to Duke University for the estab¬ lishment of a multi-disciplinary, large-scale center for research in aging. The center will be a regional resource of available scientific information on aging. Typical of the Institute’s range of extramural research are pro¬ grams at Stanford University and the University of Michigan and Ypsilanti State Hospital. The Stanford investigation seeks knowl¬ edge of how information about child care and development is com¬ municated to parents, and whether misinformation is related to the etiology of mental illness. The University of Michigan, in coopera¬ tion with the Ypsilanti State Hospital will study the physiological and psychological characteristics of schizophrenic patients. The National Academy of Sciences and the National Research Council have been awarded a grant to investigate the effects of social and cultural variables on adjustment in disaster. Individual, family, and group adjustment will be studied intensively in two “laboratory” communities and by other techniques. Institute of Neurological Diseases and Blindness An estimated 20 million Americans are affected by neurological and sensory disabilities. Many cannot be productively employed or are severely limited in the types of jobs they can hold. To a great extent, the solution to this pressing problem lies in medical research. During 1957 the National Institute of Neurological Diseases and Blindness moved ahead in such diverse areas as epilepsy, the blind¬ ing diseases, brain tumor detection, hearing research, and in such neuromuscular disorders as myasthenia gravis. In epilepsy, good results continued in surgical investigation di¬ rected to controlling or eliminating seizures localized in the temporal lobe. Glaucoma, a serious blinding disorder which results from the increase of pressure within the eye, came under intensive study. A rich nerve supply was discovered in the area of the eye directly in¬ volved in the regulation of extraocular pressure, thus offering an important research lead for treatment and prevention. Public Health Service 109 A new research approach to the problems of deafness and hearing loss was opened up with an NINDB scientist’s discovery of the oliva- cochlear bundle, a nerve system linking the cochlea of the inner ear with the brain. The finding supports the view that hearing is actually a two-way process in which the brain plays a “feedback” role — not, as previously believed, that the brain receives sound im¬ pulses but has no positive influence. The early detection of brain tumors is often the key to saving a life. NINDB investigators have developed a detection technique that makes possible the precise location and definition of tumors deep within the brain. The technique, which combines the isotopic tracer method with electronic scanner and recording devices, is more than 80 percent effective in detecting tumors. Myasthenia gravis is among the major neuromuscular disorders that involve the blockage or impeding of impulse transmission at the nerve- muscle junction. Important light on this problem may come from a fluorescence method devised for measuring minute quantities of acetylcholine, a chemical substance involved in the transmission of impulses from nerve to muscle. An Institute scientist has developed an ingenious recording tech¬ nique which should add much to our understanding of the nervous system. Using microelectrodes capable of recording electrical im¬ pulses of millionths of a volt in millionths of a second, and working with the nerve system of a squid, he has probed the synapse area of the ganglion — the infinitesimal space in which one nerve transmits impulses to another. GRANT-SUPPORTED RESEARCH Grantees in the Institute’s extramural research program partici¬ pated in a number of promising developments. One grantee has worked out a technique for diagnosing various neurological and eye disorders and for evaluating the effect of treating them with drugs. Known as electromyography of the extra-ocular muscles — the muscles that turn the eyeballs — the technique records electrical activity inside the muscles through a needle electrode. Diagnosis is made on the basis of a visualization of this activity as it appears on a television- type tube called an oscilloscope. The past year has also seen significant developments relating to multiple sclerosis, a disease in which the central nervous system is attacked through the disintegration of the fatty sheath (myelin) cov¬ ering the nerve fibers. Nutritional deficiencies were found to have © an adverse effect on the regeneration of crushed nerves in animals. More specifically, the lack of vitamin B12 retards remyelination. A means of growing myelin in the test tube has also been found. Thus, 110 Department of Health , Education , and Welfare , 1957 it is possible to study myelin chaange under controlled laboratory conditions. An Institute grantee lias developed a multiple blood transfusion technique that is successful in preventing kernicterus, a form of cerebral palsy which attacks infants immediately after birth, and which is due to the blood incompatibility between mother and child known as the Bh factor. A followup study will determine the long- range effectiveness of the technique. A large-scale investigation into the nature and causes of cerebral palsy, mental retardation, epilepsy, and allied disorders was begun by the Institute in 1957 and will continue for ten years or longer. Eleven schools are collaborating. The investigation, first of its kind, is specifically concerned with the adverse factors which bring on brain damage during the perinatal period — the time span from conception to about one month after birth. Another long-range project will evaluate the existing treatments for cerebral stroke and shed new light on its nature and causes. Ten institutions have joined the Institute-sponsored stud}q coordinated by the University of Iowa. Bureau of Medical Services The Bureau of Medical Services operates the hospital and out¬ patient facilities of the Public Health Service and administers the programs of the Service that relate to care and protection of the indi¬ vidual. It is also responsible for foreign quarantine activities; the health program for American Indians; aid in the construction of community hospitals and health facilities; and development of the Nation’s dental and nursing resources. It also gives professional supervision to members of the Service staff assigned to the health programs of other Federal agencies. Hospitals and Outpatient Facilities The Division of Hospitals operates the medical care program for American seamen and other legal beneficiaries of the Public Health Service. This nationwide activity began in 1798 with the Act “for the relief of sick and disabled seamen,” the original legislation from which the Public Health Service has grown. In addition to American seamen, the beneficiaries of the Public Health Service now include officers and enlisted men of the Coast Guard, officers and crew members of the Coast and Geodetic Survey, Commissioned Officers of the Public Health Service, civilian em¬ ployees of the Federal Government injured in performing their work, Public Health Service 111 and several other groups. Persons with leprosy and men and women who are addicted to narcotic drugs as defined by statute are treated in special hospitals. The Division also administers the Federal employee health pro¬ gram through which Federal departments at their request receive consultative assistance in establishing or improving health programs for their employees. The Division operates 23 separate health units for 45,000 employees of various Federal agencies in Washing¬ ton, D. C., New York, and Denver, and the agencies reimburse the Public Health Service for this assistance. In 1957 the Division maintained 16 hospitals, 25 outpatient clinics, and 99 outpatient offices. Twelve of the hospitals provide general medical and surgical serv¬ ices; 1 is exclusively for patients with tuberculosis; 2 treat narcotic addiction and neuropsychiatric disorders ; and 1 is for the care of per¬ sons with leprosy. Most of the hospitals are in major port cities, such as Boston, New York, Baltimore, New Orleans, Chicago, Detroit, San Francisco, and Seattle. In certain other places, depending upon the concentration of beneficiaries, outpatient clinics and outpatient offices have been established. Staffed by full-time personnel, the clinics provide a range of medical, dental, and allied health services. Local physicians conduct the outpatient offices in their private fa¬ cilities on a part-time basis as needed. VOLUME OF SERVICES Admissions in all the hospitals rose 2 percent — from 48,627 in 1956 to 49,651 in 1957. The average daily census declined 1 percent, to 5,350. The number of outpatient visits was 1,098,278, an increase of 4 percent. General Hospitals. — The general hospitals admitted 44,584 pa¬ tients in 1957 compared with 43,399 in 1956. The average daily patient-load remained substantially the same at 2,759. The number of days of care per admission averaged 22.6, compared to 23.3 the previous year. Tuberculosis. — The tuberculosis hospital at Manhattan Beach, Brooklyn, N. Y., admitted 422 patients in 1957 or 5 percent more than in 1956. The average daily census dropped 5 percent, reflecting the more rapid turnover of patients because of recent advances in chemotherapy and thoracic surgery. More patients discharged were able to return to duty in 1957 than in previous years. Since many who were discharged continue to receive chemotherapy, increasing attention was devoted to giving them follow-up care and guidance as outpatients. Cardiopulmonary function studies, including cardiac catheterization, were continued. 112 Department of Health , Education, and Welfare, 1957 Rehabilitation activities were strengthened through added oppor¬ tunities for instruction to patients wishing to qualify for high school equivalency diplomas granted by the University of the State of New York. The hospital continued to offer vocational evaluation and educational guidance for patients desiring to change their occupations. Leprosy. — The hospital at Carville, La., is the only hospital in the United States devoted exclusively to the care and treatment of patients with leprosy. Patients receive complete medical care and full main¬ tenance, including clothing. Anyone in the United States who has leprosy can be admitted. Services include not only the special medi¬ cal, surgical, and dental therapy necessary to treat leprosy, but also treatment for general illnesses and injuries. Since the course of treatment for leprosy usually lasts several years, the hospital conducts social service and community participation programs with varied recreational and educational activities. The sulfone drugs remain the “treatment of choice” at Carville. While the study of other drugs continues, workers in the field of leprosy agree that the sulfone series offers a comparatively effective form of therapy. Most sulfone-treated patients enjoy greatly im¬ proved general health. In most instances, the irreparable damage of long-standing leprosy can be avoided if treatment is started early. A stage of apparent arrest may be reached, and the patient may enjoy long periods relatively free from disease activity. The sulfone drugs work slowly; therefore, the search for a more efficient and quicker therapeutic agent continues. Admissions to the hospital totaled 61 in 1957 compared with 59 the year before. The average daily census was 315. Narcotic Addiction. — The hospitals in Lexington, Ky., and Fort Worth, Tex., treat narcotic addicts as defined by Federal law. They also serve mentally ill patients entitled to care as beneficiaries of the Federal Government. In 1957 these hospitals admitted 4,584 patients, about 4 percent fewer than in 1956. There was a slight decline in the number of narcotic addicts admitted. The average daily census of addict pa¬ tients was 1,390, the same as in the previous year. The fact that voluntary patients made up 87 percent of the admissions but only 44 percent of the average daily census indicates the addicts’ weakened ability to control their use of narcotics and their tendency to leave the hospital before they achieve a reasonable recovery. TRAINING AND^CLINICALMNVESTIGATIONS More than 250 physicians, dentists, pharmacists, and dietitians served internships and residencies in Public Health Service hospitals in 1957. Eight of the hospitals had approval for the postgraduate Public Health Service 113 training of physicians granted by the American Medical Associa¬ tion, and 8 were approved by the American Dental Association for dental internships. The American Dental Association approved a new 1-year residency program in oral surgery at the hospital on Staten Island, N. Y. Through affiliation with colleges and technical schools, approxi¬ mately 100 undergraduate students received practical experience and hospital instruction in physical, occupational, or vocational therapy ; social service; practical nursing; and medical technology. The hos¬ pital in Baltimore trained six medical record librarians. The Staten Island hospital provided the clinical nursing portion of a course for hospital corpsmen given by the Coast Guard. In 1957, the Division supported 31 research projects conducted at its field stations and recommended transmittal of 3 proposed clinical investigations to the National Heart Institute. MEDICARE The Dependents’ Medical Care Act, which became effective Decem¬ ber 7, 1956, authorized care in Public Health Service hospitals and clinics for active-duty and retired members of the Federal uniformed services and their dependents, and for dependents of deceased mem¬ bers of these services. This program — popularly known as Medi¬ care — completed the first 6 months of operation in June 1957. The program resulted in an increase in patient loads in Public Health Service hospitals and clinics. The number of uniformed service per¬ sonnel and dependents admitted to the hospitals in June 1957 was 1,001 or 8 percent more than in June 1956; the number of outpatient visits by these beneficiaries was 24,476 or 9 percent greater. The average number of Department of Defense beneficiaries in Public Health Service hospitals during the month of May 1957 was 164, while the number of Public Health Service beneficiaries in Army, Navy and Air Force hospitals was 76. EVALUATION OF HOSPITAL CARE Five of the general hospitals were visited by study groups of na¬ tional experts in hospital and medical care administration from out¬ side the Federal Government. These groups usually included an internist, surgeon, pathologist, nurse, administrator, and comptroller. They appraised the quality of care given by the hospitals, with spe¬ cial attention to adequacy of personnel, equipment, supplies, physical facilities, and funds. The teams reported that improvements in buildings and equip¬ ment were needed. However, they commended the hospitals for good 114 Department of Health , Education , and Welfare, 1957 service in spite of the staff shortages and inadequate plants. Their reports form the basis for planning corrective action. FREEDMEN’S HOSPITAL Freedmen’s Hospital, Washington, D. C., is a general medical and surgical hospital with provision for treating chronic chest diseases. It serves also as a university hospital conducting programs in medi¬ cal education in cooperation with the College of Medicine of Howard University, in Washington. Freedmen’s Hospital operates teaching programs in nursing, dietetics, pharmacy, social service, and hospital administration. It has 320 beds for general medical and surgical patients, 50 bassinets, and 150 beds in the annex for patients who have chronic chest diseases. The hospital admitted 13,715 patients in 1957, a substantial increase over the 11,638 in 1956. The daily average census was 361, compared with 366 the previous year. The outpatient service, consisting of 34 clinics and the emergency room, had a total of 91,022 visits, com¬ pared with 79,400 in 1956. Nearly 50 clinical investigation projects covering a wide range of medical and health problems were in progress during the year. The School of Nursing had 85 students, with 31 in the graduating class. The National League for Nursing reviewed the nursing edu¬ cation program during the year and gave approval. The hospital provided graduate training for 42 medical residents, 18 medical interns, 4 medical externs, 2 dental interns, and 6 clinical research fellows; it also served as a training facility for junior and senior medical students. Ten dietitians completed an internship pro¬ gram in their field offered by the hospital and approved by the Amer¬ ican Dietetic Association. The hospital continued to cooperate in a teaching program leading to the master’s degree in hospital administration. To qualify, stu¬ dents must have completed requirements of a university offering an approved course in hospital administration. The program is con¬ ducted on a preceptorship basis and meets standards acceptable to the American Hospital Association, the American College of Hospital Administrators, and the Association of University Programs in Hos¬ pital Administration. Through 1957, 13 men have been “adminis¬ trative residents” at Freedmen’s Hospital in this program. The pharmacy internship program follows the pattern established by the American Hospital Association, the American Pharmaceutical Association, and the American Society of Hospital Pharmacists. Two interns completed the course in 1957. Two students from How¬ ard University’s School of Social Work were accepted for field train¬ ing in medical social work. Public Health Service 115 Foreign Quarantine In 1957 no cases of the quarantinable diseases — smallpox, yellow fever, plague, cholera, and louse-borne relapsing fever and typhus — were reported in the United States. This was the fourth year of freedom from smallpox, although the disease was epidemic in several other parts of the world and was imported by airplane travel in three places in Europe (Naples, Hamburg, London). The smallpox vaccination requirement for international travelers, administered by the Division of Foreign Quarantine, was a significant factor in keep¬ ing this nation free of the disease. Health authorities believe that the possibility of reintroduction of yellow fever in this country is greater now than it has been for many years. The disease was known to be present in 1957 in Guate¬ mala near the Mexican border and in British Honduras; mosquitoes that can transmit yellow fever are present in Mexico and throughout the southern part of this country. The Division of Foreign Quar¬ antine strengthened measures against introduction of yellow fever in¬ fection in persons or monkeys arriving from infected areas, and against importation of mosquitoes on ships, planes, or land convey¬ ances. As a first line of defense, it began an expanded program to eradicate Aedes aegypti (yellow fever mosquito) at southern air¬ ports, dock areas, and border entry points. Typhus occurs in certain parts of Mexico. To help prevent typhus from appearing in this country, Mexican migratory laborers are treated with DDT on entering the United States. With few exceptions, recent reports of human plague infection have been confined to rural areas of certain countries in Africa, South America, and Asia. The ports of Mandalay and Phanthiet in Asia were infected in the past year. Plague will remain a minor problem in international traffic only as long as sanitary requirements for ships and ports are meticulously maintained. Cholera continued to occur in India, Burma, and Pakistan. The incidence in India was the highest since the great epidemic of 1953. In general, relapsing fever has remained a problem only in parts of Africa. Epidemic influenza in the Orient became a matter of serious concern in April 1957 upon receipt of a report of an epidemic affecting 250,000 persons in Hong Kong. It was evident at once that introduction of the disease into this country through international air and sea traffic could not be prevented. The full resources of the Division were mobilized to minimize the impact which the disease could have through international traffic. All sources of information were used to keep apprised, on a daily basis, of the places of occurrence of influenza in relation to international travel routes. Medical officers at international Department of Health , Education , and Welfare , 1957 116 airports and seaports worked out an integrated operation with local and State health personnel of their areas to detect and report all actual or suspected cases of influenza entering this country. Complete co¬ operation was received from air and surface carriers, including com¬ mercial and military transport. The Air Force, Navy, Army, and all civilian health agencies immediately made available both personnel and laboratory facilities to detect or diagnose influenza. Because the speed of modern travel enables a traveler to enter the country during the incubation period of influenza, every person ar¬ riving from an infected area was advised to go to a physician promptly in case of illness, and to inform the physician of his area of travel. Thus the occurrence of influenza in the United States was made known immediately to physicians and State health departments. INTERNATIONAL TRAFFIC VOLUME International traffic subject to Public Health Service requirements continued to increase. Airplanes inspected for quarantine or immi¬ gration-medical purposes increased from 56,891 in 1956 to 61,892 this year; ships inspected from 30,126 to 34,779; arriving persons subject to quarantine regulations from 46,993,370 to 52,253,263; smallpox vaccinations by quarantine officers from 485,967 to 541,891. The num¬ ber of persons released subject to further medical examination at destination increased from 9,670 in 1956 to 23,173 in 1957; persons detained in isolation at ports increased from 3 to 37. MEDICAL EXAMINATIONS Refugee Relief Program. — The year saw the termination of the Refugee Relief Act of 1953, under which a special program of immi¬ gration-medical examinations was conducted. Altogether, from the start of the program, services were provided abroad for examination of 206,204 applicants in Austria, Belgium, Denmark, Egypt, England, France, Germany, Greece, Iran, Italy, Jordan, Kuwait, Lebanon, the Netherlands, Norway, Sweden, Turkey, and the Far East. Disease conditions excludable under the immigration law were detected in 3,796 applicants. Refugees arriving here were reexamined for the Immigration and Naturalization Service; in all, 179,552 such exam¬ inations were made, and only 21 refugees were found to have exclud¬ able conditions. The incidence of excludable conditions among the 206,204 refugees examined abroad during the Refugee Relief Program was greater than among the 178,941 regular immigrants examined abroad in 1957. Percentages were as follows: mental conditions, 0.28 percent of refugees, 0.15 percent of regular immigrants ; tuberculosis, 1.33 per¬ cent of refugees, 1.03 percent of regular immigrants; dangerous con- Public Health Service 117 tagious diseases, 0.23 percent of refugees, 0.06 percent of regular immigrants. Hungarian Refugees. — The mass migration of Hungarian refugees starting in November 1956 taxed the medical examination facilities of the Public Health Service. Facilities were improvised to admin¬ ister the required examinations for great numbers of people. The Division of Foreign Quarantine expanded its immigration-medical examination operations in Austria and provided emergency staffing for the refugee reception center at Camp Kilmer, N. J. At the peak of activity in December 1956 the Vienna and Salzburg offices together were examining about 1,500 refugees daily. More than 26,000 were examined in 7 weeks. By the end of the year 33,413 refugees had been examined on admission to the United States; refugees having conditions that usually prevent entry were admitted under parole when they had assurance of sponsorship and treatment. Tuberculosis, and the diagnosis of cases as active or inactive, was the chief problem. The medical officer at Camp Kilmer convened a board of tuberculosis experts from the Army, State and local health departments, and the Public Health Service, to restudy cases detected by medical examiners here and in Europe. Hospitalization of 423 cases was required, but 231 of these were released to be observed as outpatients. Arrangements were made for States and localities to provide hospital beds in communities where patients’ families settled. Regular Immigration Services. — The number of aliens other than refugees examined abroad by Public Health Service officers increased from 194,736 in 1956 to 206,754 in 1957 ; most of them were prospec¬ tive immigrants. The number examined in this country increased from 2,111,237 to 2,598,741 ; these were chiefly crew members and temporary visitors. A total of 5,924 aliens wrere certified abroad and in the United States for diseases excludable under the immigration law. Farm Placement. — In the farm placement program of recruiting agricultural workers from Mexico, 440,332 laborers were examined, with 5,587 rejections, at 3 migratory centers in Mexico; and 457,360 examinations were made with 5,578 rejections, at 5 reception centers in California, Arizona, and Texas. OTHER QUARANTINE ACTIVITIES The enactment of Public Law 85-58, which became effective June 21, 1957, provided for a marked change in quarantine operations by permitting 24-hour inspection service. Overtime inspections will be performed on request, subject to reimbursement by transportation companies in most cases. 118 Department of Health , Education , and Welfare , 195 7 The Division issued a field directive on precautions to be taken by personnel handling importation of psittacine birds. Need for the directive had been shown by reports of psittacosis contracted by port personnel from contact with birds brought from other countries. The Division published a statement of sanitary measures required for the travel of aliens who have tuberculosis. This is intended to prevent the spread of infection when aliens with tuberculosis are admitted for treatment, or as immigrants under special legislation. Eight additional yellow fever vaccination centers were designated to meet the need created by increased travel. This made a total of 81 centers in health departments and private clinics, and 38 in Public Health Service facilities. Health Services for Indians The second full year of operation of the Indian health program by the Public Health Service was marked by a continuation of im¬ provements in facilities and services charted at the time this pro¬ gram was transferred from the Bureau of Indian Affairs in July 1955. Increases in both the volume and the quality of health serv¬ ices were made possible by the addition of some new Indian health staff members and by plant improvements in 1957. The Division of Indian Health provided more services to greater numbers of bene¬ ficiaries than ever before. The 1957 appropriation for Indian health activities was $38,775,000. An additional sum of $8.76 million was appropriated to meet critical needs for construction and major alterations. Approximately 370,000 Indians and Alaska Natives depend upon the Public Health Service for medical, hospital, and dental care, and preventive services such as those provided for the general public by local health departments. These beneficiaries include an estimated 335,000 Indians in 24 States, and 35,000 Alaskan Indians, Aleuts, and Eskimos. Most illnesses and fully a third of the deaths among the Indians could be prevented by modern control measures. Deaths from tuber¬ culosis, gastro-enteric diseases, and other communicable diseases are 3 to 10 times higher than in the general population. Twenty-four percent of all Indian deaths occur among infants, compared with only 7 percent for the population as a whole. This is the major factor in the early average age at time of death among Indians — 30, compared with 60 for the general population. Many of the Indians and Alaska Natives are isolated both culturally and geographically. Most of them were born into an environment which is itself a hazard to health. In many cases their sanitary facili- Public Health Service 119 ties are crude and inadequate, or entirely lacking. Often their water is scarce, and is obtained from contaminated sources. THERAPEUTIC SERVICES Hospital care and other health services are provided at 56 hos¬ pitals operated by the Public Health Service and at more than 270 non-Federal hospitals through contractual arrangements. Diagnosis and ambulatory patient care are given at health centers, field health stations, and other locations totaling more than 200. Medical serv¬ ices also-are rendered by 160 contract physicians and dentists. For the second consecutive year, hospital admissions increased by nearly 15 percent. Admissions totaled more than 66,000 including 13,000 in contract facilities. The average daily census in the hos¬ pitals operated by the Service was 2,785 — an increase of 5 percent over 1956. However, possibly as a result of earlier and more effective treatment, there was a decline in the length of stay per admission. Therapeutic and preventive services provided in hospital outpatient clinics increased 17 percent to a total of 657,474. With these increases in medical care have come improvements in hospital operations. Specialists’ consultation from outside sources was increased substantially. Professional pharmacists now super¬ vise the dispensing and storage of drugs at 16 of the hospitals and at all 6 of the area offices which administer the program in the field. The pharmacists compounded and dispensed 107,000 prescriptions for 248,000 hospital outpatients and provided supervision of pharmaceuti¬ cal services in the small hospitals and clinics. Although the nationwide nurse shortage poses a continuing prob¬ lem in recruitment, there was a net increase in nursing personnel. Medical social workers contributed to hospital operations signifi¬ cantly by facilitating the discharge of 250 chronically ill patients. These individuals no longer needed hospitalization, but lacked homes or relatives to care for them. Shortages of ancillary medical, administrative, housekeeping, and maintenance personnel remained serious. Despite these shortages, hospital staffing patterns were improved. Full accreditation of the Fort Defiance and Tuba City hospitals, both in Arizona, brought to 10 the number of accredited Indian hospitals. PREVENTIVE HEALTH SERVICES The major challenge in Indian health continues to be the preven¬ tion of disease. Much of the effort for prevention is carried on in field health facilities which are dispersed over 250 reservations and in Indian communities. Preventive services at hospital outpatient clinics alone increased 33 percent over 1956. Notable increases in- 120 Department of Health , Education , and Welfare , 1957 eluded prenatal, 36 percent; well baby, 64 percent; and immuniza¬ tions, 36 percent. The increase in public health nursing services begun in 1956 was continued in 1957 and medical social service was provided in se¬ lected contract medical facilities. Health education, which receives professional supervision in 4 of the 6 geographic areas, was expanded by increasing the professional staff from 7 to 10. The number of community workers in health education (most of whom are Indians) was increased from 12 to 24, and 4 health education aides were added. One of the major approaches to reducing the high incidence of preventable diseases among Indians is the improvement of environ¬ mental health controls and sanitary practices. The professional san¬ itation staff was increased from 22 to 35, and the number of sani¬ tarian aides (outside of Alaska) from 51 to 65. Environmental sanitation surveys were completed for 18 water systems, 19 waste disposal systems, 21 Indian schools, and 5 other facilities. Sanitation surveys were made of 11,000 Indian homes, and 18,000 homes were sprayed in fly-control demonstrations. In¬ dian sanitarian aides trained by the Service now work on 117 reser¬ vations inhabited by 60 percent of the Indian population. In Alaska, Eskimo aides serve 25 native villages. Nutrition and dietetic services were expanded through employment of a dietary consultant and three public health nutritionists to begin working on nutrition problems in two selected areas, and appoint¬ ment of a Consultant Committee on Nutrition Research to review critically nutrition research projects essential to the solution of some of the basic health problems. TUBERCULOSIS CONTROL Although tuberculosis is no longer the leading cause of death among the Indians, it is still a formidable health problem. From 1950 to 1955 — the latest year for which data are available — the tuber¬ culosis death rate for Indians was cut from 102 per 100,000 popula¬ tion to 46. Among Alaska Natives, the reduction was even more spectacular — from 630.1 per 100,000 to 100. There is evidence that the downward trends are continuing. Among both Indians and Alaska Natives, however, tuberculosis death rates and incidence are several times higher than in the general population. A new system for keeping full, accurate check on tuberculous patients was developed during the year, and is being instituted in the field. The 4 tuberculosis hospitals operated by the Division, together with facilities used through contractual arrangements, are adequate for the hospitalization of all known tuberculous beneficiaries who need this care and who are willing to accept it. Public Health Service 121 Chemotherapy nurses dispense medications, visit patients, carry out tuberculin testing, and find new cases. In Alaska, this work is done under contract with the Alaska Department of Health. Con¬ tracts are in effect with several State health departments for case¬ finding, treatment, and followup activities. Research to find more effective means of control is conducted for the Service by Cornell University and the University of Pennsylvania’s Phipps Institute. DENTAL SERVICES Unmet dental needs among the Indians and Alaska Natives are enormous. For the second consecutive year the Division increased its dental staff, adding 30 new positions. In 1957 the staff averaged 73 dental officers and 75 assistants and laboratory technicians. This expansion brought oral health services to additional groups of bene¬ ficiaries which had not received dental service in the past. During the year, 72,479 patients received treatment requiring 135,000 visits — an increase of 20,000 visits over 1956. Services were provided in 66 clinics, at 211 transient locations, and through contracts with 14 private dentists. SERVICES TO MOTHERS AND CHILDREN Adequate health care of Indian mothers and infants would go far in reducing the excessive death rates among mothers and children and reducing the sickness and handicap rates among children. In one year, disorders of pregnancy and childbirth resulted in a death rate of 6.2 per 100,000 among Indians compared with a rate of 1.5 in the general population. Of every 1,000 Indian infants born alive in 1955, 60 did not sur¬ vive the first year. By contrast, only 26 of each 1,000 infants in the general population die in the first year. The Indian infant death rate for the first day is actually less than that in the general pop¬ ulation, and for the first week of life it is about the same. This re¬ flects the early care that Indian babies receive in hospitals operated by the Public Health Service. However, for the period between the first and eleventh month, the Indian death rate is nearly 6 times that for the general population. Maternal and child health services include care of mothers during pregnancy and childbirth, health supervision of infants and preschool children, treatment of the sick, and health instruction of parents. During 1957 the professional staff in this specialty was expanded, and the first full-time pediatrician was assigned in the field to pro¬ vide guidance to other health personnel. Physical examinations of children beginning school were improved both in number and quality. Specialists’ examinations for glasses 448006—58 - 9 122 Department of Health , Education, and Welfare, 1957 and hearing aids were provided for a larger proportion of the school children who need them. These and other improvements have been achieved through closer cooperation between Indian health personnel and school personnel. A problem that once was considered solved appeared again in 1957. Surveys among Indian school children confirmed that trachoma again is prevalent. A diagnostic and treatment program for dealing with this eye disease was organized under a leading authority on trachoma. Measures to control the disease are being taken wherever it is known to exist. A pilot project to determine the most effective methods of case finding, treatment, and followup is being established in the Phoenix area. TRAINING OF INDIANS Formal courses and in-service training are provided for Indians employed in the Indian health program. Practical nurses were trained by the Service in schools in Albuquerque, N. Mex., and Mount Edge- cumbe, Alaska. The twenty-fifth class was graduated by the Albu¬ querque school in 1957. Courses for sanitarian aides were conducted at Phoenix, Ariz., and in Alaska, and dental assistants and technicians were trained at several locations. Community health workers received on-the-job training supervised by university schools of public health. More than 100 Indian and Alaska Native employees received training during 1957. CONSTRUCTION The appropriation for construction and major alterations of health facilities provided funds to build 3 new hospitals which the Congress authorized in Gallup, N. Mex.; Sells, Ariz.; and Kotzebue, Alaska. Funds for construction of a new hospital in Shiprock, Ariz., were appropriated in 1956. The $8,762,000 construction appropriation included $1 million for new housing for health personnel, mostly at remote locations. One million dollars also was provided for major alterations to old hospitals, clinics, and related facilities. LEGISLATION Two laws affecting Indian health were enacted shortly after the end of the fiscal year. Public Law 85-151, approved August 16, au¬ thorized the use of funds available for construction of Indian health facilities to assist in the construction of community general hospitals to serve both Indians and others. Any construction under provisions of this law will be coordinated with the Hospital and Medical Fa¬ cilities Survey and Construction program. Public Health Service 123 Public Law 85-137, approved August 14, authorized construction of sewer and water lines and domestic appurtenances for the Elko, Nev., Indian Colony. A supplemental appropriation provided $34,000 for this work. Health Facilities Construction Program The Division of Hospital and Medical Facilities administers the Hospital and Medical F acilities Survey and Construction Program. The legislation of 1946 authorizing this program was amended in 1954 to put more emphasis on construction of hospitals for the chron¬ ically ill and impaired, diagnostic and treatment facilities, and re¬ habilitation facilities, and to include nursing homes. In 1957 the appropriation for all types of construction grants was $123.8 million, including $21 million for the new phase of the program. The first hospital built with the aid of a grant under this program was opened in October 1948. By June 1957, 3,514 hospitals, health centers, and related facilities were approved for construction. Of these, 2,346 were completed and rendering community service, and 953 were under construction. The remainder were in the planning and preconstruction stages. The total cost of all projects is $2,875 million, toward which State and local sources contributed $1,972 million. Two dollars in State and local funds are being spent for every Federal dollar. Federal aid for these projects amounted to $903 million. The 3,514 projects will add 152,593 beds and 824 projects for out¬ patient care to the Nation’s health resources. Of the beds, 121,456 are in general hospitals; 13,245 in mental hospitals; 7,118 in tuber¬ culosis hospitals; 7,064 in chronic disease hospitals; and 3,710 in nursing homes. Facilities for outpatient care include 610 public health centers (plus 85 public health centers built in combination with general hospitals), 131 diagnostic or treatment centers, 62 re¬ habilitation facilities, and 21 State health laboratories. Of the 1,111 new general hospitals, 564 are in communities that had no hospitals before the program was begun, and 271 are in com¬ munities where the only hospital was obsolete or unsuitable. Fifty- three percent of all the new facilities are located in communities of less than 5,000 population, and only 13 percent are in cities of more than 50,000. Fifty-six percent of the new hospitals have fewer than 50 beds and only 22 percent have 100 beds or more. Among the larger projects are teaching hospitals approved for intern and residency training. Thus, in addition to meeting rural needs, the program is serving the training needs of larger institutions. 124 Department of Health , Education , and Welfare , 1957 DEFICIT OF HOSPITAL BEDS The deficit of hospital beds is still reported by the States as more than 800,000 beds, although in 11 years projects have been approved through this program which will provide 152,593 beds, and an even greater amount of hospital construction has been completed without Federal aid. The need for hospital beds is accentuated by a popula¬ tion increase which now exceeds 3 million annually. Also, large numbers of hospitals that have been in use for many years are becom¬ ing obsolete and in need of modernization to meet present standards. Additional facilities for early diagnosis and treatment of ambula¬ tory patients would reduce the demand for beds in general hospitals. The aging of the population has intensified the need for facilities for the chronically ill. People over 65 require an average of twice the number of days of hospitalization as those under 65. Many pa¬ tients now in general hospitals could be cared for in chronic disease hospitals or nursing homes at less cost than is possible in the general hospital. The amendments of 1954 were designed to help meet these needs. Under the new phase of the program alone, 344 projects were ap¬ proved by June 30, 1957, including 80 nursing homes and 71 chronic- disease facilities. The total estimated cost of these 344 facilities is $187,769,567. At the end of the fiscal year, 14 projects were com¬ pleted and in use. RESEARCH IN HOSPITAL SERVICES Grants for research, experiments, and demonstrations relating to the effective development and utilization of hospital facilities, serv¬ ices, and resources were authorized by Congress in 1949. In 1956, $1.2 million was appropriated for this type of research, and a like amount was made available in 1957. Forty grants to hospitals, health organizations, and health agencies for research in hospital services were made during the two years. Dental Resources Increasing shortages of dentists, combined with rising demands for dental care, accentuate the need for informed planning to train more dentists and auxiliary personnel, and for more efficient use of exist¬ ing manpower. To assist in meeting these needs, the Division of Dental Resources broadened its research program. Studies of man¬ power requirements, supply, and distribution were expanded. Ex¬ perimental educational projects and studies of the functions of dental assistants were begun. Research in prepaid dental care and patterns of treatment needs and demands was increased. Public Health Service 125 DENTAL MANPOWER Growing deficits in dentist supply are nationwide, affecting areas formerly well supplied. A study completed by the Division in col¬ laboration with the American Dental Association, the W. K. Kellogg Foundation, and the Western Interstate Commission for Higher Education projected manpower trends through 1975 in 11 Western States, Alaska, and Hawaii. It showed the Western supply of den¬ tal manpower, now among the Nation’s best, beginning to fall be¬ hind; by 1975 shortages may be critical unless training facilities are greatly expanded. A similar survey of the South, for the Southern Regional Educa¬ tion Board, was completed. Although recently its supply of den¬ tists has gained slightly, the South is still the least well supplied section. Two further studies were begun, one of New England, and one for the Nation as a whole. Scholarships and student aid programs may also be needed. An analysis of dental students’ characteristics, finances, and practice plans, completed in cooperation with the American Dental Associa¬ tion, indicated that high educational costs leave most dental and den¬ tal hygiene students in debt and may impede future enrollments. Auxiliary personnel are an important component of dental man¬ power. In cooperation with the American Dental Hygienists’ As¬ sociation, the first national survey of dental hygienists was completed and published; it evaluated supply, distribution, practice plans, job opportunities, and school facilities. Wider use of chairside dental assistants would enable dentists to treat more patients because individual treatment time would be shortened. To find effective ways of teaching dental students to work with aides, pilot projects sponsored by the Public Health Serv¬ ice wyere undertaken by 6 dental schools. One of these included sum¬ mer training for dental assistants. PREPAID DENTAL CARE Because of close correlation between ability to pay and demands for dental services, prepaid dental care, which lowers cost barriers, may spur demands for needed care. Both the number of plans and interest in them are growing. To fill requests from groups inter¬ ested in organizing prepayment programs, a national inventory was prepared, describing organization, administration, eligibility rules, coverages, and rates of existing prepayment plans. Since growth of prepayment makes more cost and utilization data essential, research in this field was increased. An analysis of how St. Louis Labor Health Institute members utilize clinic facilites was continued to provide workload and cost estimates for a relatively 126 Department of Health , Education , and Welfare , 1957 low-income group. A similar study of dental services supplied to Public Health Service and Coast Guard families was begun. Two studies of maintenance service patterns also were started. One cov¬ ers various age groups at the Group Health Association dental clinic, Washington, D. C. The other covers children enrolled in prepay¬ ment plans in California, Oregon, and Washington. Nursing Resources The most important new development in nursing is the growing trend toward use of scientific research techniques in solving problems associated with giving patients more and better care. In 1957 the Division of Nursing Resources became increasingly the national center for assistance with research in nursing. The program now includes not only the development of study methods and manuals but also the training of nurses and other professional personnel for research in nursing. In addition, the Division guides the new pro¬ gram through which graduate nurses are preparing for teaching or nursing administration. These activities have been added to the Division’s continuing program of studies on the care of patients : analyses of how nursing time is spent in hospital assignments; job satisfaction and persomiel turnover; and review of other situations which create an impression of nursing shortage or which are caused by actual shortages of personnel throughout the hospital. Through 1957, the Division had assisted with 149 studies of hospital nursing services. The participating hospitals represent 1.2 million patients annually who benefit from subsequent improved services. RESEARCH GRANTS AND FELLOWSHIPS The Division awarded $529,000 in grants for research in nursing, approving 18 new projects in 1957. This program, conducted in cooperation with the National Institutes of Health, has granted more than $1 million since its inception in 1956, for 39 research projects. To a large extent these projects explore areas of nursing care never before investigated. In addition, 81 fellowships in nursing research amounting to $121,000 were awarded; in the two years of this pro¬ gram 170 fellowships totaling $246,000 have been awarded. TRAINEESHIPS The Health Amendments Act of 1956 authorized the appropriation of funds for traineeships for graduate nurses wishing to obtain ad¬ vanced preparation for teaching, supervision, and administration. The $2 million appropriated was allocated to 56 institutions in 23 Public Health Service 127 States which awarded 553 full-year traineeships to individual nurses, also 34 partial traineeships. Of the nurses aided, 50 percent enrolled in programs designed to prepare them to teach in schools of nursing ; and 50 percent enrolled in courses in nursing administration or supervision. STUDIES OF PATIENT CARE Opinions expressed by 20,000 patients and personnel in 60 hospitals were analyzed to see whether satisfaction with nursing care had any relationship to the general impression of nurse shortage. The com¬ plaint expressed most frequently was that nurses could not spend enough time with their patients. Nurses felt this even more keenly than their patients. More than two-thirds of the patients were highly satisfied with their nursing care. HOW NURSES SPEND THEIR TIME Since World War II, hospitals have sought ways of avoiding the loss of scarce nursing skills which occurs when nurses perform non¬ nursing duties, which take her away from the patient. A method of studying this loss, devised by the Division in 1951, has been revised and refined and is now available for use in studying activities of the supervisor, head nurse, staff nursing personnel, and personnel of the outpatient departments. Encouraged by the Division, many hospitals have made studies of their nursing services. More than 50 hospitals found that staff nurses and practical nurses spent 76 percent of their time functioning at the level for which they had been trained ; aides and orderlies spent 68 percent, and clerks 86 percent, in the duties for which they were trained. Head nurses, however, performed head- nurse functions only 50 percent of the time and spent only 23 percent of their working day with patients. Staff nurses spent only 38 per¬ cent of their time with patients. Other nursing personnel were with patients 47 percent of the time. This situation, in which professional nurses are with patients less than 25 percent of the time although functioning more than 75 percent of their time at their proper level, suggests the need for action to bring nurse and patient more frequently together. The fact that patients see nonprofessional per¬ sonnel far more frequently than they see professional nurses may ex¬ plain why patients believe there is a “shortage” of nurses. In 1957 the Division trained 76 nurses in Tennessee to conduct these utilization studies and the State hospital association planned studies in 62 hospitals. A nurse consultant of the Division was assigned to Region IV for 2 months; she gave consultation to 27 agencies in 5 States and held 7 training sessions for 81 key nursing personnel on how to study nursing activities. As a result, 12 utiliza- 128 Department of Healthy Education, and Welfare, 1957 tion studies were conducted. In Utah, 7 hospitals studied nursing activities. Consultation on utilization of nurses was given a group of small hospitals in Missouri, and corrective action was begun. TURNOVER OF NURSING PERSONNEL Almost 67 percent of hospital staff nurses and 70 percent of nursing aides and orderlies change jobs each year. It costs the hospital at least $125 each time an employee resigns — an amount which could be saved if the causes of turnover were known and could be eliminated or minimized. The Division studied 51 hospitals which submitted turnover data and supplemented these findings by studies of job satisfaction in 18 hospitals. Administrative and supervisory nursing personnel proved to be the most stable. The practical nurse resigns least often in small hospitals where her status receives the greatest recognition. Aides seek and retain employment chiefly on a short-term basis. The relationship of turnover to job satisfaction is very complex. Employees leave to be with husband or wife, to work nearer home or in a more modern facility, to be with friends, or to obtain con¬ veniences such as air-conditioning. Young people change jobs more frequently than the older age group. Among staff nurses, relatively few indicate that working conditions cause dissatisfaction with their jobs. Many, however, say they leave because they do not have enough time to spend with patients. For the most part, employees leave less often when there is good supervision, good communication between personnel at all levels, and a generally constructive atmosphere throughout the hospital. When turnover is reduced, productivity and quality of work improve; patients receive better care and are better satisfied. Medical Services for Federal Agencies The Public Health Service is responsible for providing medical services to certain other Federal agencies, both in this Department and in other Departments. Through the Bureau of Medical Services, medical, psychiatric, dental, nursing, and other personnel are assigned on a reimbursable basis to agencies that request assistance in operating their medical programs. OFFICE OF VOCATIONAL REHARILITATION Officers detailed to the Office of Vocational Rehabilitation provided professional direction and basic staff for its medical program. In- service training of medical and medically-related personnel of State rehabilitation agencies was a major activity. Two regional institutes Public Health Service 129 were conducted for State medical administrative consultants. Work¬ ing relationships between State mental health programs and voca¬ tional rehabilitation agencies were strengthened; three regional conferences for this purpose were held, sponsored by the National Institute of Mental Health and universities. Assistance was provided in a training program to increase the number of specialists in physical medicine and in strengthening medical school curricula in the rehabil¬ itation phases of medicine. The officers also assisted in administering rehabilitation facilities provisions of the 1954 amendments to the Hospital and Medical Facilities Survey and Construction Act and in helping communities plan and establish rehabilitation centers. BUREAU OF OLD-AGE AND SURVIVORS INSURANCE, SOCIAL SECURITY ADMINISTRATION Six medical officers were detailed to the Division of Disability Operations of this Bureau in 1957. As members of the medical staff they participated in administering the disability provisions of the Social Security Act. Their principal activities were consultation on medical policy and procedure at national and State levels; develop¬ ment of medical standards for the determination of permanent and total disability; training of personnel; liaison with medical groups; and medical consultation to the General Counsel of the Department. BUREAU OF PUBLIC ASSISTANCE, SOCIAL SECURITY ADMINISTRATION The medical officer assigned to this program serves as medical consultant on all phases of public assistance. Most of his work in 1957 was connected with plans to put into effect the new medical care provisions of the Social Security Act as amended in 1956; a new formula for matching payments to vendors of medical services was to become effective July 1, 1957. The medical officer visited 24 States for field consultation. OFFICE OF EDUCATION A nurse director of the Public Health Service was assigned to the Division of Vocational Education of the Office of Education in con¬ nection with the program of vocational education in practical nurse training authorized by the Health Amendments Act of 1956. Most of her work was assisting the States in developing plans to extend and improve educational programs in practical nursing. UNITED STATES COAST GUARD, TREASURY DEPARTMENT Ninety-one Public Health Service officers were on duty with the Coast Guard, including 32 physicians, 46 dentists, 10 nurses, a phar- 130 Department of Health , Education , and Welfare , 1957 macist, a sanitary engineer, and a scientist. Medical officers were assigned to ocean vessels and to ocean weather stations ; both a doctor and a dentist were assigned to the vessel engaged in the Bering Sea Patrol. During the year, dental officers assigned to this program revised the dental requirements for all Coast Guard personnel, except en¬ listed men in the Reserve. Improvements were made in sanitary engineering services on Coast Guard vessels and installations. MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE The medical officer assigned to the Maritime Administration super¬ vised preparation of clinical abstracts and provided professional counsel to the Office of Seamen’s Services and the legal and insurance departments. A senior surgeon and two dental officers served at the U. S. Merchant Marine Academy, Kings Point, N. Y. The medical pro¬ gram included administration of the academy hospital and outpatient clinic as well as care of beneficiaries. The medical officer in charge of the Public Health Service hospital on Staten Island was assigned to the hospital as consultant and was responsible for professional supervision. FOREIGN SERVICE, DEPARTMENT OF STATE The medical unit, directed by a Public Health Service officer, gave between 50 and 60 physical examinations a day to members of the Foreign Service. The medical director visited 24 missions in South America to inspect health and sanitary conditions and observe the medical care Foreign Service personnel were receiving in local facili¬ ties from local physicians. The associate medical director went to Africa and the Middle East to visit 33 missions for the same purpose. BUREAU OF PRISONS, DEPARTMENT OF JUSTICE The Public Health Service continued to provide medical care for the Federal prison system, which includes 30 institutions. Officers and employees of the Service assigned to penal hospitals and clinics not only provided medical services but supported the administrators of the institutions in developing personnel training programs and other means of rehabilitating prisoners. About 40,000 prisoners were provided with medical care. There were 13,606 admissions to the hospitals for a total of 427,038 days; 921 major operations and 5,472 minor operations; 27 births and 44 deaths. The outpatient clinics gave 823,114 treatments and 24,058 physical examinations. Public Health Service 131 As in previous years, medical research in which prisoners volun¬ teered for various tests was carried on in several institutions. The use of chloroquinized salt to suppress malaria was successfully dem¬ onstrated. Development of a new psychological test for use of offenders of various ages was virtually completed. Other research in progress included experiments with d-lysergic acid and a search for antidotes ; study of the development of delinquent gangs ; gathering of data on effects of industrial noises on hearing; study of rates of DDT in absorption and excretion ; and studies of the value of orally administered attenuated poliomyelitis vaccine. Prisoners in 20 institutions donated 8,636 pints of blood to Red Cross and local blood banks, establishing a new record. BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR Medical care and compensation are provided Federal civilian em¬ ployees for injuries in performance of duty and illness attributable to conditions of employment. Medical care is provided by Federal medical officers and hospitals where available and by about 3,000 designated private physicians in areas where Federal hospitals are not available. Hospitals, clinics and other facilities of the Public Health Service are utilized to a large extent. Medical officers of the Public Health Service administer and supervise the medical care program, serve as technical advisers in adjudication of cases, and assist in the staff educational program of the Bureau of Employees’ Compensation. In 1957 special studies were conducted, in cooperation with the Public Health Service Hospital in New Orleans, La., to find out whether there are latent or delayed effects of mustard-gas poisoning. Studies of hearing loss cases leading to development of formulas to determine disability through loss of hearing also were made. A statistical study revealed a decline in the number of nonfatal injuries reported during the 5 years 1951 to 1955. It showed signif¬ icant reductions in tuberculosis, eye disabilities, traumatic injuries of the hands, and traumatic injuries to the head and neck; no change in occurrence of hernia cases ; and an increase in the number of back injury cases. Bureau of State Services The Bureau of State Services cooperates with States, professional organizations, and other health groups to apply public health pro¬ grams which will control and prevent disease. In addition to pro- 132 Department of Health , Education , and Welfare , 1957 viding financial, technical, and consultative services nationally, it administers Federal health activities in which the United States par¬ ticipates abroad. Division of General Health Services The Division of General Health Services administers grants-in-aid to the States, conducts a research program in Arctic health, coordi¬ nates the Nation’s vital statistics program, provides services in public health nursing and public health education, administers a traineeship program for public health workers, and does exploratory work in new program areas. STATE GRANTS For the first time, grants for public health services were made available to Guam, and Alaska received authority to develop an integrated mental health program, including construction of mental health facilities within the Territory. Federal funds amounting to $203,013,000 were available in fiscal 1957 for grants-in-aid to States on health programs. This amount included $123,800,000 for hospital and medical facilities construc¬ tion and $50,000,000 for waste treatment works construction. Actual payments were made as follows : General health services _ _ _ $11, 962, 098 Venereal disease special projects _ _ _ 1 1, 669, 801 Tuberculosis control _ 4, 485, 949 Mental health activities _ 3, 949, 845 Cancer control _ 2, 235, 318 Heart disease control _ 1, 987, 983 Medical facilities survey and planning _ 383, 878 Construction of community facilities _ 301, 875 Hospital and medical facilities construction - 71, 503, 847 Waste treatment works construction _ 843, 735 Water pollution control _ . _ 2 1, 864, 463 Poliomyelitis vaccine assistance - 28, 849, 606 1 Includes $470,083 in services and supplies furnished in lieu of cash. 2 Includes $181,132 paid to interstate agencies. In addition to the above, payments totaling $890,912 were made for traineeships under the Public Health Traineeship Program and $160,771 for training and demonstration projects in air pollution control. POLIOMYELITIS VACCINE ACTIVITY The Poliomyelitis Vaccination Assistance Act of 1955 expired at the end of fiscal 1957, at which time about $53.2 million was ex¬ pended from $53.6 million appropriated. Public Health Service 133 The PHS continued an active surveillance program over the pro¬ duction, distribution, and use of poliomyelitis vaccine. In coopera¬ tion with the American Medical Association, the National Foundation for Infantile Paralysis, and State health officials, the Service urged the use of the vaccine. About 91 million cubic centimers of polio vaccine were produced during the year, and sufficient vaccine was available to provide a full 3-dose immunization to 46 percent of the population under age 40. ARCTIC HEALTH RESEARCH CENTER A research project in an Alaskan Indian village sought basic in¬ formation about diseases of the eye, middle ear, and respiratory tract. Initial physical examinations showed high frequency of inactive tu¬ berculosis, widespread dental caries often neglected, many middle ear conditions, and that about 30 percent of the population had presump¬ tive hypertension usually without evidence of cardiovascular diseases. A food intake study on Alaskan Eskimos and Indians in their native villages pointed out wide differences in diet, with pre-school children having the most deficient diet of any age group. Ex¬ ploratory studies were begun to find a possible relationship between the moderate anemia found in Alaskan natives and the fish tape¬ worm infection prevalent in many areas. Using different types of construction materials for comparative study, 2 experimental houses were built in remote areas as part of the Native Village Sanitation Program. Three additional cases of methoglobinemia, a rarity in other parts of the world, were discovered during the year in the course of nutri¬ tional studies, making a total of 15 cases to date. Intensive clinical studies of the cases led to the conclusion that some enzymatic factor, lying between reduced nucleotides and methoglobin, is missing from red cells of those with the condition. The missing component in pa¬ tients’ cells may be replaced by such substances as methylene blue, ascorbic acid, and riboflavin. A beginning has been made to isolate the enzyme factor from normal blood. EMERGENCY HEALTH SERVICES This program, discontinued at the end of fiscal year 1957, supplied leadership to develop and improve State, regional, and local plans for civil defense and natural disaster activities, including action to insure continuity of government health functions in the event of an enemy attack. The staff helped develop and participated in Operation Alert 1957. Drought, hurricane, tornado, and flood damage was extensive during the year. Additional disaster relief assistance w^as needed, especially in the South and the Southwest. The Service sent supplies, equip- 134 Department of Health , Education , and Welfare, 1957 merit, and reserve manpower to the stricken areas. Program guides were distributed to State and local health agencies on the sanitary aspects of mass evacuation, and the detection of chemical warfare agents in water. PROGRAM DEVELOPMENT In cooperation with the Children’s Bureau, State and local health agencies, and others interested in migrant health problems, the Divi¬ sion devised a health record to be carried by migrant workers. A plan was developed to use the record on a pilot basis to learn its value as an aid in providing continuity of health services to this mobile group. A review of immunization programs for agricultural mi¬ grants indicated that more flexible immunization schedules could be followed without impairing the effectiveness of the treatment. In the school health area, the State of Florida received staff as¬ sistance in organizing a State school health program. Major empha¬ sis was placed on the orientation and training of health coordinators for schools. PUBLIC HEALTH EDUCATION Staff activity sought to learn how to get the individual to assume good health habits as well as how to achieve more effective public health programs through community action. Some significant research studies dealt with: factors influencing participation of the public in tuberculosis case-finding programs; staff turnover and job satisfaction among hospital personnel; and identification of barriers to adequate certification of death and ways to overcome them. In an effort to improve adjustment of heart pa¬ tients to their disease, an exploratory study was made in a city- county health department to determine patient reactions. These findings will be used to develop a large scale sampling study in the same area. Preliminary action began on the problems of integrating health services in a community; developing methods to measure quality of nursing care; identification of health needs of people as they see them; personal and situational factors influencing a person’s de¬ cision to take specific health actions; and cultural determinants of health behavior. In conjunction with State and local health departments and other agencies technical assistance went into studies of the social and psy¬ chological conditions which predispose to heart disease, and the re¬ actions of local citizens to a natural disaster. Public Health Service 135 PUBLIC HEALTH NURSING Increased interest in the school health problem by Boards of Edu¬ cation is reflected in a Biennial Census of Nurses Employed for Public Health Nursing which showed a 20-percent gain in school nurses hired during the biennium. The report revealed a total of 29,396 nurses employed in all public health fields. In cooperation with the University of Minnesota’s Public Health Nursing Section, the Division set up a project to operate extension courses in public health nursing to further the academic preparation of nurses who are unable to take full-time university study. Data analysis was completed on a field study of nursing services to individuals offered by local health departments. The study will be published under the titles: “Amount of Nursing Service Re¬ quired by a Household” and “The Distribution of Nursing Services to Individuals According to Diagnostic Category.” Staff assistance was given to a school nursing study in Montgomery County, Maryland, and to work measurement studies in Seattle, Washington, and Spartanburg, South Carolina. The staff also con¬ sulted with a National Red Cross Committee on revision of its Home Nursing Handbook to make it more useful in civil defense programs. At the request of the Iranian Government, a staff member helped to organize a program for nursing in Iran, as one segment of the country’s long term health plans. TRAINING Stimulated by the traineeship program authorized by Title I of the Health Amendments Act of 1956, the downward trend in the number of persons receiving specialized public health training was reversed. Under this program, funds were provided for the train¬ ing of 363 persons. In addition, State and local health departments increased their traineeships by 8 percent over 1956. Thus a total of 764 persons received advanced training with the aid of public funds during the 1957 academic year. NATIONAL OFFICE OF VITAL STATISTICS The National Office of Vital Statistics is responsible for the col¬ lection, tabulation, analysis, and publication of national data on births, deaths, marriages, divorces, communicable diseases, and for the conduct of special statistical studies in the field of health and demography. Vital statistics are essential to administrative and re¬ search activities of business, government, medicine, public health, and other aspects of our society. The Office also cooperates with the 136 Department of Health , Education, and Welfare, 1957 World Health Organization and its member countries to develop comparable international statistics. A highlight of fiscal year 1957 was the establishment of a Marriage Registration Area to improve the knowledge of marriage statistics. Pilot studies of marriage registration completeness were conducted in three States. At the request of the Bureau of the Census, esti¬ mates of births in the U. S., by months, from 1915 to 1952 were pre¬ pared for use in studying possible relationships between fertility and economic trends. To provide an estimate of future demands for poliomyelitis vaccine, a national poliomyelitis survey was made. The development of the Model Vital Statistics Act entered its final stages, and a guide to statistics in the field of home accident prevention was developed. 1956 State legislative activity relating to vital statistics and records was summarized. In cooperation with the National Health Survey, a study was made on the hospital utilization experiences of recently deceased residents of the Middle Atlantic States. A sample survey study to develop methods and procedures was conducted in conjunction with the Na¬ tional Cancer Institute and the Pennsylvania Department of Health. Division of Special Health Services The Division of Special Health Services acts on health maintenance problems associated with accident prevention, medical aspects of air pollution and radiological health, long term illness, heart disease, occupational health, and tuberculosis. ACCIDENT PREVENTION The Accident Prevention Program conducts studies and investiga¬ tions, and helps develop control measures to reduce accidental injuries and deaths. Plans were begun to extend established public health epidemiologic techniques to accidental deaths and injuries in order to develop a bet¬ ter understanding of basic factors involved. A group of studies was planned to learn the role of physical conditions and emotional fac¬ tors involved in accident causation. Since initial first aid applied, as well as later medical care received, often determines the extent of recovery from accidental injury, studies were planned to determine the adequacy of care and ways to improve it. At the request of the American Academy of Pediatrics and the American Public Health Association, a National Clearinghouse for Poison Control Centers was established. With the rapid expansion of local poison control centers, this PHS unit will help to spread information about new toxic products, effective methods of treatment, and to analyze trends in fatal and non-fatal accidental poisonings. Public Health Service 137 AIR POLLUTION MEDICAL PROGRAM Fiscal 1957 saw research emphasis shifting from laboratory work on air pollution to study of its effects upon people and their com¬ munities. In cooperation with the National Institutes of Health, action began in three major areas : (a) effects upon the respiratory system, particu¬ larly the phenomena of hypersensitivity and allergenicity; (b) effects on the cardiovascular system, especially the extent to which cardio¬ vascular and pulmonary respiratory conditions are aggravated by air pollution; (c) eye effects, with emphasis on eye irritation. Other studies began on the relationship of air pollution variations to the incidence and progression of various diseases ; air pollution by specific industries (initial studies in steel and lead storage battery industries) ; and effects of different kinds of air pollution. CHRONIC DISEASE CONTROL This year the Chronic Disease Control Program expanded its activi¬ ties against diseases and crippling conditions which are among the leading causes of death and disability in the U. S. Research projects included evaluation of screening and diagnostic tests for diabetes and glaucoma ; studies in the prevention of diabetes and its complications ; evaluation of periodic health examinations as a vehicle for attacking the problems of older age groups ; action on the relationship of chronic illness to application for social service; and appraisal of programs dealing with long term illness and health of the aged. A significant achievement was concerned with abnormal carbohy¬ drate metabolism in pregnancy conducted in the prenatal clinic of the Boston City Hospital, Massachusetts. Preliminary data showed that more women with abnormal CHO metabolism had large babies (9 pounds or more) than other mothers included in the study. After treatment with insulin during pregnancy, however, mothers with ab¬ normal CHO metabolism had about the same proportion of large babies as women without this condition. As a result of these and other findings, efforts will be made to determine the relationship be¬ tween the birth of a large baby and the later development of diabetes. National data collected from more than 120,000 persons known to have been screened for diabetes showed a rate of previously undiag¬ nosed diabetes of about seven per thousand persons tested. Staff members worked with the State health departments of Mich¬ igan, New Jersey, New York, and Ohio, as well as the Memphis-Shelby County Health Department, Tennessee and the University of Ten¬ nessee Medical School, to develop five long range diabetes screening programs. 448006—58 - 10 138 Department of Health , Education, and Welfare, 1957 In an effort to demonstrate the extent to which a patient may be¬ come a more valuable member of the health team, a physician, nurse and nutritionist gave weekly group instructions to 300 patients in the Diabetic Clinic, Boston on administration of insulin, urine testing, diet instruction, and general patient care. Plans have been initiated to augment consultation services to the States toward improving standards of care in nursing homes. HEART DISEASE CONTROL Because of a shortage of medical personnel in local communities, the Program assigned medical officers to 11 States requesting assist¬ ance to expand control activities. New rheumatic fever and heart disease control programs were begun in Illinois, Missouri, Wisconsin, and Colorado ; epidemiological studies were initiated in North Dakota, Georgia, Connecticut, and Florida; and health units and diagnostic facilities were organized in Georgia, Tennessee, Florida, and California. A study showing geographic variations in mortality from heart disease has helped to define the problem in this country. Further study of population groups with high and low death rates were begun. These studies may give clues on factors responsible for the disease. Planning was begun with the Department of Commerce on a pro¬ posed nationwide survey of body weight measurements among men, for use in studies on the apparent relationship between overweight and the development of heart disease. Coronary and control groups are undergoing study to learn the social and psychological factors which may predispose a person to develop heart disease. New data revealed that heart disease patients detected by mass X-ray surveys, when followed by intensive medical and nursing care, have about 1 percent reduction in mortality during the three year period following participation. Studies of mortality showed that deaths due to hypertension have dropped sharply since 1953, due possibly to increased use of hypo¬ tensive drugs. Pilot studies are being made among Indians, and certain popula¬ tion groups whose diet is largely vegetarian, to learn if such factors as dietary fat intake and blood lipid concentration may be related to heart disease prevalence rates. OCCUPATIONAL HEALTH The Occupational Health Program promotes measures to improve the health of workers both on and off the job. To help industry protect its workers from health hazards arising from the great number of chemicals introduced each year, an Occu- Public Health Service 139 pational Health Information Exchange was set up in the program’s field headquarters in Cincinnati, Ohio. The Exchange will serve as a clearinghouse for information on the nature and extent of new disease problems in industry, total occupational health resources available, and methods for stimulating additional research on con¬ tinuing industrial hazards. Occupational health experiments with laboratory animals yielded information which may help to evaluate possible hazards to the gen¬ eral population from ozone-containing smog. Seven factors have been found to affect the toxicity of ozone. Youth, physical exertion, alcohol, and respiratory infection tend to exacerbate the injurious response; while intermittent exposure, premedication, and preex¬ posure, either reduce or eliminate the injurious effects. From long range continuing studies by the PHS on health hazards in uranium mines, it was found that radiation dosage from breathing a radon-containing atmosphere arises mainly from radon daughter products accompanying radon in the air. Engineering controls developed by the program are being applied by the uranium mining industry to keep the concentrations of radon and its daughter products within recommended limits. Millions of workers in the U. S., especially those in small plants and business establishments, still do not have the benefit of employee health services. To determine obstacles to progress in this area, a study of managerial attitudes and evaluations was conducted for the Occupational Health Program by the University of Michigan’s In¬ stitute of Social Research. Data collected in five separate commu¬ nities revealed management’s chief consideration in the development and expansion of employee health services is the improvement of em¬ ployee-management relationships. Of secondary import is the financial benefit resulting from decreased absenteeism and lowered workmen’s compensation costs. Significant also was the finding that management welcomes and seeks assistance from health department personnel in the expansion of employee health services. A revaluation of silicosis in the Vermont granite industry was completed. Only one possible case of early silicosis has been diagnosed among workers who began their employment in the granite industry since the time when dust control measures were introduced in 1937. RADIOLOGICAL HEALTH MEDICAL PROGRAM A new unit, the Radiological Health Medical Branch, was set up to plan health services in connection with the exposure of the popu¬ lation to ionizing radiation. During the year there was increased recognition of the importance of medical and dental X-rays in the exposure to such radiation. 140 Department of Healthy Education, and Welfare, 1957 Consultation on the development of legislation and regulations in radiological health was given to State agencies. Of particular signifi¬ cance was the adoption of measures by one State banning the use of fluoroscopes as shoe-fitting devices. A cooperative activity conducted with the Division of Sanitary Engineering Services and the Atomic Energy Commission was the Medical Liaison Officer Network set up nationally to aid in the investigation of instances of human disease and injury alleged to be related to the Continental Nuclear Weapons Tests. This group also assisted in the training of State health personnel working with ionizing radiation. At the request of the United Nations Scientific Committee on the Biological Effects of Atomic Radiation, a study was begun on the feasibility of keeping radiation exposure records for the entire popu¬ lation of the United States. TUBERCULOSIS CONTROL Recent prevalence estimates show that there were 800,000 cases of tuberculosis in the United States in 1956, of which 250,000 were active. This represents a decline since 1952 of 30 percent in the ac¬ tive group and 10 percent in the inactive. Human studies of isoniazid as a preventive of tuberculosis were be¬ gun in 1956, involving contacts of new active cases in communities throughout the country. A pilot study to evaluate isoniazid as a preventive of complications of primary tuberculosis in children in¬ cludes over 2,600 children in 33 pediatric clinics. Continuing evaluation of antimicrobial therapy confirmed the superiority of isoniazid plus PAS in treatment. Preliminary results of an uncompleted study indicated that Streptomycin plus Pyrazin- amide may be as effective but more toxic. Immunization studies con¬ tinue to show that most of the new tuberculosis cases appear among initially tuberculin positive members of the study population. Inci¬ dence has been greatest among those who had strong tuberculin re¬ actions. This observation is confirmed by a recent report of tuberculosis morbidity in about 70,000 Navy recruits. These results emphasize the need to concentrate control efforts on the tuberculin positive segments of the population. In cooperation with a Committee on the Care of the Unhospitalized Tuberculosis Patient, steps were taken to develop standards for home care of patients with tuberculosis. To help communities define their problem in this area, a “Guide for Conducting an Unhospitalized Tuberculosis Patient Study” was prepared. A statement on the role of X-ray case-finding programs in tubercu¬ losis control discussed modifications in X-ray case-finding activities Public Health Service 141 necessitated by changes in the control problem and by findings con¬ cerning the significance of relatively low level radiation exposure. The selective use of mass X-ray surveys was recommended. Initial research evaluated three major social problems concerning adequate care for tuberculosis patients: legal residency, means tests, and forcible hospitalization. Statistical studies of trends in the num¬ ber and use of tuberculosis hospital beds were also made. To meet one of the more significant developments in this area, a “Guide for a Tuberculosis Control Program for General Hospitals” was published. Division of Sanitary Engineering Services The Division of Sanitary Engineering Services helps States, in¬ dustry, civic groups, and other Federal agencies identify and solve environmental health problems. ROBERT A. TAFT SANITARY ENGINEERING CENTER The Robert A. Taft Sanitary Engineering Center at Cincinnati, Ohio, is the Nation’s largest facility devoted to sanitary engineering research. Major activities involve basic and applied research, train¬ ing, and technical consultation on water supply and water pollution control, sewage and industrial wastes disposal, milk and food sanita¬ tion, radiological health, and air pollution problems. AIR POLLUTION ENGINEERING The National Air Sampling Network was designed to provide the basic data necessary to an understanding of the national air pollution problem. The Network was developed in cooperation with State and local authorities. One hundred ten urban and 14 nonurban stations distributed in every State and major population area participated in the program involving the collection, identification, and measure¬ ment of particulate and gaseous components of polluted air. The Sanitary Engineering Center is the headquarters of the Network. Studies of automotive exhaust, various types of incineration, and the removal of sulfur dioxide from stack gases are being conducted in cooperation with the Bureau of Mines at their facilities. Eleven grants were awarded to ten universities to initiate or expand curricula in air pollution engineering, under the provisions of Public Law 159. Nine traineeships were awarded to individuals for train¬ ing in air pollution. Statewide appraisals of air pollution problems were made in Con¬ necticut, Tennessee, and Washington. City surveys were completed for Denver, Colorado, Steubenville, Ohio, and Portland, Oregon. 142 Department of Health , Education , and Welfare , 1957 Major field studies were under way in the New York-New Jersey area and in Louisville, Kentucky. Considerable research support was given to California and the Los Angeles County Air Pollution Con¬ trol District for the solution of smog problems. GENERAL ENGINEERING Eight Special Citations, the largest number annually to date, were awarded to interstate carrier companies for achieving high standards of sanitation in all travel conveyances operated during the year. An Ad Hoc Study Group was called together to define national needs in the field of solid waste disposal. The group recommended that the Public Health Service intensify its efforts in training, re¬ search, and education of the public in proper methods of storing and disposing of solid wastes. Special planning for sanitation involved in the construction of a nuclear powered passenger vessel, engaged in jointly with the Mari¬ time Administration and the Atomic Energy Commission, will great¬ ly affect construction and operation of future American flag vessels. Because new buses offer food service and sanitary facilities, it was necessary to plan for review of bus construction and inspection of the buses, as well as bus-servicing areas and food-catering establishments. In cooperation with the Pan American Sanitary Organization and the Pan American Union, the staff continued to develop and recom¬ mend sanitation practices to give improved health protection to trav¬ elers in Inter- American countries. In consultation with other Federal agencies, the transportation in¬ dustry, and drug companies, a new section of the Interstate Quaran¬ tine Regulation to cover shipment of etiologic agents was developed and adopted. MILK AND FOOD SANITATION Five representative milksheds of the Nation were used as sampling points for collecting milk in a pilot study to gather data on the levels of radioactivity in typical milk supplies. The study was conducted with the cooperation of State and local agencies and the milk in¬ dustry. Information on feeding practices and water supplies for animals in the milksheds was also obtained for use in interpreting laboratory findings. Designed to promote uniformity of State and local vending ma¬ chine regulations, a guidebook entitled, “The Vending of Foods and Beverages: A Sanitation Ordinance and Code — 1957 Recommenda¬ tions of the Public Health Service” was developed and distributed to the States and the industry. Public Health Service 143 Reports on simultaneous studies made on dry milk at the Sanitary Engineering Center, the Universities of Wisconsin and Minnesota, and by the American Dry Milk Institute, confirmed the hypothesis that the 1957 outbreaks of food poisoning in Puerto Rico were caused by a preformed toxin, probably of bacterial origin, which was present in dry milk. The reports indicated that enterotoxigenic staphy¬ lococci will grow prolifically in concentrated milk when organisms exist at one stage prior to drying. The milk and food staff, with the Committee on Poultry Hygiene of the American Public Health Association, developed basic prin¬ ciples for the official inspection of poultry for wholesomeness; and with State and local officials, engaged in poultry sanitation surveys of processing plants, and further developed a set of effective poultry sanitation ordinances. RADIOLOGICAL HEALTH The Service continued its offsite monitoring activities at the Atomic Energy Commission Nevada atomic weapons test-site. Under an agreement with the Atomic Energy Commission’s Di¬ vision of Biology and Medicine, a 40-station nationwide air and rain¬ water radiation surveillance network was operated. Program personnel, together with staff from the Division’s Inter¬ state Carrier Branch, the Atomic Energy Commission, and the Coast Guard reviewed cooperative interests on present and future problems connected with design and operation of nuclear-powered merchant ships. WATER SUPPLY AND WATER POLLUTION CONTROL The new Federal Water Pollution Control Act (PL 660) author¬ ized grants to assist municipalities in the construction of needed sewage treatment plants. A total of $50 million per year up to a $500 million aggregate was authorized. Of the more than 1,000 ap¬ plications for grants totaling over $97.9 million, received in fiscal 1957, 446 requests involving $37.9 million, were approved. A hearing board, acting on a complaint of interstate pollution in the Corney Drainage System, found that oil field wastes originating in Arkansas were affecting water uses in Louisiana. Upon an order to cease and desist such interstate pollution, the 75 oil wTell lease operators involved corrected the situation. Compilation of background data on the status of more than 100 interstate pollution problem areas was begun during 1957. Three con¬ ferences on interstate pollution were called by the Surgeon General. Digests of present State water pollution control laws are being made to provide a basis for further refining the Suggested State 144 Department of Health , Education , and Welfare , 1957 Water Pollution Control Act originally developed by the PHS in 1950 as a guide to States to improve their laws. Preliminary work toward the establishment of water quality base¬ line data on the Nation’s streams was started during the year, when 10 of the 250 sampling stations proposed for strategic location throughout the country began operating daily. Data collected will be used to show the present quality of water, the degree of pollution, and the extent of water quality improvement. Revisions of 1955-56 data on water supply facilities were made in order to determine more adequately the location of critical facilities and their vulnerability to nuclear weapons attack. Standards are being developed to enable water utilities to reduce injury to personnel and minimize damage to facilities. Research was extended to provide information on the ability of conventional treatment processes to cope with economic poisons, in¬ cluding insecticides which reach water through drainage from agri¬ cultural lands and fish killing preparations. A nationwide study of the effectiveness of municipal water treat¬ ment plants in removing coliform organisms substantiated earlier findings that modern plants could handle extremely high loadings. ENGINEERING RESOURCES A survey of sanitary engineers in the Nation, conducted jointly with the National Science Foundation, was completed. During 1957, grants for sanitary engineering and occupational health research were doubled, and there now is a backlog of approved grants awaiting the availability of funds. The grants are awarded through the Division of Research Grants. The Commissioned Officers Student Training Extern Program for sanitary engineers was initiated this year. About 14 students were employed for the summer months. Forty-five persons were awarded training grants for sanitary engi¬ neering courses under the provisions of PL 911, an act designed to bring more people into the health professions. Communicable Disease Center The control of infectious disease is the mission of the Communi¬ cable Disease Center (CDC), which is located in Atlanta, Ga., with laboratories and field stations in various parts of the United States. In cooperation with the States, the Center develops national pro¬ grams against communicable diseases through direct aid in epidemics and disasters, continuing field studies on the epidemiology of dis¬ eases, laboratory investigations, development of materials and Public Health Service 145 methods of disease control, consultations and demonstrations, and training of public health personnel. The direction of the Center’s continuing program is influenced by specific needs encountered dur¬ ing epidemic and disaster situations. During the past year, the Venereal Disease Control Program was transferred from the Division of Special Health Services to the Communicable Disease Center. EPIDEMIC AN1) DISASTER AID CDC supplemented State health resources in 23 epidemics involv¬ ing various diseases and in 20 disasters. REPRESENTATIVE FIELD AND LABORATORY INVESTIGATIONS Poliomyelitis The Center continued to maintain a poliomyelitis surveillance pro¬ gram. The effectiveness of the poliomyelitis vaccine was evaluated through broad epidemiological observations and laboratory studies. Regular reports on the status of the disease were compiled for national distribution. Laboratory investigations of outbreaks of nonparalytic poliomye¬ litis led to a change of diagnosis from polio to polio-like disease (aseptic meningitis, etc.) in approximately 50 percent of the cases. So far, clinical investigations have failed to disclose any signs or symptoms which, in individual cases, could be used to differentiate true nonparalytic polio from other aseptic meningitis. Respiratory Diseases A Respiratory Disease Unit was organized to undertake studies on the influenza viruses, the adenoviruses, and other viral agents which attack the respiratory tract. In connection with the outbreaks of Asian influenza in this country, the Center kept national health officials apprised of developments, assisted pharmaceutical houses in formulating monovalent vaccines and initiated studies on the potency and effectiveness of these prod¬ ucts, and provided prototype viruses and diagnostic reagents to over 100 laboratories. Venereal Diseases Reported cases of syphilis in fiscal year 1957 rose for the second successive year; 135,543 cases in all stages were reported by State health departments. This was 7.4 percent above the number reported in the continental United States in 1956 and 11.0 percent above the number reported in 1955. Early infectious cases showed a slight decline. 146 Department of Health, Education, and Welfare, 1957 The number of cases of gonorrhea reported this year was 216,476 as compared with 233,333 cases reported in 1956, a decline of 6.4 percent. Approximately 52 percent of all infectious venereal disease occurred in the 15- to 24-year age group which represents 13 percent of the total population. Since underreporting of venereal disease morbidity continues to be a problem, several States inaugurated programs to stimulate com¬ plete reporting of cases by private physicians and to provide epi¬ demiological services. A new blood test for syphilis, the Rapid Plasma Reagin (RPR) method, which gives on-the-spot results, has proved highly adaptable to mass testing in situations where it is advantageous to treat reactors immediately. Cluster testing, a newly developed case-finding technique involving serologic screening of friends and associates of known infected per¬ sons, was found to be 30 percent more effective than traditional epidemiological methods. Viral Encephalitis Human cases of Saint Louis encephalitis (SLE) occurred widely in the Midwest, and in recognized outbreaks in the Texas Panhandle, in the Louisville, Ky. area, and in the Missouri River Valley. East¬ ern equine encephalitis (EEE) was seen in a distinct small outbreak of human cases in Massachusetts. The Center continued its investi¬ gations on the ecologic interrelationships of the encephalitis viruses, their mosquito vectors and reservoirs, and the specific circumstances under which the diseases occur in man and domestic animals. Diphtheria In recent years, localized sharp outbreaks of diphtheria have oc¬ curred in every part of the Nation, but a disproportionately large number of cases are still seen in the South. Throughout the North and the West, older children and adults have exhibited an increas¬ ing susceptibility. To understand the overall problem better, im¬ munity studies are being conducted on adults in parts of the South. Rabies Although the incidence of canine rabies is declining, the dog is still the most important vector of this disease. Reported cases in wild animals, notably foxes and skunks, are increasing and stringent control measures are needed to deal with this reservoir. Since 1953, 175 cases of rabies in insectivorous bats have been diagnosed in 17 widely scattered States, but the significance of the disease in these creatures is not yet fully understood. Public Health Service 147 There were 10 human deaths from rabies in 1956. Methods of pre¬ exposure immunization for humans have been sought, since the Pasteur treatment is increasingly hazardous with repeated courses. Preliminary results of antibody studies in humans showed that a single booster inoculation of HEP (high-egg passage) Flury rabies vaccine elicited immediate and robust serum neutralization antibody responses in more than 90 percent of people who had some history of previous rabies immunization. Psittacosis There was a slight rise in national incidence of human psittacosis, with California, Pennsylvania, Wisconsin, and Minnesota reporting the largest number of cases. Parakeets and poultry were incrimi¬ nated about equally when source of infection was known. Typhoid Fever Epidemiologists traced 22 cases of typhoid fever (1 fatal) dissemi¬ nated to 7 States by participants at a convention held in MonArk Springs, Mo. Salmonella typhi phage C-2 was isolated from stools in 16 of the cases and from an asymptomatic known typhoid carrier who attended the meeting. Fluorescein dye tests showed a connec¬ tion between the water supply and the sewage system. Staphylococcus Diseases Present methods of control are inadequate to handle infections due to antibiotic resistant strains of staphylococci among hospitalized pa¬ tients. CDC has now identified some of the previously unidentified strains. LABORATORY ACTIVITIES The Center provided diagnostic services for State and Territorial laboratories, Federal agencies, and foreign countries by identifying 40,000 troublesome isolates. When satisfactory diagnostic reagents are not available commercially, CDC produces limited numbers and amounts for internal use and for State laboratories. In a large proportion of specimens from cases clinically diagnosed as poliomyelitis which failed to yield polio virus, other agents, par¬ ticularly of the ECHO, Coxsackie, and Buffalo groups, and a number of unknowns were recovered. Contracts for diagnostic services on these agents have been established with 34 laboratories, principally in academic institutions. Experiments with attenuated Type 1 and Type 3 polio viruses sug¬ gest that these strains are promising candidates for a live virus vaccine. 148 Department of Health, Education, and Welfare, 1957 Laboratories of the Communicable Disease Center sought to extend the application of fluorescent antibody techniques to rapid identifica¬ tion of a wide variety of bacteria and parasites, thus enabling early treatment and control. VECTOR CONTROL PROBLEMS Insect resistance to one or more of the insecticides normally used for their control is the most serious single problem confronting organ¬ ized vector programs throughout the world. Forty insect species of public health importance are now known to be resistant. CDC de¬ veloped a testing kit, using standardized materials, for evaluating re¬ sistance of adult mosquitoes to DDT and dieldrin and determined resistance baselines for two species of mosquitoes. No clinical or laboratory evidence of abnormalities resulted from intensive and prolonged occupational exposure of 40 men to DDT, although 26 of them had absorbed approximately 200 times the normal dietary intake of the insecticide for intervals as long as 6.5 years. Studies continued on composting of municipal refuse and garbage as a disposal method which precludes feeding and breeding of disease- bearing insects and other vermin. TRAINING More than 8,200 persons from a variety of organizations in this country and from abroad received training in epidemiology, environ¬ mental control of communicable diseases, laboratory diagnostic meth¬ ods, civil defense, disaster aid, and other subjects offered by CDC. Division of Dental Public Health The Division of Dental Health directs studies on the magnitude of the dental problem in the United States and on the development of procedures which may be applied by States and communities to reduce the size of the problem. FLUORIDATION An additional 165 communities with a total population of over 4% million began fluoridating their public water supplies as a means of reducing tooth decay. This advance brought the national total to 1,522 communities providing fluoridated water to 31,664,474 people. Also, a natural fluoride census showed an additional 1,900 places, serving about 7 million, had at least one source of water with 0.7 ppm. or more fluoride. A highlight of the year was the finding that the compound fluor¬ spar could be used in the fluoridation of public water supplies. The Public Health Service 149 new method will provide people with fluoridated water at less than one-third the present cost. Studies of topical fluoride agents as caries preventives were continued. OTHER SERVICES Two pilot studies were initiated to investigate dental problems of long-term illness patients and develop ways of extending dental care services to them. Montefiore Hospital and the Beth Abraham Nurs¬ ing Home in New York City provided sites to study the technical aspects, while administrative and community organizational problems are being studied in the Kansas City area. A study in two cities was made to determine the dental health status of children five years after termination of care, in which their dental needs wTere met on an incremental basis. Analysis of the data should indicate the extent of lasting benefits to a community which adopts such a school dental program. Two other long-range studies involving children were the changing level of dental care required to meet the needs of those residing in a community adding fluorides to its water supply ; and the extent of the dental care problem in a group using an optimum fluoride con¬ centration water supply for the past 10-12 years. Consultation occurred with dental directors and representatives of Federal and State public assistance programs to stimulate action whereby dental care may be given to public assistance recipients under recent legislation. Division of International Health The Division of International Health provides program and policy guidance on international health activities. During the year, the Division developed health policies affecting U. S. participation in the World Health Organization, the Pan American Sanitary Organization, and the South Pacific Commission. These policies included the issuance and acceptance of a U. S. Gov¬ ernment invitation to the World Health Organization to celebrate in Minneapolis, Minnesota, the Tenth Anniversary of the founding of the Organization. The anniversary meetings will be held on May 26 and 27, 1958, and will be followed by sessions of the World Health Assembly through June 14, 1958. Preparatory action began on U. S. and USSR agreements to ex¬ change reciprocal missions in public health administration during the later half of 1957. Public health institutions in each country will be visited by both exchange groups. 150 Department of Health , Education , and Welfare, 1957 Under the international epidemiology program of the Division, studies were completed on health conditions and facilities in Cam¬ bodia, Laos, South Vietnam, North Vietnam, and Afghanistan, mak¬ ing a total of seven studies made since the program began in 1956. Between 40 and 50 countries annually request assistance of the United States Government in the field of health, requiring consulta¬ tive assistance from about 500 American health technicians. Since long-term projects are now Avell established in many countries, the tendency was to request Division assistance to evaluate program accomplishments as guideposts for future expansion. This was es¬ pecially true of countries which are expanding limited demonstra¬ tions into nationwide control programs — such as India’s malaria control program and the tuberculosis control program of the Philippines. This Division is responsible for arranging programs for foreign health and medical personnel selected for training in the United States to fit them for specific positions of responsibility in their own national health services. Training programs were planned for 438 such persons from 44 countries. Also, the Division arranged tech¬ nical visits for 127 trainees from 62 countries at Public Health Serv¬ ice field stations and health and medical facilities in the Washing¬ ton area. At the request of the Philippine Government, the Division developed a new type of training program, wherein groups of health and medical workers were trained as a team to work together in the Philippine health department. The team approach was also used in the field of medical education when deans from six Philippine med¬ ical schools came to observe together medical education methods in the United States. Table 1. — Statement of appropriations, authorizations, obligations, and balances, fiscal year 1957 [In thousands] Funds available for obligation Appropriations Appro¬ priations and authori¬ zations Net transfers between appro¬ priations Repay¬ ments for services Prior year un¬ obligated balances Total funds available Amounts obligated Balances Total _ $534, 234 — $4, 045 $20, 932 $122, 644 $682, 516 $548, 566 $133, 950 Appropriations, PHS . . . _ 534, 165 -4, 045 20, 932 122, 518 673, 570 541,099 132, 471 Control of tuberculosis... 6, 660 6,660 6, 575 4,153 17, 599 6,094 1,189 9, 502 3,335 43, 162 85 Control of venereal diseases.... 4, 195 17, 591 5,750 1,170 9,000 3, 315 40, 195 4, 195 17, 763 6, 103 1,192 9, 701 42 Assistance to States, general _ Control of communicable dis¬ eases. _ _ . 172 164 353 9 Disease and sanitation investi¬ gations and control, Alaska. . Sanitary engineering activities. . Foreign quarantine service. _ 22 3 701 199 32 3, 347 43,624 12 Hospitals and medical care _ 3,429 U62 See footnotes at end of table. Public Health Service 151 Table 1. — Statement of appropriations , authorizations , obligations , and balances , fiscal year 1957 — Continued Funds available for obligation Total Appropriations Appro- Net Repay¬ Prior funds Amounts Balances priations transfers ments year un¬ available o bligated and between for obligated authori- appro- services balances zations priations Salaries and expenses, hospital $1, 381 38, 775 $1,381 $1,337 $44 241 $555 2 -$678 38, 652 38, 411 Construction of Indian health 8, 762 3,641 12, 403 877 * 11, 526 Grants for hospital construe- tinn ( 1 957-581 125, 000 125, 000 38, 899 4 86, 101 Grants for hospital construe- tion (1956-57) - _ 76, 551 76, 551 76, 253 298 Grants' for hospital construe- tion (1955-57) 2, 067 2, 067 2, 062 5 Grants for hospital construe- tion (1948-55) *-$1,064 1,064 -100 100 Surveys and planning for hos- 1,558 1,558 384 * 1, 174 Patients’ benefit fund, Public 24 20 44 24 3 20 Operating expenses, National 15, 321 12, 122 27, 443 27, 322 121 Salaries, expenses, and grants, National Cancer Institute _ . . — 48, 432 35, 197 43 48, 432 35, 240 42, 556 30, 317 5, 876 4, 923 Salaries, expenses, and grants, 33, 396 6, 026 33, 396 32, 392 5, 949 1,004 6, 026 77 Buildings and facilities, Cin¬ cinnati, Ohio . _ _ 105 105 74 3 31 Arthritis and metabolic dis¬ ease activities. . _ 15, 885 13, 299 237 16, 122 13, 348 16, 087 35 Microbiology activities _ . 49 13, 320 28 Neurology and blindness ac¬ tivities . _ 18, 650 18, 650 147 17, 361 147 1,289 Gorgas Memorial Laboratory. . Operations, National Library 147 of Medicine 1,004 1,004 988 16 Construction of library facil¬ ities 350 350 332 3 18 Grants for waste treatment works construction 50, 000 50, 000 37, 621 3 12, 379 Grants to States for poliomye¬ litis vaccination * -4, 000 33, 396 29, 396 28, 850 546 Construction of Biologies Stand¬ ards Laboratory Building. 3,500 3,500 157 *3, 343 Construction of surgical facil¬ ities 1,630 1,630 74 3 1, 556 Construction of Dental Re¬ search Building 200 200 71 3 129 Grants for construction of health research facilities _ 30, 000 30,000 30, 000 Construction of animal quar¬ ters 1,371 300 1,371 1,183 171 3 188 General office building 300 3 129 Construction of research facil¬ ities .. . _ _ _ _ 1,288 1,288 1,087 3 201 Retired pay of commissioned officers (annual) 1,450 1,450 1,384 6 Retired pay of commissioned officers (no year)... . . -6 6 Salaries and expenses _ 3,892 21 18 3,931 3,900 31 Appropriations, special project funds made avail¬ able by other agencies . 8,751 7, 415 1,336 Salaries and expenses, Bureau of Prisons (transfer to HEW, PHS) . 1,563 1,561 2 American Sections, Interna¬ tional Commissions, State (transfer to HEW, PHS) 76 75 1 Refugee Relief, Executive (transfer to HEW, PHS) _ 315 306 9 See footnotes at end of table. 152 Department of Health , Education , and Welfare, 1957 Table 1. — Statement of appropriations , authorizations, obligations, and balances , ^sca/ year J957 — Continued Funds available for obligation Appropriations Appro¬ priations and authori¬ zations Net transfers between appro¬ priations Repay¬ ments for services Prior year un¬ obligated balances Total funds available Amounts obligated Balances Operations, Federal Civil De¬ fense Administration (trans¬ fer to HEW, PHS) _ $187 15 $186 14 $1 3 1 38 38 3 1 Operating expenses, Atomic Energy Commission (transfer to HEW, PHS) _ Plant acquisition and construc¬ tion, Atomic Energy Com¬ mission (transfer to HEW, PHS). . _ 12 4 Research and development, Navy (transfer to HEW, PHS) _ 20 12 Research and development, Army (transfer to HEW, PHS). _ 6 5 Army, industrial fund (trans¬ fer to HEW, PHS) _ 13 13 Farm labor supply revolving fund, Bureau of Employment Security (transfer to HEW, PHS). _ 481 347 3 134 Technical Assistance to Amer¬ ican Republics and Non-Self- Governing Territories of the Western Hemisphere, Exec¬ utive (transfer to HEW) . .. —1 —1 Technical Assistance, U. S. Dollars Advanced from For¬ eign Governments, I. C. A. (transfer to HEW). _ . . 1 3 1 Administrative expenses, Sec¬ tion 411, Mutual Security Act, Executive (transfer to HEW) _ 83 81 2 Technical cooperation, general executive (transfer to HEW) (no year) 1,504 2,647 267 910 3 594 421 Technical cooperation, general executive (transfer to HEW) (annual) _ ... . _ 2, 226 163 Defense support, Asia, Execu¬ tive (transfer to HEW) _ 104 E ducational exchange fund pay¬ ments by Finland, World War I debt, Department of State (transfer to HEW). 2 2 Government and relief in occu¬ pied areas, Army (transfer to HEW) . 8 8 Salaries and expenses, civil de¬ fense functions of Federal agencies, Federal Civil De¬ fense Administration (trans¬ fer to HEW) _ 1, 552 1,503 49 Gift funds donated for general and specific purposes. $68.6 $126. 0 194.6 51.9 3 142.7 Public Health Service uncon¬ ditional gift fund _ _ _ 17.6 89.0 106. 6 1.3 3 105. 3 Public Health Service condi¬ tional gift fund 51.0 37.0 88.0 50.6 3 37.4 1 $1 available for obligation in subsequent years. 2 Liquidation of contract authorizations obligated in 1956 fiscal year. 2 Available for obligation in subsequent years. * $86,083 available for obligation in subsequent years, s Rescinded. Table 2. — Commissioned officers and civil service personnel as of June 30, 1957 Public Health Service 153 448006-58- 11 footnotes at end of table. Table 2. — Commissioned officers and civil service personnel as of June 30, 1957 — Continued 154 Department of Health, Education, and Welfare, 195 Part-time (civilian) Other 78 *^22 rH W O . kO 00 ^ ^ ^0*0* CD 05 r-H kO h-^NOION 05 Tf< CO h ^ o*^hcdoin 205 rJ c £ c a P C *5 c PC d *c c t a jj 1 3* a ;c National Institutes of Health.. _ _ Office of the Director.. - - - ... National Cancer Institute - - National Heart Institute - National Institute of Allergy and Infectious Dis¬ eases. _ - - .. - - National Institute of Arthritis and Metabolic National Institute of Dental Research - National Institute of Mental Health ... - ._ National Institute of Neurological Diseases and Blindness ... ... . ... _ _ Clinical Center.. . . ... ... Division of Biologies Standards - - - - Division of Business Operations. .. _ ... Division of Research Grants . . ... _ Division of Research Services . . ... _ ... Details to other agencies.. .... . . National Library of Medicine _ _ . 1 Includes 1,422 Regular Corps officers, 1,759 Active Reserve officers, and 175 Com- 2 Excludes those part-time employees not in pay status during the month of June missioned Reserve officers on temporary training duty. 1957. *Includes 2,292 collaborating epidemiologists and special agents. Table 3 .—Research grants and awards , fiscal year 1957 Public Health Service 155 N>CrH00C0NN00Oi»CO5rf( -T i-T O Tt< ■ © c ) »-H I © < co »o ^NCOCM CO *0 © 00 05 3228K8 CO CO CO CO CO CM «H »C SSI CMCOiOTf ( 05 ^ o ^ < CO CO ^ CO c cfoorCofi gfe I* CM ^ CM lO co ^ ^ CO 05 oo io CM CO ^ CO CO il .52 ^ So §C) BS O '-/ oa„® .2 "cS 2^-2 53 .SfiSSiai&ss^fg ◄ • rH C4 TfUO CO 05 N CO N *OX^OXn*OXOcO © 00 © O 04 © CO T* © o f^CO*OCO^H © 04 CO T}< r-H ^ 00 THXXNiHNNrHft W Nh©©hh 04 04 © *0 CO Water pollution control CO 00 CO ©XONiH04 0J©*ON CD»H0400*ONCO©^04 *C © © * 00 © © 00 CO CO CO f-H CO 04 CO 04 r-H CO CO f-H t*h t-h 04 CO CO 04 CO *C *C CO CO CO rH i h»Ch ©>0^0 04 i i Heart disease control $1, 988 Tf r-H 04 *C ^ 04 © 04 NOHC0HX^©ff*0 04 00 CO 04 © © © © 04 © 00 r-H 00 04 *0 *0 C0H 04 04rtrH^CD f-H 00 *C 04 CO CO ^ CO *0 04 *0 *C 04 *0 r-H CO *0 t-h 00 00 Cancer control $2, 235 CO CO ,-1 0 05 CO CC OM»N © Tfi U5 CO — < CO CO 00 CO CO © © 00 *0 00(Nh®CO’<1,(NNQOO NOMO-CMNNOH CO N to 05 CJ CO N IN -H O >0050 OJ 05 I-H f-H >— 1 co I-H General health $11, 962 OCON©CO©OrH»OcD C4NiOcO’H(NNcONTt< f-H *0 © © 04 t>» t“>- f— J 04 SJ ^ ^ 2£ i£ £3°°§2 Tubercu¬ losis control $4, 486 ,-H 05 i-l "SO-* I-H Venereal disease special projects 8 CO <&■ oo005 ! ! t" 05 ® 'CO ; JH i tj- JO C5 >C 05 ooiMTitrH tt co co ' ' too • i— * ; co j © >o r""' II III II II 1 II 11 1 II II 1 II II 1 II II 1 II II 1 II II ' CO © r-H *C 1 © © ^ 04 04 04 i*OH i i i ; «a ! S ■ H O- g 0 a s m g'So =3.2 c3SCoS2&trOta0 . . d , <2.2 <3 o3 .M C w O c8 — _ l!iiil5wga -s.ssiiigs'ssa il.2.2 §11111 lill 3^^o665afe SsalflaSSSS SSSaSgfcfcfcfc ttZo ooQ >*©.£3 Oklahoma. Public Health Service 157 ■ Office of Education Introduction Fiscal Year 1957 was one of healthy growth and activity in American education. Men and women in every phase of life — cultural, social, economic, and industrial — recognized the need for more education. Many demands were made on school officials at all levels. For ex¬ ample, progress in medicine, in dentistry, in industrial arts means changes in educational programs preparing doctors, dentists, and in¬ dustrial artists. Population growth and mobility, changing occupa¬ tional patterns, and technological advances mean changes in educa¬ tional patterns as well as increased facilities. As the spotlight focused on the schools, educators went to work to solve their problems. A few facts will indicate the size of these problems. Schools and colleges in the United States enrolled 41,366,000 stu¬ dents in the 1956-57 school year, an all time peak and an increase of 1,567,300 over enrollment in 1955-56 (see table 1). Public and non¬ public elementary schools — kindergarten through grade 8 — enrolled 29,711,000 children, an increase of 1,196,800 ; secondary schools — grades 9 through 12 — enrolled 7,820,000, an increase of 72,900; colleges and universities, 3,244,000, an increase of 248,000. In all other types of schools — private commercial, day and evening, nurse training schools not affiliated with colleges and universities — enrollment increased from 541,400 to 591,000. In the fall of 1956, 94 percent of all children in the 5- to 13-year-old age group were in school, and 88.2 percent of those in the 14- to 17- year-old group as compared to 80.1 percent 10 years ago. Of the total enrollment, 5,133,000 pupils were in private elementary and secondary schools, an increase of 5 percent over the preceding 159 160 Department of Health , Education, and Welfare, 1957 year. In recent years enrollment in private schools has increased more rapidly than in public schools. The classroom shortage in public elementary and secondary schools, which had been accumulating over a period of years, continued in 1957. In the school year 1956-57 public elementary and secondary school enrollment exceeded normal capacity by about 2.3 million children. Of this number about 840,000 pupils were on half-day schedules, and the others were in overcrowded classrooms or in makeshift facilities not designed for school work. The number in excess of normal capac¬ ity represents the number of pupils that cannot be accommodated without double sessions in the instruction rooms of the publicly owned school plant in use, according to State standards of normal capacity. Pupils were housed in 1,087,000 instructional rooms, which was 49,000 or 4.7 percent more than the number available in 1955-56. State departments of education reported that in 1956-57 an additional 159,000 instruction rooms were needed in the continental United States, 80,000 of them to accommodate the 2.3 million pupils in excess of normal capacity and 79,000 to replace those in unsatisfactory con¬ ditions. A total of 69,200 instruction rooms in public schools were scheduled for completion during the year. The shortage of qualified elementary and secondary teachers in public and nonpublic schools was a little less severe than it was a year ago — 120,700 as compared to 141,300 in 1955-56 (see table 2). Of the total 1.2 million teachers in the public school system in the fall of 1956, 89,400 or 1 in every 13 were emergency teachers — that is they did not meet the State’s standards for the lowest teaching certificate. State departments reported that full-time teachers holding emer¬ gency certificates constituted 7.5 percent of the total teaching staff in public elementary and secondary schools as compared with 6.8 per¬ cent the year before. The increase in the proportion of emergency teachers was caused in part by the adoption of higher certification requirements in some States. Turnover among teachers was high — about 7.5 percent of the quali¬ fied teachers. Turnover, as used here, included those who died and those who left the classroom because of death, retirement, marriage, or to work in another field. It does not include teachers who moved from one teaching job to another. The Office estimates that when public and nonpublic schools open in the fall of 1957, there will be a shortage of 135,000 qualified elemen¬ tary and high school teachers — 55,000 teachers will be needed to meet the enrollment increase; 12,600 to make up the difference between the 94,000 leaving the profession and the 81,400 new teachers who com¬ pleted their college training in 1956-57 ; and 67,400 to replace the Office of Education 161 emergency teachers employed last year (22,000 of last year’s 89,400 emergency teachers will have become qualified before school opens). In 1956-57 the shortage of qualified teachers was met by the employ¬ ment of emergency teachers and further overcrowding of classrooms. The National Education Association reports that in 1956-57 more than half of all teachers were women in elementary grades, and 40.1 percent of all teachers were in rural districts ; that in general the level of preparation was higher in urban districts than in rural, in secondary schools than in elementary, and among men than women. Only a few teachers were paid less than $2,000 a year or more than $7,000; the average was $4,220. The cost of education was high. For education in public elemen¬ tary and secondary schools, including capital outlay, the country spent about $12 billion. Expenditures per pupil in average daily attend¬ ance averaged $400 for the school year 1956-57. Office of Education reports indicate that about 56 percent of public school funds were provided from local property taxes; 40 percent from State taxes on incomes, sales, and other forms of business activity; and the other 4 percent from the Federal Government. The growth of education in the States and local communities led to increasing demands for leadership and to increasing requests for service and information from the Office of Education — information on such subjects as curriculum organization, efficient operation and administration, and on methods of expanding educational opportuni¬ ties at all levels and to persons of varying degrees of ability. With a 65 percent increase in funds and under recently enacted legislation, the Office of Education was able to expand its professional staff and services and to initiate new programs in cooperative research. These services and programs as well as the new programs of grants for li¬ brary service in rural areas and the extension of vocational education are discussed in more detail in the following pages. LEGISLATION Although the number of congressional enactments affecting educa¬ tion was small, the number and variety of bills introduced and considered during the year reflected national interest in education. Bills introduced included proposals for general scholarships and fellowships, veterans’ educational benefits, graduate and undergrad¬ uate traineeships in specialized fields, assistance for State studies of education beyond the high school, general aid for school construc¬ tion, aid for federally affected areas, vocational training in the fishing industry, and programs in the fine arts. A number of proposals for general Federal aid to the States for school construction were made. During the 84th and 85th Con- 162 Department of Health , Education , and Welfare, 1957 gresses the Administration’s legislative program included recom¬ mendations for the enactment of such legislation. A general school construction aid bill failed to pass the House of Representatives on July 15, 1956. The President, in his State of the Union Message on January 10, 1957, and in a special message to the Congress on the status of education, January 28, 1957, again requested the enactment of such legislation. A general school construction aid bill again was reported to the House in 1957 and debated, but failed to pass. Among the measures enacted by the Congress during fiscal year 1957, ten in the second session of the 84th Congress are of direct interest to education. They are briefly summarized below. Public Law 752, approved July 20, 1956, amends the Agricultural Act of 1949, as amended, by further extending the Special School Milk Program to nonprofit nursery schools, child-care centers, settlement houses, summer camps, and similar nonprofit institutions devoted to the care and training of children, whether or not such in¬ stitutions are caring for underprivileged children on a “public wel¬ fare or charitable basis.” Public Law 813, approved July 26, 1956, authorizes appropriations for allotments to the States to assist them in providing for a com¬ mittee for education beyond the high school and authorizes appropri¬ ations for the expenses of the President’s Committee on Education Beyond the High School. Public Law 880 (Social Security Amendments of 1956), approved August 1, 1956, amends the Social Security Act in three ways which concern education. Title II, Section 218 (a) (6), is amended so that employees of State and local governments who desire to come under Old-Age and Survivors Insurance (OASI) may be considered as a separate group for purposes of coverage — at the option of the State and provided that all new employees do come under OASI. The amendment affects Florida, Georgia, New York, North Dakota, Pennsylvania, Tennessee, Wisconsin, and the Territory of Hawaii. Title II, Section 218 (d) (6), is further amended to permit affected States (Nevada, New Mexico, Oklahoma, Pennsylvania, Texas, Wash¬ ington, and the Territory of Hawaii) to cover under OASI nonpro¬ fessional school employees who are under a teachers’ retirement sys¬ tem, and permits them to do so without a referendum and without covering the professional employees who are in a system. Title III, Section 406 (a) , is amended by removing the requirement that, in order to receive aid, a needy child between the ages of 16 and 18 be in attend¬ ance in a school. Public Law 881 (Servicemen’s and Veterans’ Survivor Benefits Act), approved August 1, 1956, provides, among other things, for a continuing — until age 21 — dependence and indemnity compensation Office of Education 163 for an orphan child who reaches age 18 and is pursuing a course of instruction in an approved educational institution. The bill also provides that, when there is a widow with a child who has attained age 18, when social security survivor benefits are terminated, the child shall be provided with a supplemental veterans administration benefit of $35 per month while pursuing a course of instruction in an ap¬ proved educational institution. Public Law 896, approved August 1, 1956, extends to the Territory of Guam benefits provided under other Federal statutes, including assistance to vocational education, to schools in federally affected areas, and for library services. Public Law 911, approved August 2, 1956, amends the Vocational Education Act of 1946 to authorize grants not to exceed $5 million for the fiscal year ending June 30, 1957, and for each of the next 4 fiscal years to States with State plans for extending and improving practical nurse training. Public Law 922, approved August 2, 1956, amends the act to pro¬ mote the education of the blind (Act of March 3, 1879, as amended), so as to authorize wider distribution of instructional materials and to increase the amount authorized to be appropriated for this purpose from $250,000 to $400,000. Public Law 949, approved August 3, 1956, extends until June 30, 1958, the programs under Public Laws 815 and 874 of the 81st Con¬ gress, as amended, which provide for Federal financial assistance in constructing and operating schools in areas affected by Federal ac¬ tivities ; and makes certain technical changes in the provisions of these laws. Public Law 1020, approved August 7, 1956, amends and extends the National Housing Act, increasing the amount of college housing loans authorized to be outstanding at any one time, from $500 million to $750 million. Public Law 1027, approved August 8, 1956, amends the Vocational Education Act by authorizing the appropriation of $375,000 for vocational education in the fishery trades and industry, and distrib¬ utive occupations therein, to be administered by the United States Commissioner of Education in consultation with the Secretary of the Interior. The Secretary of the Interior is authorized to make grants to public and nonprofit private universities and colleges to promote the education and training of professionally trained persons needed in commercial fishing, and an appropriation not to exceed $550,000 for each fiscal year is authorized for this purpose. During the year the Office of Education continued to develop its services in the collection and interchange of information in the field of school law. A principal objective is to develop and maintain a 164 Department of Health , Education , and Welfare, 1957 clearinghouse of information on the status of, and trends in, school law developments in the States and to service the requests of State and local school officials and organized groups on such developments. Two basic reports on the provisions of State school law governing special education of exceptional children and early elementary edu¬ cation were compiled and published. General information on State and Federal educational legislation was also collected and made avail¬ able to the public. Organization and Administration of Education STATE SCHOOL ADMINISTRATION Through the development and distribution of information on var¬ ious aspects of State school administration and through consultive services to State departments of education, legislative committees, special committees, and other agencies, the Office of Education con¬ tinued to assist States in their efforts to achieve more effective pro¬ grams of State school administration. During the year, the Office published as a handbook the results of the financial accounting study completed in fiscal 1956. Entitled, Financial Accownting for Local and State School Systems , the hand¬ book was officially approved by leading national educational associa¬ tions who cooperated in its development as the basic guide for financial accounting for local and State school systems throughout the country. By the end of the fiscal year a number of States had already started to incorporate the handbook’s recommendations into their accounting systems. This handbook is the second in a basic educational records and reports series aimed at laying the ground¬ work for comparable educational information among States and communities. With such groundwork established, it will be possible to have available adequate and reliable educational information for local, State, and national spheres of activity. The year saw the substantial beginning of a project on property accounting for local and State school systems. Aimed at standard¬ izing the meanings of basic items of information and terminology relating to school lands, buildings, and equipment, the project is being conducted in cooperation with the American Association of School Administrators, the Association of School Business Officials of the United States and Canada, the Council of Chief State School Officers, the National Council on Schoolhouse Construction, and the National School Boards Association. Hundreds of representatives of the coop¬ erating associations from all parts of the country will participate, through national and regional conferences, in the production of the third handbook in the series. In this way, the handbook will reflect the needs and wishes of a broad representative sample of its prospec- Office of Education 165 tive users with respect to the kinds and the meanings of basic infor¬ mation about school property that should be available. LOCAL SCHOOL ADMINISTRATION Efforts to secure more soundly organized local school districts con¬ tinued with marked success in some States but with many others either attempting to launch new districting programs or to improve the effectiveness of those already in operation. To assist the States with this widespread problem, the Office of Education completed a study dealing with the conditions which facilitate and those which hinder progress. To help local communities engaged in redistricting activities, Office specialists developed a manual of planning pro¬ cedures which is scheduled for publication in fiscal year 1958. Another problem directly related to sound district organization is that of determining the nature and scope of services beyond regu¬ lar classroom instruction and activities a school system can provide at reasonable cost. These are the administrative, supervisory, and other systemwide services needed to provide good conditions for teaching and learning in the classroom and for overall efficiency of the school system. In fiscal year 1957 a special Office project was initiated dealing with this problem. During the year the Office cooperated with State and national organizations engaged in serving local boards of education and com¬ pleted a study of State statutory provisions governing membership on local school boards. SCHOOL FINANCE The Office continued its services to States and local communities which have problems in supporting schools. Throughout the Na¬ tion there was continued difficulty in securing reasonably adequate tax revenues for schools. During the past year the financing prob¬ lems were intensified by increases in enrollments, public demands for additional services, and rising costs which required greater ex¬ penditures. To aid the schools in solving such problems the Office published studies reporting and interpreting information on status, trends, and developments in school finance and school business management. The Office also gave consideration to the requirements of State legislatures and State departments of education in developing im¬ proved plans for financing the schools. Among such new plans are those which propose (1) enactments of foundation programs for supporting schools, (2) allocations of State funds for public 2-year colleges, (3) authorizations of local nonproperty taxes as additional sources of school revenue, (4) appropriations of State funds to help 166 Department of Health , Education , and Welfare , 1957 local school districts construct additional classrooms, and (5) the easing of restrictions on the creation of debt to permit local districts to borrow funds for the construction of new school buildings. SCHOOLHOUSING Since 1950 the schoolhousing program has become big business. During the first 7 years of the decade a total of $13% billion was spent to provide schoolhousing for an enrollment increase of 7% million public elementary and secondary students, for rehousing those who moved to new localities, and for replacement of some old build¬ ings. This total expenditure represented an average capital outlay investment of approximately $36,000 per classroom with related fa¬ cilities. The number of children born each year continued to in¬ crease; building deterioration, pupil mobility, and other factors helped create new housing demands. The recent nationwide school facilities survey gave impetus to the drive for adequate schoolhousing and provided the States with preliminary data for long-range school- plant programs. In 1957 the Office of Education provided leadership and encour¬ agement to help expand and improve State department of education services and guidance for local school-plant programs. Various State departments established new or expanded existing school- plant service units. Some States increased State financial assistance for local school-plant construction. Office specialists in school hous¬ ing participated in numerous State or regional conferences or work¬ shops organized to provide data on the development and maintenance of efficient and economical school-plant programs. Providing adequate schoolhousing for modern educational pro¬ grams requires careful functional planning and designing with specific attention to space and facility arrangements best adapted to the program to be offered. The schoolhousing specialists cooperated with various national organizations in developing planning criteria and assisted State department of education and local school officials through publications, conferences, and advice in developing tech¬ niques and procedures for studying program needs and for develop¬ ing plant layouts best adapted to facilitate the educational program. They also assisted in establishing criteria and procedures for local cooperative planning. Substantial progress was made in developing essential criteria to be used in manufacturing and selecting the school furniture and equipment needed in carrying out effective educational programs. Data on pupil body measurements were being used extensively as guides for architectural and other designers of buildings and particu¬ larly for designers of school furniture and equipment. The present Office of Education 167 trend in planning school buildings is to develop school facility ar¬ rangements, furniture, and equipment which are adapted to the ages and sizes of pupils using them and to the learning activities of the pu¬ pils. Such features as working heights and spacing, the needs of left-handed pupils, and the dimensional spacing and heights desirable for certain types of physically handicapped children are all con¬ sidered. Designers and manufacturers are making extensive use of such data, and during the year they requested the advice and services of the Office in applying them to new design problems. The completed school plant must be maintained ready for use. The Office provided guidance to the States and local districts in developing maintenance, modernization, rehabilitation, and custodial improvement programs. A 1956 school-plant insurance study stim¬ ulated several State, many local district, and some college graduate student studies on school building insurance. Many State and city school officials established custodial training programs along lines suggested by the Office to improve school custodial services. Schoolhousing specialists serve in a liaison capacity between the field of building and equipment technology and school officials. The Office is constantly engaged in various studies in cooperation with technological organizations having a bearing on school-plant con¬ struction and efficiency. One study under way is to establish newT standards for school lighting to replace those developed in 1948; and another to establish a standard pattern for measuring of floor areas in school buildings. These measurements are to serve as bases for computing and comparing school building space allotments and unit costs. Services to Local Schools ELEMENTARY EDUCATION In recent years the States have intensified their efforts to provide adequately for the education of young children in the public schools. They have expanded services, widened age ranges, increased their re¬ quirements for teacher certification, and made an effort to extend edu¬ cational opportunity to all groups at varying levels of ability. Greater activity at the State and local level has led to greater need for Office of Education information and services. The activities de¬ scribed below will give an indication of the type of services the Office rendered to elementary education in 1957. During the year specialists in elementary education completed a number of studies: 1) On improved methods of reporting to parents on pupils’ progress; 2) on teacher recruitment and retention, show¬ ing what State groups have done in the recruitment and selection of teachers and wdiat some schools have done to promote teacher profes- 168 Department of Health , Education , and Welfare , 1957 sional development; 3) on conservation practices in elementary schools; and 4) on the status of physical education in elementary schools in the United States. The Office continued its efforts to improve educational opportuni¬ ties for children of migrant agricultural workers. Through repre¬ sentation on the Working Group of the President’s Committee on Migratory Labor, the Office cooperated with other agencies and De¬ partments in studying the relation of education to the problems of transportation, housing, and health — problems which the Committee dealt with during the year. The Office initiated a study to make a census of migrant children attending school; it will be completed in 1958. The Office also organized and participated in two regional con¬ ferences on the education of migrant children, one in Kalamazoo, Mich., for the North Central States, the other in Santa Fe, N. Mex., for the Southwest States. Throughout the year staff specialists con¬ sulted with private and public agencies working on migrant education projects, such as the planning of summer schools for migrant chil¬ dren, teacher education workshops for teachers of migrant children, and preparation of printed materials on the education of migrant children. Significant proposals for elementary education resulted from two conferences held in the Office of Education. About 60 persons from 50 large cities attended a conference for supervisors of elementary education in large cities. One proposal was that children and par¬ ents be invited to participate along with professional educators in developing good programs of instruction and that schools should help children become selective in what they learn through greater emphasis on critical and creative thinking and problem solving. A second conference was concerned with the role of special teachers of art, music, and physical education in the elementary school. Spe¬ cialists in these fields and in general elementary education attended. SECONDARY EDUCATION In general, the school year 1956-57 reflected increased emphasis by educators and citizens on improving the quality of curriculum content and instruction in secondary schools and at the same time on devising methods of school organization and teaching appropriate to the indi¬ vidual differences of adolescent youth. Specialists for mathematics and science continued to devote atten¬ tion to the completion of basic studies of the quantitative and qualita¬ tive status of mathematics and science instruction. A pilot study of the qualifications and teaching loads of mathematics and science teachers was conducted in three States. The study pattern developed was adopted by other States working to improve their programs. Office of Education 169 The 1954 study of mathematics and science offerings and enroll¬ ments was repeated, and analytical comparisons were made. Results show continued increase in the availability of courses in high school and increase in enrollments. Staff specialists, in cooperation with those of other Government agencies, reviewed studies of the growing national need for foreign language competence in Government, business, industry, and educa¬ tion. A conference attended by school administrators, supervisors, teachers, and teacher-educators was held which identified problems and the need for modernizing and extending foreign language in¬ struction to more pupils for longer sequences of time. A study of research findings, administrative and organization pat¬ terns, and instructional materials for developmental and remedial reading programs in junior high schools was completed. Another study was released which analyzed the various types of cooperative school-community work experience education programs in secondary schools. Suggestions useful to school administrators in initiating and conducting such programs were made. ADULT EDUCATION During the year the Office of Education, through one of its staff members, worked with the Adult Education Association in estab¬ lishing the National Commission on Literacy. The Commission will help develop a national awareness of the problem of adult illiteracy and the importance and urgency of solving the problem. It will also give leadership in attacking the problem. With the National Education Association the Office developed a cooperative program making the consideration of adult education a part of American Education Week. Heretofore, emphasis during this annual national observance has been on the education of chil¬ dren and youth. From now on educational leaders plan to em¬ phasize lifelong learning as one of the major areas of American education as a means of making adult education an integral part of the regular educational programs. Another phase of the Office of Education’s effort to promote na¬ tional concern for adult education was the development of an adult education exhibit for the use of teachers, lay leaders of community groups, and others interested in adult education. Underlying all the Office’s plans and activities in adult education are its regular and basic studies in the various areas of adult edu¬ cation. During the year, work was begun on the collection and in¬ terpretation of adult education statistics; on studies of activities in State departments of education and local school systems relating to adult education ; and on education for the aging. 448006—58 - 12 170 Department of Health , Education , and W'elfare , 1957 For the first time questions on the extent to which people partici¬ pate in adult education activities will be asked in the current popula¬ tion survey of the Bureau of the Census. This survey, planned for October, will cover a sample of 35,000 households in 330 subdivisions of the country and will yield a national estimate of the number of adults who have pursued some educational activity during the past year. Office specialists in adult education, in cooperation with the adult Education Association and the Fund for Adult Education, made the arrangements with the Census and obtained the cooperation of several voluntary agencies in planning the questions and the pre¬ liminary instructions for Census enumerators. It is hoped that the experience from the inclusion of these questions in the October Pop¬ ulation Survey will be sufficiently satisfactory to warrant the in¬ clusion of similar questions in the 1960 Census. EXCEPTIONAL CHILDREN Children whose physical, mental, or emotional qualities differ sig¬ nificantly from the average or normal are called exceptional children. Public interest in the education of exceptional children in the United States continued to mount in 1957. It was focused primarily on children with mental retardation, speech and hearing impairment, and blindness. This interest was evident at Federal, State, and local levels. In recent years there have been many developments in the education of the mentally retarded. One of national significance is the pro¬ gram of cooperative research in this field which was launched by the Office of Education during the year (See Cooperative research) . For the first year in a new program, the variety and coverage of areas for study was extensive. Research projects initiated included studies on trainable and educable children, age groups ranging from pre¬ school to adolescence, day-school and residential-school programs, and urban and rural population. National interest in developing and improving standards for su¬ pervisors and teachers to work with the various types of exceptional children also continued. One of the deterrents to the development of educational programs for handicapped or gifted children has been the shortage of specially prepared and trained teachers for them. For a number of years the Office has given leadership to a nationwide study on this problem, and during fiscal 1957 completed three of the study reports: one on the preparation of teachers of mentally retarded, one on teachers of socially maladjusted children, and the third on speech correctionists. Plans for the education of blind children in this country seem to be changing somewhat. On the basis of preliminary figures col¬ lected by the American Printing House for the Blind, an increased Office of Education 171 number of blind children were being educated in day schools in 1957. The ratio of enrollments in residential schools to day schools was about 6 to 4. Together with this shift in philosophy and practice, some changes were made in the Federal act to promote the education of the blind (Public Law 922, 84th Cong., 2d sess.) . AUDIOVISUAL EDUCATION The Office continued to provide services relating to the audiovisual materials of the Federal Government, including cataloging new films for Library of Congress catalog cards, administering the Govern¬ ment’s contract covering the sale of films, and preparing a supple¬ ment to the 1955 catalog, “United States Government Films for Public Educational Use.” Work was started on the compilation of a catalog of Government maps available for educational use. As part of its program to strengthen State and local educational resources, the Office prepared directories of audiovisual employees in the Federal Government, State departments of education, and large city school systems; and made a study of audiovisual education in State departments of education. This study showed that the States, while differing in individual practices, were providing a number of services affecting the classroom use of audiovisual instructional ma¬ terials — through curriculum development, school accreditation, teacher certification, publications, and workshops as well as through the production and distribution of audiovisual materials. RADIO-TELEVISION SERVICES The nationwide development of radio and television in education was indicated by the increase in the number of program offerings on commercial and noncommercial stations cooperating with educa¬ tional institutions, in the large number of courses for credit offered over television, and in the number of stations. Program offerings over noncommercial TV stations increased to a general average of 56 hours a week, and commercial stations made sharp increases in in¬ stitutional cultural programs. The number of courses for credit in¬ creased, particularly where experimental use on a noncredit basis justified the offering. The number of educational radio stations in¬ creased from 176 in 1956 to 193 in 1957, and educational television stations from 26 in 1956 to 29 on the air in 1957 and 11 in the con¬ struction or planning stages. Closed-circuit television in schools and on college campuses also showed the results of successful experimentation over the past year. Large cities, such as Los Angeles, Atlanta, Chicago, and New York, maintained closed-circuit as well as open-circuit broadcasting. Smaller cities like Evanston, Ill., Hagerstown, Md., Wichita, Kans., 172 Department of Health , Education , and Welfare , 1957 and San Jose, Calif., carried on teaching experiments demonstrating the educational possibilities of television. During the year the Office cooperated with educational institutions and with the Department of Defense, Department of State, the Treasury Department, Department of Commerce, the United States Information Agency, the National Science Foundation, and other Government agencies in planning and producing programs. Staff specialists advised on educational projects in many parts of the United States, under various State auspices, the Commonwealth of Puerto Rico, and a number of foreign countries just starting television. GUIDANCE AND STUDENT PERSONNEL During the year the Office prepared and distributed pamphlets, circulars, and leaflets on various occupations for the use of school guidance and student personnel workers. Major publications dealt with such areas as certification requirements for guidance workers including school psychologists, summer and academic year offerings at colleges and universities in the preparation of guidance and student personnel workers, and retention in high schools in large cities. Staff members continued research in evaluation of guidance and student personnel services, characteristics of students and educational pro¬ grams in schools having low student dropout rates, guidance practices in 260 local schools, and guidance procedures for the selection of students in vocational education. The Office also carried on a number of activities in cooperation with other agencies and groups, both private and governmental. In one of these — the Stay-in-School Campaign — the Office cooperated with the Departments of Labor and Defense in preparing and dis¬ tributing press and radio releases and a handbook for the use of communities in urging high school youth to stay in school. A study on the transition from school to work prepared to aid schools, civic clubs, PTA’s, and employers in assisting youth as they move from education to employment was the outgrowth of discussions with a subcommittee of the Inter-Departmental Committee on Children and Youth. A study of the retention of students in high schools grew out of a 6-year planning and research program involving 22 large city school systems. A study of careers in atomic energy was made, with technical assistance from the Atomic Energy Commission. Staff specialists also cooperated with other governmental and pro¬ fessional groups concerned with guidance and personnel. Vocational Education One of the functions of the Office of Education is to administer the grant-in-aid funds for vocational education of less than college grade made available under provisions of the Smith-Hughes and Office of Education 173 George-Barden and supplementary acts and to assist States in the promotion and improvement of such education. To carry out the provisions of these acts the Congress appropriated slightly more than $38 million in matching funds for allotment by the Office to the States in 1957, an increase of about $5 million over the 1956 total. In 1956 State and local expenditures for vocational edu¬ cation amounted to $142,705,208. That year more than 65 percent of the high schools in the country olfered training in one or more of the vocational programs — agriculture, distributive occupations, home economics, trade and industry, practical nurse education — and ap¬ proximately 3,500,000 youths and adults were enrolled. The Federal grant included $2 million for the extension and im¬ provement of practical nurse training, under legislation enacted by the 84th Congress (Public Law 911), amending the George-Barden Act. The action of the Congress in providing special funds for prac¬ tical nurse training stimulated the States to extend such training. By the close of the year 47 States and Territories were participating in the program. The Office assisted the States through intraregional conferences in working out program plans for the growth and de¬ velopment of practical nurse training. Five such conferences were conducted during the year by three professional nurse-educators who had joined the staff to assist with the program. Policies for the administration of the practical nurse training pro¬ gram under the provisions of Public Law 911 covering the most im¬ portant points were developed and distributed to the States early in the year. By the end of the fiscal year a full statement of policies for the administration of the program for training practical nurses had been completed. The 84th Congress also enacted legislation (Public Law 896) en¬ titling Guam to participate in the vocational education program. Other legislation (Public Law 1027) was designed to promote voca¬ tional education in the fishery trades and industry and distributive occupations therein. No funds were appropriated for the fiscal year 1957 under either of these acts. The changing economic and social conditions affecting farming, industry, distribution, and family living emphasize the importance of continual appraisal of vocational programs and adjustments to them to meet the needs of workers, as well as the demand for workers. States report that training is needed for many new in¬ dustries and for old industries employing new production methods. New and higher skills are needed by workers to meet the job require¬ ments of the present and the future. To help the States improve their program, the Office conducted 17 regional conferences for State personnel in vocational education. Special emphasis was given to 174 Department of Health , Education , and Welfare, 1957 adapting instruction to changing conditions, keeping abreast of tech¬ nical improvements, meeting the need for preservice and in-service training of teachers and supervisors, providing new areas of training, and developing leadership in vocational education, adult education, and action research. In carrying out studies and plans for improving the program in specific areas, the Office brought together groups of persons with ex¬ perience in successful programs or with experience in the areas under consideration. Representative of these were : (1) A conference on various phases of the practical nurse train¬ ing program in which 20 persons participated to advise the staff on significant steps in the preparation of plans for programs of practical nursing; to develop criteria for evaluating progress; and to identify studies needed. (2) A group of 17 home economists who reexamined the program of home economics for adults, considered the development and im¬ provement of these programs, and assisted in preparing basic con¬ tent materials for a much needed bulletin in this field. (3) A conference on implications for trade and industrial educa¬ tion of technological change in industry, in which vocational edu¬ cators from 16 States participated. Special contributions were made by representatives from industry, Government, and other groups concerned with the training of technicians. To assist the States in developing various phases of the program for which there was an expressed need, the Office rendered service in the following ways: 1) Conducted a second national conference for the development of leadership in trade and industrial educa¬ tion for new and potential State supervisors, with 59 industrial edu¬ cators from 38 States participating. 2) Organized and conducted, in cooperation with representatives of the textile industry, a series of textile fiber clinics to bring to State and local leaders in distributive education information on recent de¬ velopments and on sources of teaching materials. 3) Held the first regional conference on farm mechanics for teach¬ ers of vocational agriculture, with 11 States participating, to develop functional programs in farm mechanics instruction in keeping with modern mechanized agriculture. 4) Conducted workshops on farm mechanics in a number of States for State staffs in agricultural education. 5) Cosponsored, with a university which offers teacher training in home economics, the first of a series of workshops on improvement in home economics teaching — emphasizing social, economic, and scientific developments as they affect home and family life. Several projects were undertaken during the year. They included a preliminary investigation into the study and research needed in Office of Education 175 vocational education in secondary schools ; a study of the importance of business education as a field of training and as a potential source of workers; the development of curriculum materials for quantity food preparation in hotels and restaurants; and management train¬ ing needs of small business establishments and the contribution that distributive education in secondary schools can make to such training. The Office reviewed programs in the several States and assisted the States in appraising their administrative practices and at the same time program specialists assisted the States in further developing their programs. Office specialists participated in teacher-training workshops and in meetings of State supervisory and teacher-training staffs on the improvement of instruction; assisted in State-conducted studies of vocational education; served on committees concerned with curricu¬ lum improvement; worked with State staffs and teacher-training institutions on research projects; helped in the preparation of resource materials for use in universities and local school systems; and participated in many of the annual State conventions of voca¬ tional educators. The revision of the Statement of Policies for the Administration of Vocational Education (Bulletin No. 1), begun in fiscal year 1956, neared completion by the close of the fiscal year. In this task there has been wide participation by State directors of vocational educa¬ tion, with the final work to be done by a special committee composed of chief State school officers and State directors, working with mem¬ bers of the staff of the Office of Education and the Office of the General Counsel. Higher Education The following projects are representative of Office research and consultive services to higher education during fiscal year 1957. COST OF GOING TO COLLEGE During the year, the Office completed a study (reported in Bulletin 1957, No. 9, 91 p.) of what a year in college costs undergraduate students and the major source of student budgets. Based on the experience of 15,325 students in 110 colleges in 41 States during the school year 1956-57, the study reports that the estimated cost of attending undergraduate college per school year averaged $1,500 for publicly controlled colleges and $2,000 for private and related institutions. These costs were double those undergraduate students paid in 1940. The family of the average student provided from its current income 41 percent of the student’s budget; he earned 26 percent of it; received 20 percent from trust funds and other forms of long-time 176 Department of Health , Education , and Welfare, 1957 family savings ; and received the remaining 13 percent from scholar¬ ships, loan funds, veterans’ benefits, and miscellaneous resources. STATEWIDE PLANNING AND COORDINATION OF HIGHER EDUCATION The Office published a roundup on what each of the 48 States is doing in the field of statewide planning and coordination of higher education. The Office provided consultive services on the topic to State executive and legislative councils and to boards of regents in 8 States : Colorado, Florida, Louisiana, Michigan, New Mexico, Nevada, Tennessee, and Wisconsin. Staff specialists also contributed to improved State planning and coordination in higher education through work with the President’s Committee on Education Beyond the High School, and through service to the Southern, Western, and New England regional compacts of States for developing higher education. COLLEGE STUDENT RETENTION AND WITHDRAWAL During the year, the Office completed a 4-year study of the extent and causes of the retention and withdrawal of college students. It was based on the experience of 13,700 students who first enrolled in college in the fall of 1950. The students attended 147 representative institutions in 46 States and the District of Columbia. The study shows that 40 percent of the freshmen who entered college in 1950 remained to graduate 4 years later and that an additional 20 percent were ultimately graduated. The holding power of colleges indicated by these figures represents a significant improvement over those shown by a study done in 1937. Among freshmen general dissatisfaction with the instructional and counseling program ranked highest among causes for withdrawal. Academic failure ranked second. For sophomores, juniors, and seniors, personal financial problems ranked highest. The greatest number of dropouts were in the freshman year. COLLEGE AND UNIVERSITY FACILITIES SURVEY Preliminary reports from a college and university facilities survey now underway indicate that during the last 5 years the country has spent $2 billion for new buildings and expects to spend $4 billion for this purpose during the next 5 years. Approximately 62 percent of new construction in the last 5 years was for publicly supported institutions and 38 percent for private colleges and universities. Publicly controlled institutions got 56 percent of their construction funds from local, State, and Federal taxes; 31 percent from bond issues; and 13 percent from other sources. During the same period, privately supported institutions got 56 percent of their construction funds from gifts, 20 percent from bond issues and other borrowings, Office of Education 177 10 percent from current institutional funds, 8 percent from endow¬ ment, 4.5 percent from governmental appropriations, and 1.5 percent from other sources. SURVEY OF ORGANIZED OCCUPATIONAL CURRICULUMS The Office of Education, in cooperation with the American Society for Engineering Education, has published detailed statistics on engi¬ neering enrollments and degrees since 1949. In 1957, following a re¬ quest from the President’s Committee on Scientists and Engineers, the joint enterprise was extended to cover organized occupational curriculums (both engineering and nonengineering) of less than 4 years’ duration in technical institutes, junior colleges, and other higher educational institutes. Questionnaires covering curriculums of less than 4 years’ duration for the academic year 1956-57 were sent to all recognized institutions of higher education. Returns from 95 percent of them show that 639 institutions enrolled 92,430 students in nonengineering curriculums, and 60,242 in engineering-related curriculums; and graduated 23,441 students from nonengineering curriculums and 10,737 from engineer¬ ing-related curriculums. Publication of complete data early in fiscal year 1958 will make available for the first time information on the extent and type of training at the technician and semiprofessional level. COLLEGE STAFFING STUDY There were 301,582 faculty members in American colleges and uni¬ versities in the fall of 1955. According to Office of Education esti¬ mates, college student enrollments will increase from 3,244,000 in 1956-57 to 6,676,000 by 1970-71. Thus, about double the number of present college teachers will be required if the present teacher-student ratio is to be maintained. The already difficult staffing problems are expected to become more serious. In consideration of these facts the Office, in May 1957, sponsored a conference of representative leaders in higher education to advise on (1) how colleges and universities are now meeting the teacher short¬ age, and (2) the ability of the American graduate school to prepare a sufficient number of suitably qualified college faculty members to meet the demand. Initial steps were taken in fiscal 1957 on an Office study of these problems. INSTITUTIONAL FINANCIAL AID TO STUDENTS Specialists in higher education completed a nationwide survey of institutional financial assistance — excluding student aid grants of the States, corporations and other business firms, labor unions, and other organizations — to undergraduate and graduate students. Although 178 Department of Healthy Education , and Welfare, 1957 1,560 colleges and universities reported some type of student aid, 190 others reported that they had no form of financial aid for their stu¬ dents. Preliminary data showed that in the school year 1955-56 in¬ stitutional aid to undergraduates totaled $141,985,153, of which 45.9 percent was for employment, 45.2 percent was for scholarships, and 8.9 percent was for loans. Institutional financial aid for graduate students totaled $64,928,950, of which 54.0 percent was for assistant- ships, 28.3 percent for fellowships, 10.0 percent for employment, and 7.7 percent for loans. As a byproduct of its student aid study, the Office completed two directories listing the institutional student aid resources separately for undergraduate and graduate students. These directories will be published early in fiscal year 1958. The Office plans to distribute copies of the directories to all secondary schools and to all institutions of higher education in the United States. COLLEGE HOUSING PROGRAM During fiscal 1957, the staff of the Office was requested by the Com¬ munity Facilities Administration to review and report on the second largest number of loan applications for college housing since the in¬ ception of the program. These applications totaled 315, three-fourths of which were from private colleges and 67 percent from institutions with enrollments under 1,000 students. The total amount requested in 1957 by the 315 applicants was $403,991,000, as contrasted with $413,250,000 requested by 386 applicants in fiscal 1956. Amendments to the Housing Act, enacted by the 85th Congress, 1st Session, will increase the college loan fund from $750 million to $925 million. The interest rate, now at 2.78 percent, will be about 3 percent for fiscal 1958. ADMINISTRATION OF GRANTS For the year ending June 30, 1956, the Office administered a total of $5,051,500 to land-grant colleges and universities under the Morrill- Nelson and Bankhead-Jones Acts. Office responsibility in this pro¬ gram is to certify that each State and Territory is entitled to receive its share of the annual appropriation and the amount it is entitled to receive. The amounts allotted to the States, Territories, and the Commonwealth of Puerto Rico are shown in table 3. International Education Throughout 1957 the Office continued to shape its program to meet the growing interest in international education. As the public be¬ comes increasingly aware of the importance of education to mutual Office of Education 179 understanding of the cultures of the world and thus to world peace, there are increasing demands on the Office. In 1957 the Office re¬ ceived many requests for service from Federal, national, and inter¬ national agencies and from American and foreign educators. RESEARCH AND STUDIES President Eisenhower, in a commencement address at Baylor Uni¬ versity, Waco, Texas, in 1956, proposed that colleges and universities in the United States cooperate in the development of higher educa¬ tion in countries with inadequate educational facilities. Since that time several appraisals have been made of the status of American higher education abroad ; among them was the Office study, American Cooperation With Higher Education Abroad , published in 1957. It is a summary of governmental and nongovernmental programs. In addition to its regular studies of comparative and international education, the Office introduced two new series of publications in 1957 : A series of yearbooks on education around the world, and a series of bibliographies. The first yearbook was released under the title Education for Better Living : The Role of the School in Com¬ munity Improvement. It is a survey of what schools are doing in 16 nations and colonial areas to improve community living condi¬ tions. The first of the annual series of bibliographies, Bibliography : 1956 Publications in Comparative and International Education , was issued as an aid to American professors and leaders in comparative and international education in the United States and abroad. In 1957 work was begun on three studies which will be published in 1958: (1) Educational developments in Japan since the war, based on a field study by a specialist in Far Eastern education, (2) the edu¬ cational organizations, institutions, and programs in Brazil, based on a field study by a specialist in Latin American education, and (3) the functions and organizations of ministries of education, to be pub¬ lished as the second yearbook on education around the world. Offi¬ cials of other United States Government agencies, particularly those with overseas posts, cooperated with Office specialists in planning the study of ministries of education and in securing data for it. FAR EAST UNIT A Far East unit was established in the Office in 1957 to handle the increasing workload relating to education in Asian countries. The unit was organized after staff specialists had conferred with representatives of the Government and educators outside the Office on the direction educational research on the Far East should take to serve the needs of the Government and the profession. 180 Department of Health , Education, and Welfare, 1957 EVALUATION OF FOREIGN CREDENTIALS The number of foreign nationals studying in the United States has risen steadily since World War II, to at least 40,000 in 1957. The increase in foreign students studying in the United States and of United States students studying abroad adds to the work of the staff members who evaluate foreign study for the use of educational insti¬ tutions, State certification offices, boards of licensure, civil service commissions, and personnel offices in making decisions on the equiva¬ lence of specific foreign study to study in the United States. In 1957, two trends were evident in requests for evaluation: A higher proportion of the requests were from governmental boards of licensure, probably reflecting a larger number of mature persons coming here with the intention of practicing a profession; and a larger number of requests were for information about the status of foreign universities from government agencies with responsibility for United States citizens studying in higher institutions overseas. EDUCATIONAL CLEARINGHOUSE The Office provided the Department of State with 183 statistical tabulations on government-sponsored grantees entering and leaving this country during the year, a service it has given annually since 1952. The statistical studies include such information as numbers and types of grantees by country of destination or origin, State of origin or destination, fields of specialization, age groupings, and veterans’ status. During the year, the Office prepared records giving the name, address, category, specialty, occupation, and institution of placement of every foreign grantee entering this country between 1952 and 1955. INTERNATIONAL CONFERENCES The Office coordinated the preparation of educational reports re¬ quired for United States participation in international organizations. These reports dealt with decisions of governments on education and provided background data for technical groups at international conferences. For example, a report on the training of primary (elementary) teacher training staffs was prepared for the Twentieth Annual Inter¬ national Conference on Public Education at Geneva ; and in response to requests from UNESCO, materials were assembled on special edu¬ cation in the United States for the Belgian Ministry of Education and on vocational and technical education for the Netherlands Ministry of Education. On the recommendation of the United States delegations to the In¬ ternational Conference on Public Education, sponsored by UNESCO and the International Bureau of Education, the Office of Education, Office of Education 181 in cooperation with the United States Information Agency, prepared an exhibit for display in the Palais Wilson in Geneva from July 1957 to June 1958. The exhibit is on school construction, the major sub¬ ject of the 1957 conference. EDUCATIONAL MATERIALS LABORATORY The Educational Materials Laboratory has been in operation since 1953 for the use of foreign visitors, United States educators, and other persons interested in improved educational materials. In 1957 the Laboratory had a collection of approximately 6,000 items in¬ cluding textbooks supplied by the American publishers and materials developed by United States education missions in foreign countries. During 1957 the Laboratory served other government agencies ; ed¬ ucators from other countries, most of whom were brought to the United States by the International Cooperation Administration and the International Educational Exchange Service of the Department of State; American educators going abroad under the technical as¬ sistance program of ICA or to administer American sponsored schools in other countries; and a number of ICA missions overseas. A ma¬ jority of the ICA requests were for assistance in obtaining materials in American educational specialties and for technical advice on estab¬ lishment of education materials centers in several missions. Service to American schools continued to be a major part of the Laboratory’s activities. In 1957, 1,166 individual requests were re¬ ceived from 47 States, 2 Territories, the District of Columbia, and Guam. Most of them were for assistance in planning courses and in locating materials from other countries. A series of “Teaching Aids for Developing International Understanding,” which include anno¬ tated lists of teaching materials, was initiated for use by American teachers. Thirteen such lists were compiled. TEACHER EXCHANGE PROGRAM The continued exchange of American and foreign teachers results in an effective interpretation of educational systems and cultures to par¬ ticipating groups in the United States and abroad. To further this aim the Office cooperates with the IES, Department of State, in re¬ cruiting American teachers for overseas assignments and matching American and foreign teachers for interchange of positions. During the year 25 new teaching opportunities overseas were announced. In 1957 the Office placed 502 American and foreign teachers, includ¬ ing 71 American teachers for summer seminars in France, Germany, and Italy; 104 Americans for teaching assignments abroad and 15 foreign teachers for similar assignments in the United States; and 156 American and 156 foreign teachers wdio exchanged positions. 182 Department of Healthy Education, and Welfare, 1957 TEACHER EDUCATION PROGRAM The teacher education program in which foreign teachers are brought to the United States for a 6-month study of American educa¬ tion has reached into many American communities. The 303 teachers from 43 countries here under this program during the past year visited more than 6,000 schools and homes in 1,100 communities and met over a million people. They appeared on radio and television programs and were the subject of newspaper articles in at least 37 States. Study programs were arranged for them in 12 university training centers in elementary, secondary, and vocational education, English, and American civilization. The following countries participated for the first time during the past year: Chile, Colombia, Ecuador, Fiji Islands, Honduras, Jor¬ dan, Laos, Malta, Turkey. The second teacher development workshop was held at the Univer¬ sity of Puerto Rico for 32 educators from countries of the Caribbean area. The 30-day program in elementary and secondary education was conducted in Spanish. This program is also carried on in co¬ operation with IES, Department of State. TECHNICAL TRAINING PROGRAM During the year the Office assisted the International Cooperation Administration by arranging training programs for 540 participants from newdy developing countries. The participants received their academic training in 130 educational institutions in a wide variety of subjects such as elementary, secondary, and vocational education; engineering; and physics; and supplementary training in different types of commercial and industrial installations. As part of their training the participants visited unions, PTA’s, civic groups, granges, and hundreds of other organizations. TECHNICAL COOPERATION PROGRAM The Office continued to work with the ICA in the development of technical cooperation programs in 37 newly developing countries. Eighty-seven specialists were selected for appointment by ICA to serve in educational programs of these countries where approximately 300 educators, exclusive of college contract employees, are helping to improve educational conditions. The Office also furnished essential technical support on special educational problems of these educators in the countries where they work, participated in international conferences, and consulted with education officials of many other countries on professional matters of common concern. NONPROGRAM VISITORS The Office also serves large numbers of foreign visitors who are not participants in any one of the three programs for which funds have Office of Education 183 been transferred to the Office. Some of these “nonprogram” visitors make appointments directly with staff members in all divisions of the Office. A number of visitors are referred by other Government agencies, educational organizations, and foreign embassies for assist¬ ance in educational matters. It is estimated that during the year 350 non-program foreign educators received educational services from the Office. These activities are a traditional service of the Office. Research and Statistical Services COOPERATIVE RESEARCH In 1957 the Office launched the cooperative research program, which is authorized under Public Law 531, 83d Congress. The act authorizes the United States Commissioner of Education to “enter into contracts or jointly financed cooperative arrangements with universities and colleges and State educational agencies for the con¬ duct of research, surveys, and demonstrations in the field of educa¬ tion.” An appropriation of $1,020,190 was made for the support of such research during fiscal year 1957. Proposals under the program are received by the Office from insti¬ tutions of higher education and State departments of education. All such proposals are submitted to the Research Advisory Committee for their review and recommendations. This Committee ordinarily meets three times each year, in October, January, and May. The Committee evaluates the proposed projects on the basis of the following criteria: (1) Significance of the project for education throughout the Nation; (2) soundness of technical design of the study; (3) personnel and facilities available to carry out the project; and (4) economic efficiency (economy of the proposed procedures and expected value of findings in relation to Federal cost). Projects con¬ sidered outstanding are recommended by the Committee to the Com¬ missioner of Education. When projects are approved by the Commissioner, contracts are negotiated for their support. Although a substantial amount of the necessary financial support is provided by the Federal Government, the cooperating institution or agency also contributes to the total cost of the project. By the end of fiscal year 1957 the Office had received 324 applica¬ tions for the support of research proposals representing requests for Federal funds of more than $15 million. Of these, the Research Advisory Committee had reviewed 316 proposals and had recom¬ mended 108 of the projects for final approval. Since two-thirds of the total amount of Federal funds appropriated was designated for research in the education of mentally retarded children, more proposals were received dealing with this subject than with any other. At the end of the fiscal year a total of 72 projects had 184 Department of Health , Education, and Welfare, 1957 been initiated and were receiving financial support under the Coop¬ erative Research Program. These projects received current-year sup¬ port of approximately $1 million. Most of the projects will require an additional year or more for completion. Of the 72 projects ini¬ tiated, 42 deal with the mentally retarded. Of the 30 projects in areas other than the mentally retarded, 10 deal with staffing the Nation’s schools and colleges, 6 with the retention and continuation of students in school, 3 with the development of special abilities, 3 with educa¬ tional aspects of juvenile delinquency, and 8 with other aspects of education. The projects are being carried on in 30 different institu¬ tions of higher education and in 6 State departments of education. STATISTICAL SERVICES During fiscal year 1957 the research and statistical staff was in¬ creased from 26 to 68 persons. As a result, the traditional basic sta¬ tistical surveys of school systems and institutions have been strength¬ ened, studies of new areas of educational statistics have been initiated, and a new section (the Reference, Estimates, and Projections Section) has been established. The new section will systematize and expand the program of educational estimates and projections in order to pro¬ vide current data urgently needed for policy-making purposes. Study has already begun for projections of enrollment at elementary, secondary, and higher education levels; the number of high school graduates; and the number of degrees conferred by institutions of higher education. During the year improvements were made in survey techniques, such as sampling procedures, coverage of surveys, forms design, meth¬ ods of data collection, and analysis and interpretation of data. Im¬ provements were also made in the collection of data through visits of staff members to State departments of education. Staff time in the field was shortened through the employment of local clerks or the preparation of photocopies of State records. NEW SURVEYS During the year work was begun on a number of new surveys which will be reported in fiscal 1958. The major studies are described briefly in the following paragraphs. Survey of Beginning Teachers. — This study is focused primarily on the economic status of beginning teachers, their degree of satisfac¬ tion with various aspects of their job, and their commitment to teach¬ ing as a career. It is based on a scientifically selected sample in two stages — the first, a sample of school districts which were requested to submit lists of beginning teachers, and the second, a sample of these beginning teachers, to whom a detailed questionnaire was mailed. Office of Education 185 Suburban City School Systems. — Because virtually all of the in¬ crease since 1950 in the civilian population of the United States has taken place in the 168 standard metropolitan areas it has become im¬ perative that information about the large and increasing number of suburban school systems within these areas be collected and made available. Consequently the current biennial survey of city school systems was expanded in coverage and content. The expanded survey will contain information on about 475 sub¬ urban cities, all located in standard metropolitan areas, including personnel and financial matters, the qualifications of their teachers, salary practices, specialized curriculum offerings, and class size. County-Unit School Systems. — The county-unit school system, which is rapidly becoming a significant type of school organization, has not been systematically studied prior to the present survey. This survey of “complete” county units, that is, those counties which oper¬ ate single school systems, represents an extension of the coverage of the Biennial Survey of Education. Rural County School Systems. — This year the Office began to de¬ velop a program of rural school statistics designed to provide data similar to those published for city schools. A questionnaire identical with that which went to cities has been sent to about 1,200 counties which had been identified as having “rural” characteristics. Through the program the Office expects to provide valuable information for persons interested in improving the educational opportunities of rural children. Highway Safety. — In cooperation with the National Commission on Safety Education of the National Education Association, the Office has requested all institutions of higher education to report the courses or activities they provide for training people in the field of highway safety. The results will be analyzed by specialists of the National Education Association and this Office, and will be published as a classified directory which should prove useful to students, counselors, employers, safety councils, and insurance groups. Enrollment by Scientific Subject Field. — This survey was insti¬ tuted in response to urgent requests from organizations and institutions concerned with the present and future supply of scientific manpower. A pretest was conducted in which 600 institutions of higher education were requested to report enrollments of junior-year students, by major field of science. Other Surveys. — Two other fields of study which deserve mention, although they were in the drawing-board stage at year end, are a sta¬ tistical study of adult education activities and a survey of teacher turnover, the primary purpose of which is to obtain a reliable estimate, on an annual basis, of the number of teachers leaving the profession. 448006—58 - 13 186 Department of Health , Education , and Welfare , 1957 Assistance to Schools in Federally Affected Areas Fiscal year 1957 was the seventh year of continuous operation of the program for Federal assistance to schools in areas affected by Federal activity. Like the preceding years the seventh year showed a growth in the number of participating districts. Federal payments to federally affected districts (P. L. 874, as amended) to aid in meeting current operating expenses for the year amounted to $113 million. These payments were made on behalf of some 1,200,000 federally connected pupils claimed by school districts which had a total attendance of over 7.6 million pupils. The school districts receiving these funds provided free public education to ap¬ proximately one-fifth of the Nation’s public school enrollment. The number of participating districts in fiscal year 1957 amounted to approximately 3,400, an increase of about 500 in the number of eligible districts over the previous year. This increase in eligible districts was the largest since 1952, the second year of the program, when 600 new districts were found to be eligible. From the beginning of the program in 1950 to the end of fiscal 1958, school construction projects approved numbered 3,705 for which Federal funds amounting to $712 million had been allocated (Public Law 815, as amended). Local school districts which have received school construction aid under this program have added $303 million in their own funds to these projects and in addition have provided sites and off-site improvements not included as a part of the approved project. The school construction work thus far initiated under this program is more than $1 billion, and the classroom accommodations provided by the approved projects will be sufficient to house some 950,000 pupils. One of the principal causes of the continued extension of the school construction program is the substantial program of military housing which has been authorized by the Congress under title VIII of the National Housing Act. This program, popularly known as the Capehart housing program, authorizes the Federal Government to issue mortgages sufficient to provide funds for some 150,000 family housing units on military installations. The program has been amended twice since its original enactment with the effect that the number of housing units to be approved under it has been enlarged and the date for final commitment of mortgages has been extended until June 30, 1959. Since the children who will live in these family housing units will need school facilities on or near the military installations, the Congress has provided for continued Federal assist¬ ance under Public Law 815 for school construction. Office of Education 187 Since the amendments to the Capehart housing program extend the time for the approval and construction of the housing units, a 1-year extension of Public Law 815 to accommodate these new housing units, was recommended by the Department and adopted by the Congress. This extension will enable school districts to make claims for Federal assistance in school membership through fiscal year 1959. In extending Public Law 815 for one additional year the Congress indicated its intention “to make a thorough study of the entire Fed¬ eral impact problem in order to develop a program which will oper¬ ate efficiently and economically without periodical extension and piecemeal changes” ; and to this end directed the Department to pre¬ sent its recommendations early in the next session of the Congress. Library Service PUBLIC LIBRARIES In 1871, the Commissioner of Education said in his Annual Report: “Public libraries are at once an important means and a valuable index of education. . . . Year by year this office should be able to present the growth of this valuable auxiliary to all forms of culture.” In 1957 the Office revised and enlarged its regular program of activities in the public library field. A public library specialist was appointed to the staff, with the special responsibilities for planning and conducting research and other studies to meet the increasing de¬ mands for objective data and trends. Added to the work in this area has been the coordinating of library services with adult education and services to the aging at the national and State levels. Further evidence of the growing awareness of the important role which public libraries play in the educational life of the Nation can be found in the enactment of the Library Services Act (Public Law 597, 84th Cong.) signed by the President on June 19, 1956. This legislation provides for a 5-year program of Federal assistance to the States and Territories in extending public library services to those rural areas which have either no libraries or inadequate libraries. Regulations were drafted and reviewed at a series of four regional conferences with heads of State library administrative agencies charged with the responsibility of carrying out State plans for the improvement and extension of rural public library service. Thirty-five States and Hawaii submitted plans and qualified for their Federal allotments of $40,000 each under the $2,050,000 appro¬ priation for fiscal 1957. These States not only matched the Federal allotment of $1,440,000, but overmatched it by $2,941,259; although they were required to put up only $1,282,861, they put up a total of $4,224,120. The percentages of total funds budgeted in State plans 188 Department of Health , Education , and Welfare , 1957 by categories of expenditures were: Salaries and wages, 40.6; books and materials, 36.8; equipment, 10.6; and all other operating, 12. Under the impetus of the Library Services Act a number of States have enacted new legislation and increased their appropriations for public libraries to meet the requirements of the act. Other States appropriated emergency funds so that they could immediately qualify. One State created a new library extension agency and appropriated funds to match the Federal allotment. The reports in the periodicals issued by the State agencies speak enthusiastically of the helpful effect of the Library Services Act on the library programs in the respective States. EDUCATION FOR LIBRARIANSHIP To meet requests for information pertinent to the widespread short¬ age of trained librarians throughout the United States, the Office has endeavored to maintain for the past 5 years a current list of higher educational institutions which offer courses in library science. The number of such institutions has increased during this period from about 400 in 1951-52 to nearly 600 in 1956-57. PUBLIC SCHOOL LIBRARIES A comprehensive statistical survey of public school libraries for 1953-54, the first since 1947-48, was completed during the year. By appropriate adjustments for the use of sampling and for nonresponse, it was possible to derive figures for the Nation as a whole. The cal¬ culations showed that 128,831 schools were involved. The number of librarians employed in 1953-54 was 30,753, of whom 15,971 were professionally trained and 14,782 had little or no professional train¬ ing. The number of volumes in the school libraries at the close of 1953-54 was 102,915,052, of which 9,609,949 were added during the year. The total annual library expenditure, excluding salaries, was $25,222,207, of which $16,066,277 was spent for books and pamphlets and $2,199,352 for periodicals and newspapers. Advisory Committees In carrying out its activities the Office had the cooperation of ad¬ visory committees, professional associations and groups, State de¬ partments of education, and educators and laymen. Among the ad¬ visory committees working with the Office during the year were Office of Education Research Advisory Committee, the National Commit¬ tee on the Study of the Qualification and Preparation of Teachers of Exceptional Children, the National Advisory Committee for the Exchange of Teachers, the Advisory Committee of National Organ- Office of Education 189 izations, and the Advisory Committee on the Library Services Program. The cooperation of these committees provides a vital link in the continuity which the Office seeks to maintain in citizen-educator teamwork. To provide a direct means of communication with and between or¬ ganizations and associations the Office launched a new publication, Education Fact Sheet, and put out seven issues during the year. The publication carries brief items on the activities of the Office, national organizations interested in education, and the States and communities. The President’s Committee on Education Beyond the High School The First Interim Report of the President’s Committee on Educa¬ tion Beyond the High School was submitted to the President on November 16, 1956. The report, which included the Committee’s preliminary conclusions, was intended to promote discussion among as many educators and laymen as possible. About 25,000 copies of the report were distributed. Following the submission of the First Interim Report, the Com¬ mittee organized itself into subcommittees for the purpose of prepar¬ ing the Second Report to the President. This report will contain recommendations on the need for teachers and for student assistance, the problems of financing and of providing a diversity of educational opportunity beyond high school, and the relationships of the Federal Government to education beyond the high school. In addition to making its own studies, the Committee sponsored five regional conferences during April and May 1957. The confer¬ ences, held in Boston, New York, Louisville, Saint Louis, and San Francisco, were attended by 1,400 laymen and educators who con¬ sidered problems of post-high-school education as they related to the region. The staff developed a source book of statistical information and salient facts on post-high-school education for the use of con¬ ference participants. Each of the conferences submitted a report of its proceedings to the President’s Committee. The second report will be submitted to the President in fiscal 1958, and copies will be distributed to 120,000 educators and laymen throughout the country. 190 Department of Health , Education , and Welfare, 1957 Major Publications Off the Press in Fiscal Year 1957 Accredited Higher Institutions, 1956 Administration of Public Laws 874 and 815, 6th Annual Report of the Commis¬ sioner of Education, June 30, 1956 Adventuring in Research to Improve School Practices in Homemaking Programs American Cooperation with Higher Education Abroad Austrian Teachers and Their Education Since 1945 Directors and Supervisors of Special Education in Local School Systems A Directory of 3,300 16mm Film Libraries Education for Better Living, 1957 Yearbook on Education Around the World Education Directory, 1956-57 (Parts 1, 2, 3, 4) Education for National Survival, A Handbook for Schools Education in Taiwan Engineering Enrollments and Degrees, 1956 Extraclass Activities in Aviation, Photography, and Radio for Secondary School Pupils Fall 1956 Enrollment, Teachers, and Schoolhousing in Full-Time Public Elemen¬ tary and Secondary Schools Federal Funds for Education, 1954-55 and 1955-56 Financial Accounting for Local and State School Systems Home Economics in Colleges and Universities, Planning Space and Equipment National Stay-in-School Campaign, Handbook for Communities Opening Enrollment in Higher Educational Institutions, Fall 1956 Planning and Conducting a Program of Instruction in Vocational Agriculture for Young Farmers Progress of Public Education in the United States of America, 1956-57 Pupil Transportation Responsibilities and Services of State Departments of Education Research in Industrial Education, Summaries of Studies, 1930-55 Resident and Extension Enrollment in Institutions of Higher Education, Nov. 1955 School District Reorganization Policies and Procedures School Property Insurance, Experiences at State Level The Secondary School Plant, An Approach for Planning Functional Facilities Statistics of City School Systems ; Staff, Pupils, and Finances, 1953-54 Statistics of Higher Education : Faculty, Students, and Degrees, 1953-54 Statistics of Higher Education : Receipts, Expenditures, and Property, 1953-54 Statistics of Land-Grant Colleges and Universities, Year Ended June 30, 1955 Statistics of State School Systems: Organization, Staff, Pupils, and Finance, 1953-54 Summaries of Studies in Agricultural Education (Supplements 9 and 10) Summary of Federal Funds for Education Teachers of Children Who Are Blind Teachers of Children Who Are Mentally Retarded Teachers of Children Who Are Partially Seeing Teaching about the United Nations in United States Educational Institutions Trends in Significant Facts on School Finance, 1929-30 to 1953-54 Work Experience Education Programs in American Secondary Schools Higher Education (9 issues, September through May) School Life (9 issues, October through June) Office of Education 191 Table 1. — Enrollment in the continental United States, 1955—56 and 1956—57 [Office of Education estimates! School Year 1955-56 1956-57 Kindergarten through grade 8: Public school systems, regular full-time _ ... - - . 24, 588, 000 3, 768, 000 32, 200 16, 000 110, ooc 25, 283, 000 4, 267, 000 26, 000 19, 000 116, 000 Other. . . . .. . . . . . . . . _ _ _ _ 28, 514, 200 29, 711,000 Grades 9—12: Public school svstems, regular full-time 6, 860, 000 823, 200 9, 800 900 53, 200 6, 876, 000 866, 000 11,000 1,000 66. 000 Private and parochial schools, regular full-time _ _ Federal schools for Indians. _ _ Federal schools under Public Law 874 _ _ Other . . . . .... .. _ _ _ _ _ _ _ . Total grades 9-12 . . _ .. _ . _ 7, 747, 100 7, 820, 000 Total elementary and secondary _ _ _ . _ _ 36, 261, 300 37. 531,000 Higher education: Universities, colleges, professional schools, including junior colleges and normal schools _ . . . . . _ 2, 996, 000 3. 244, 000 Other schools: Private commercial schools, day and evening _ _ _ _ 2, 996, 000 3, 244, 000 450, 000 91, 400 500, 000 91, 000 Nurse training schools, not affiliated with colleges and universities _ Total other schools . . . . . . . . . 541, 400 591,000 Grand total . . _ _ _ 39, 798, 700 41. 366, 000 Table 2. — Supply and demand for elementary and secondary public and nonpublic school teachers, 1956—57 Item Elementary and secondary Supply Total teachers, 1955-56 1 _ .. _ _ _ _ _ 1, 266, 000 77, 600 Less emergency teachers, 1955-56 _ _ _ _ _ Total qualified teachers, 1955-56 _ ... _ _ _ _ 1, 188. 400 89, 100 Less 7.5 percent turnover of qualified teachers. _ Qualified teachers returning for 1956-57 _ _ _ .. .. _ 1, 099, 300 20, 000 76, 100 Emergency teachers qualifying for 1956-57 _ _ . . . . New supply of qualified teachers (81.6 percent of elementary and 62.9 percent of high school teachers trained in 1955-56) _ Total qualified supply, 1956-57 _ _ _ 1, 195, 400 Demand Total teachers, 1955-56 L _ 1. 266, 000 50, 100 Teachers needed to meet increase in enrollment in 1956-57 _ _ _ Total demand, 1956-57 _ _ _ _ 1, 316, 100 Shortage of qualified supply _ _ _ _ _ 120, 700 1 The number of elementary and secondary school teachers in the public school system, in the fall of 1955. was 1,135,930 (Office of Education Circular No. 467, Revised). To this must be added the number in non¬ public schools (private and parochial), in model and practice schools, in colleges and universities, in resi¬ dential schools for exceptional children, and in schools operated under Federal auspices. The number in Catholic private and parochial schools in 1955-56 was 114,000 (estimated by National Catholic Welfare Conference, Dept, of Education). The number in the other types of schools is estimated as 16,250. 192 Department of Health , Education , and Welfare , 1957 Table 3. — Grants 1 to States: Office of Education, fiscal year 1957 States, Territories, and possessions Total Colleges for agriculture and me¬ chanic arts Library services Cooperative vocational education Maintenance and opera¬ tion of schools (Public Law 874) School con¬ struction (Public Law 815) 1 2 3 4 5 6 7 Total _ $204, 336, 577 $5, 051, 500 $1, 440, 000 $37, 582, 036 2 $93, 194, 675 $67, 068, 366 Alabama.. - - 4, 440, 916 100, 541 40, 000 1, 023, 505 2, 403, 230 873,640 Arizona _ 2, 312, 158 77, 477 40, 000 197, 420 1, 343, 063 654, 198 Arkansas _ _ . ... 2, 337, 833 89, 048 40, 000 '759,496 725, 618 723, 671 California _ 33, 748, 271 175, 599 40, 000 1, 873, 650 16, 107, 775 15, 551, 247 Colorado _ 4, 428, 815 83, 218 40, 000 324, 396 2, 380, 448 1,600, 753 Connecticut _ 2, 175, 268 90, 023 40, 000 347, 696 1, 103, 323 594, 226 407, 328 73, 173 170, 186 113, 919 50, 050 79, 961 79, 961 5, 429, 497 97, 644 602, 112 2, 717, 369 2, 012, 372 Georgia - 6; ns; 713 104; 360 40, 000 1, 123, 236 3, 091, 693 1, 759, 424 Idaho.. _ ... 867, 535 75, 872 210, 327 538, 165 43, 171 Illinois _ 4, 52i; 467 156, 905 40, 000 1, 690. 318 1, 990, 787 643, 457 1, 928, 961 109, 245 963, 073 661, 799 194, 844 Iowa _ 1, 315; 854 96, 146 40, 000 844, 810 276, 918 57, 980 4, 198, 327 89, 006 574, 038 2, 871,295 663, 988 Kentucky _ ... 2, 268; 184 99, 375 40, 000 1, 029, 962 766, 318 332, 529 Louisiana _ . . 1, 827, 217 96, 769 40, 000 724, 292 659, 970 306. 186 1, 107, 971 79, 115 202, 875 689, 238 136, 743 Maryland _ 9; 674; 701 93; 372 453, 365 4, 199, 910 4, 928, 054 Massachusetts _ 3, 049, 749 116, 789 40, 000 720, 724 1, 604, 452 567, 784 Michigan.. _ _ 7, 008, 278 133, 559 40, 000 1, 344, 240 399, 902 5, 090, 577 Minnesota _ 1, 594, 176 99, 751 40, 000 918, 835 83, 204 452. 386 Mississippi _ _ 1, 780, 390 91, 735 40, 000 967, 241 553, 065 128, 349 Missouri... . . 3, 717, 508 109, 448 40, 000 1, 063, 406 1, 243, 468 1, 261, 186 Montana - 1, 263, 528 75, 896 40,000 210, 270 374, 668 562, 694 Nebraska _ 1, 970, 096 83, 222 40,000 427, 369 866, 250 553, 255 Nevada . 944, 319 71, 597 160, 628 585, 810 126, 284 New Hampshire _ . 732, 599 75, 319 40, 000 149, 790 403, 871 63, 619 New Jersey _ 3, 215, 614 118, 233 40, 000 740, 906 1, 471, 328 845. 147 New Mexico.. _ _ 4, 552, 144 76, 795 40, 000 217,207 1, 791, 937 2, 426, 205 New York.. _ 6, 526, 311 217, 934 40, 000 2,405,413 1, 954, 331 1, 908, 633 North Carolina _ 3, 053, 848 110, 518 40, 000 1, 441, 575 961,914 499, 841 North Dakota _ ... 577, 236 76, 181 40,000 280, 375 151, 013 29, 667 Ohio _ 6, 296, 978 149, 269 40, 000 1, 686, 442 2, 921, 747 1, 499, 520 Oklahoma _ 7, 391, 471 92, 279 40, 000 681, 177 3, 905, 274 2, 672, 741 Oregon - 1, 733, 154 85, 176 40, 000 390, 110 681, 904 535, 964 Pennsylvania _ 3, 904, 622 174, 720 2, 059, 943 1, 245, 487 424, 472 Rhode Island _ 1, 475, 735 77, 899 136, 282 941, 121 320, 433 South Carolina _ 3, 152, 164 91,118 40, 000 734, 059 1, 605, 891 681, 096 South Dakota _ 1, 821, 457 76, 511 40, 000 277, 504 951, 741 475, 701 Tennessee - 3, 293, 230 102, 835 40, 000 1, 074, 226 1, 199, 033 877, 136 Texas . 12, 348, 662 146, 921 40, 000 1, 878, 287 6, 565, 589 3, 717, 865 Utah _ _ 1, 973, 903 76, 871 181, 265 1, 020. 735 695, 032 Vermont _ . 330, 302 73, 768 40, 000 167, 670 48, 864 Virginia. . _ 14, 284, 826 103, 104 40, 000 975, 5C8 7, 655, 804 5, 510, 410 Washington _ 6, 633, 305 93, 731 580. 427 3, 762. 991 2, 196, 156 West Virginia _ 938, 918 90, 006 40, 000 617, 951 144. 026 46, 935 Wisconsin . . 1, 623, 066 104, 260 40, 000 954, 778 278, 331 245, 697 Wyoming _ . 688, 791 72, 898 176, 475 281, 666 157, 752 Alaska _ 3, 478, 734 71, 283 18, 937 3, 153, 264 235, 250 Guam _ _ 287, 160 287, 160 Hawaii _ . 2, 889, 362 74, 986 40, 000 182, 334 1, 457, 996 1, 134,606 Puerto Rico _ 595, 964 50, 000 545, 964 Virgin Islands.. _ 20, 000 20, 000 1 On the basis of checks issued. 2 Totals do not include payments made to the Air Force, $989,619; Navy, $649,661; Veterans’ Adminis¬ tration, $2,649. Food and Drug Administration The original Federal Food and Drugs Act went into effect on Jan¬ uary 1, 1907. Nationwide commemoration during the whole year 1956 of the passage of that law immeasurably increased public under¬ standing of the importance of food and drug control in our very com¬ plex modern life. A host of new and increasingly difficult problems must be faced today and in the years ahead. New developments will continue to serve the public health, but will not decrease the need for watchful protection under our food and drug laws. The public wants more and more convenient food — greater and greater diversification — improved nutrition — better packaging. To meet these demands industry scientists must employ a wide variety of substances in food which they did not previously contain. In the development of these newer foodstuffs there is opportunity for serious error. Both industry and regulatory scientists must be ever on the alert to prevent changes from reacting in any way to the detriment of the consumer. They must also prevent public misunderstandings fostered by uninformed statements questioning the safety of the food now on the market. While no food known to be injurious is on the market today, authority is needed to insure the safety of products containing new chemical additives. Also, in the field of new drugs, there must be constant watchfulness lest products that save lives and ease the pain of the suffering do not in turn take their toll when administered over the years to patients who may develop adverse reactions. The fiscal year 1957 was a fruitful one for the Food and Drug Administration. In the first year of the expansion program recom¬ mended by the Citizens Advisory Committee at the end of fiscal year 1955, there was an increase of 15 percent in appropriations over those of the previous year. This increase permitted a return to the size 193 194 Department of Health , Education;, and Welfare , 1957 of the enforcement staff of 1951, the previous high. The inspection staff in 1956 numbered 250 ; in 1957 it was increased to 300. Despite the nationwide shortage of professional young people of the caliber FDA needs to train for its work, the budgeted positions for 1957 were filled with promising personnel. The Department requested and Congress approved for the 1958 fiscal year an increase of 19 percent over the 1957 appropriation for expansion of current activities, in addition to certain specialized ex¬ penses not in previous budgets, including replacement and moderniza¬ tion of equipment and a new field district headquarters. The 1958 increase was requested to permit added attention to new drugs, and to more basic scientific research, including pharmacolog¬ ical studies on pesticides and chemical additives, nutritional studies on processed foods, bacteriological studies on precooked and frozen foods, reappraisal of some official testing methods for drugs, and studies of new cosmetic ingredients. It also included more attention to food standards, and an increase in the number of establishments to be inspected and samples to be collected for examination. The Citizens Advisory Committee recommendations concerning management and operations have received careful study and been acted upon in many ways. An internal reorganization led to the establishment of five Bureaus, with the Office of the Commissioner maintaining direct supervision over administrative management, re¬ lations with States, trade, industry, and consumer groups, and mat¬ ters relating to new laws and regulations. The scientific divisions were grouped into the Bureau of Physical and Biological Sciences. The other Bureaus are Enforcement, Field Administration, Medi¬ cine, and Program Planning and Appraisal. A carefully planned survey was begun in 1957 in an attempt to measure, by statistically sound methods, the potential workload of the Food and Drug Administration. This will be of value in cal¬ culating manpower requirements and other aspects of budgetary planning and in directing enforcement activities. The Citizens Advisory Committee also recommended increased at¬ tention to medical quackery and economic cheats, and more educa¬ tional activities to inform consumers and industry of FDA programs, objectives, and opportunities to further public protection. At the end of the year, more defendants were serving jail sentences for false curative claims than at any time in FDA history — four of them after prolonged litigation. Statutory authority to issue public warning against activities in¬ volving imminent danger to health was invoked by poster warnings against an ineffective cancer treatment. Education of the public as to facts and fallacies concerning food and nutrition was likewise Food and Drug Administration 195 stressed in an attempt to offset organized promotion of food supple¬ ments as medicines to cure or prevent serious disease conditions. Those fanatically swayed by cultist teachings — and prejudiced against recognized medical treatment — have been encouraged by every means known to specialists in mass psychology to protest Government persecution of their “leaders” or “masters.” Through mass meetings under the guise of “scientific lectures,” radio, T. V., circulars, “re¬ ligious” publications, and even barnside signs, the public has been encouraged to write to congressmen and the President, demanding investigations of FDA actions. Countersuits were threatened, and subsequently filed, against the Secretary of Health, Education, and Welfare, and the Commissioner of Food and Drugs. The Federal judge who sentenced a “health food” lecturer and the United States attorney who prosecuted him wTere sued when the defendant was required to serve his jail sentence. Food , Drug , and Cosmetic Act DISASTER AND DEFENSE ACTIVITIES Although natural disasters — hurricanes, floods, tornados — occurred repeatedly throughout the year, the major damage to foods and drugs was to unharvested crops and retail stocks. Alert State and local officials, assisted where needed by FDA inspectors, prevented con¬ sumption of polluted supplies. In some cases the inspectors reported “Nothing left to salvage.” An explosion on a Brooklyn pier in December damaged 27 food and cosmetic processing and warehousing firms nearby. Approximately 235 tons of merchandise was damaged by polluted water, excessive heat, and flying debris, including glass. FDA inspectors, working with city health officers, checked the damage and supervised destruction. In the same month fire in a storage grain elevator in South Chicago required the diversion of thousands of carloads of water- and fire- damaged grain to animal feed and industrial use. Other major losses included 2,700 tons of canned citrus juice and 200 tons of frozen fish flooded with polluted water when freighters were rammed at sea. FDA inspectors maintained surveillance over disposal of the damaged food. The three FDA civil defense programs conducted under a delega¬ tion from the Federal Civil Defense Administration were continued. Training of State and local food and drug officials in the problems of radiological, biological, and chemical contamination of foods and drugs was expanded to include segments of the food industry. The food test program was continued by exposing various types of staple 196 Department of Health , Education, and Welfare, 1957 foods to atomic explosion. Some progress was made in studying the vulnerability of packaged foods to bacteriological attack and decon¬ tamination to permit safe use of foods so exposed. Each of these FDA programs was terminated at the close of the fiscal year, since no funds were appropriated to continue the work in fiscal year 1958. ON THE FOOD FRONT Potential Health Hazards Deleterious ingredients. — In cooperation with the United States De¬ partment of Agriculture and the National Milk Producers Federation (which reaches some half million farmers) an intensive program has been undertaken to eliminate antibiotic and pesticide residues from the milk supply. Changes in the regulations to provide better label warnings to farmers are discussed under New Regulations. F ull-time surveillance of the use of pesticidal chemicals to meet crop problems in major growing areas began when the official tolerances for pesticides on raw agricultural commodities became fully effective in July 1956. When misuse of the pesticides that would lead to exces¬ sive residues was encountered, the growers were warned through citations that crops so treated could not be shipped interstate. Growers, in general, have responded to the educational program of State and Federal food control groups, agricultural agencies, and pesticide distributors urging them to comply rigidly with schedules recommended by experts. When pests are threatening their crops, however, farmers occasionally use a wide variety of insecticides with¬ out regard for recommended practices. An FDA inspector found that a lettuce farmer had used chlordane, endrin, dieldrin, DDT, toxaphene, malathion, cryolite, and rotenone on his crop and still had 11 days to go before harvest ! Thirty-two seizures were made to remove from the market foods contaminated with chemicals. Twenty-one contained pesticidal resi¬ dues not permitted by formally established tolerances. Eighteen involved carloads of grain containing grain treated for seed use with mercurial compounds. A carload of celery was seized in two cities. The shipper had applied parathion in an amount 5 times the recom¬ mended maximum within 15 days of harvest. Another seizure in¬ volved frozen spinach which contained a DDT residue in excess of that permitted on fresh spinach. Other foods seized because of potential danger to health were four shipments of imitation vanilla flavor containing coumarin, four of shell pecans dyed with uncertified coal-tar colors, ice cream cones con¬ taining boric acid, and two carloads of wheat contaminated by resi¬ dues of lead pigments previously transported in the car. After the Food and Drug Administration 197 first load was seized, the car was reloaded without cleaning and the second load also became contaminated with lead and was seized. Vessels transporting green coffee in burlap bags have also carried ore concentrates and poisonous insecticides. Improper cargo han¬ dling or disasters at sea have resulted in large lots of coffee becoming seriously contaminated, with detentions required. Prosecutions were filed in 1957 against three bean warehouses and responsible officers, based on the reckless use of poisonous rodenticides which contaminated about 5,000 tons of stored beans the previous year. There was only one recall of a dangerous food — grape jelly containing slivers of glass, possibly from a broken thermometer. Food Poisoning. — FDA investigated 22 staphylococcus outbreaks affecting 950 individuals. Insanitary handling during the prepara¬ tion of the foods for serving and inadequate refrigeration continue to be the most important contributing factors. Inadequate processing in home-canned foods was responsible for 7 botulism outbreaks with 6 fatalities among the 13 persons affected. In 3 separate outbreaks, affecting over 700 persons, boiled turkey was implicated. Three per¬ sons became ill after eating frozen dinners, defrosted at some stage after production. This points to the dangers of inadequate refrigera¬ tion during the transportation and marketing of “heat and serve” frozen foods. Defective hermetically sealed containers were suspected in 4 outbreaks; where the investigations revealed additional leaking containers the lots were removed from the market. Two ranchers lost valuable farm stock after feeding them com¬ mercially prepared wafers. The wafers were found to contain exces¬ sive urea and both lots were seized. To Keep Food Clean Food seized for filth or decomposition totaled 5,675 tons — 83 per¬ cent of the total volume seized. Of 533 actions against unfit foods, 249 involved merchandise that became unfit in storage after inter¬ state shipment. An additional 4,162 tons of unfit food were volun¬ tarily destroyed or converted to nonfood use by their owners after their attention was called by inspectors to unsatisfactory lots. Written notices of violative conditions, followed by laboratory re¬ ports on unfit foods sampled, bring them forcefully to the attention of top management and often result in voluntary correction. Clean raw materials have been emphasized in educational pro¬ grams carried on with the assistance of industry and agricultural groups and State and local food and drug officials. Wheat and corn, cream, grape, and fish programs were all aimed toward elimination of unfit materials for processing. FDA personnel have worked with industry on better laboratory procedures, and have helped plan and further improvement pro- 198 Department of Health , Education , and Welfare, 1957 grams. State and local officials and agricultural groups can bring the clean raw materials message to the individual producer much more directly and effectively than can FDA. Under lower tolerance levels of rodent and insect contamination in carload lots of wheat, which went into effect in July 1956, 44 car¬ loads were seized, in comparison with 11 in fiscal year 1956, and 12 in the 6 months the program was in effect in fiscal year 1955. Since the annual shipment of wheat approximates 500,000 carloads it is evi¬ dent that the industry as a whole is benefiting from the intensive edu¬ cational work in which various organizations have participated. In the dairy field “drip milk” collection became a regulatory prob¬ lem that ended when 39 producers abandoned the practice after cita¬ tions to hearings and the principal user reportedly went out of busi¬ ness for lack of supplies. Drip milk is the residue draining from cans while they are inverted on conveyors after dumping and enroute to can washes. This milk contained excessive sediment. FDA in¬ spectors followed trucks carrying drip milk to a separator and thence to a creamery where it was seized before it was used for butter. Table 1. — Actions on foods during the fiscal year 1957 Projects Seizures Criminal prosecu¬ tions in¬ stituted Injunction petitions Total _ 672 77 8 Beverages and beverage materials _ - _ - - _ 6 Bakery, ready to eat cereal, and macaroni products. . _ . _ 14 15 Cereals and grain products: Human use _ _ _ - __ _ . _ 111 9 1 Animal use _ . ... _ _ _ - _ 5 3 Chocolates, sugars, and related products. . _ _ _ _ _ 22 4 Dairy products: Butter and churning cream _ _ _ 15 1 Cheese and other dairy products ... . _ _ _ 5 6 Eggs and egg products.. . _ _ _ __ _ _ _ 8 2 Flavors, spices, and condiments _ _ _ _ 31 2 Fruits and fruit products _ _ _ 27 1 Meat products and poultry _ _ _ 21 3 1 Nuts and nut products _ _ _ _ 72 Oils, fats, and oleomargarine _ _ . _ _ 10 1 Seafood _ _ _ _ _ _ _ __ _ _ 108 13 3 Vegetables and vegetable products _. _ _ _ _ _ _ 72 7 1 Miscellaneous foods (mixed lots) 11 1 Warehoused foods 109 9 1 Food for special dietary uses 1 24 Violative serving of oleomargarine _ _ _ _ _ . _ 1 Food adjuncts _ _ _ _ _ 1 1 Includes vitamin products intended as food supplements. The poultry program advanced in 1957 with agreements with re¬ spect to inspection and disposition of unfit poultry, following dis¬ cussions for a number of years with other Federal agencies concerned with the fitness of poultry. Among the factors agreed upon were the necessity for antemortem inspection and for immediate evisceration after slaughter. The agreement culminated in an FDA manual to Food and Drug Administration 199 assure uniformity of action, intended primarily to provide guidelines for enforcement and public health officials. Slow but progressive improvement was encountered during poultry plant inspections and market sampling ; fewer seizures were required. Surreptitious dealings in incubator reject eggs — suitable only for tanning use — are still encountered. A State fine was levied against a manufacturer receiving night deliveries by trucks from three other States of incubator rejects ranging from 5-day clears to fully devel¬ oped embryos. Federal seizures w^ere made of substantial quantities of rejects in his possession. Two shippers of decomposed frozen eggs were fined in Federal courts. The courts were requested to enjoin five firms from shipping pop¬ corn, poultry, pickles, vegetable oils, and dried beans that had been processed or stored under insanitary conditions. At the end of the year temporary restraining orders were in effect in those cases where a final court hearing was pending. Two defendants prosecuted for contempt of a November 1955 injunction prohibiting shipment of poultry prepared under insanitary conditions were fined $500 each. Sixty-two criminal prosecution cases charging the shipment of filthy or decomposed foods or insanitary operations were instituted during the year. The highest number of cases involved perishable products — bakery items and seafood — which are distributed so rap¬ idly that it is often impossible to protect the public by seizure actions. Next in number were warehouses and their operators, who were charged with holding food under insanitary conditions. Two and a half million pounds of chocolate stored on a railway pier after import was so seriously attacked by insects that salvage under bond was required, with 33!/2 tons being lost by surface trim¬ ming. A car used to transport a load of flour harbored rodents which resulted in a 20-ton loss. One of the most severe food penalties of the year was 18 months in jail and a $2,000 fine levied against a producer of filthy mushroom salt, on a second-offense charge. He lost his appeals. Pocketbook Protection Limitations of manpower in recent years have required restriction of work against abuses affecting the consumer’s pocketbook. With the increase in the 1957 appropriation, more attention was turned to this field. One of the leading projects was against substandard oysters that contained excess water, often deliberate, through im¬ proper drainage or extensive soaking. Thirty-one shipments packed by 22 firms, were seized. Injunction cases were filed against three firms and one enjoined in the previous fiscal year was fined $7,500 and its president sentenced to 90 days in jail for criminal contempt. 200 Department of Health , Education, and Welfare, 1957 Other items seized for excess water were frozen fish containing as much as 2 pounds of ice in a 15-pound carton, low-fat butter, and diluted orange juice. Eight lots of misbranded olive oil blends were seized for substitu- tions of cheaper oils in the blends. Labeling practices were improved in one production area after a number of blenders were cited to hear¬ ings. Other foods seized for debasement or misbranding included canned vegetables failing to meet official standards, country sorghum containing corn sirup, coffee adulterated with spent grounds and cereal, and cocoa with cottonseed meal or excess shell. Seafood Inspection Service Two seafood canneries operated under FDA seafood inspection, a service furnished on a fee basis for processors who voluntarily apply for it and meet Government requirements for sanitation and controls. They packed 849,797 pounds of shrimp and 20,918 cases of oysters. The service became inactive at the end of the fiscal year, since no firms applied for continuation of inspection. When seafood inspection began in 1934, 90 percent of the canned shrimp packers operated under it and learned how to pack wholesome shrimp. PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE In June FDA District Chiefs throughout the country launched an educational campaign designed to warn consumers against false and misleading claims made in the privacy of homes by house-to- house food supplement peddlers. Their principal sales “pitch” is misinformation about nutrition, presented by “scare” methods. In October a jury convicted a “nutrition expert” and his firm for the promotion of “natural” vitamin supplements through mis¬ branding claims in collateral literature to be used by house-to-house salesmen. An appellate court upheld the Government’s charges that the following claims were false and misleading: (1) That nearly everyone in this country is suffering from malnutrition or may be endangered by it. (2) That United States soils are so depleted that they no longer produce nutritive food. (3) That refining and pro¬ cessing of foods destroy their nutritive value. (4) That practically all of mankind’s illnesses and diseases stem from improper nutrition. (5) That the defendant’s products would treat, cure, or prevent all of the diseases of mankind. Among the “deficiency diseases” in the sales literature were diabetes, polio, tuberculosis, and cancer. In a 20-page opinion the court stated that prospective purchasers “are more likely than not to be persons who are pathetically eager to find some single cure-all for the diseases with which they are afflicted, or who are susceptible to luridly painted scare literature as to the prospect of being disease-ridden unless they consistently partake of Food and Drug Administration 201 the vaunted drug product.” The firm was fined $6,000 and its head was sentenced to a year in jail; his appeal of the conviction was lost and the Supreme Court refused to review the case. Also convicted during the year were a number of house-to-house salesmen of a food supplement, who made exaggerated curative claims that numerous friends and relatives had recovered from a wide variety of serious disease conditions after they began taking this food supplement regularly. The sentence in May 1956 of a pioneer “health food” lecturer who had been found guilty by a jury the previous year of misbranding his wares was appealed. In 1957 he lost his appeal and is now serving his year and a day jail sentence, with strong protests by followers. Twenty-six shipments were seized because they contained less vita¬ mins than declared on their labels. Three shipments of “low-sodium” foods were seized because they contained more sodium than labeled. A manufacturer of foods designed to provide carefully calculated amounts of sodium and vitamins for use in hospital diets was fined in a case originating in complaints from hospital dietitians. Samples revealed sodium ranging as high as 426 times the amount claimed on the label and vitamin shortages as high as 94 percent. Another firm fined for vitamin deficiency in its product had misplaced decimals in a manufacturing formula. DRUGS AND DEVICES The pilot study on the reporting of adverse reactions to drugs, in¬ augurated in 1955 in cooperation with various medical, pharmacy, and hospital groups, was extended for another year. Fifteen hos¬ pitals throughout the country report monthly to FDA all cases en¬ countered, to test the feasibility of a large-scale system of voluntary reporting to assist in the evaluation of the safety of new drugs after they are released. Salicylates have caused a number of deaths through careless use that might have been avoided by 'warnings of their potential hazards. Under a program initiated in April 1957, special attention is being given to the labeling of salicylates during FDA inspections of drug manufacturing plants and through special surveys of stocks of aspirin and other salicylates in wholesale drug houses. Problems in determining what levels of cobalt may be safely offered for use in self-medication, what amounts may be offered under medical supervision, and at what levels cobalt-containing drugs must be re¬ garded as new drugs were resolved by the publication of a policy statement in the October 27, 1956, Federal Register. Another policy statement, published in the Federal Register of February 12, 1957, warned that stem-type and wing-type intracervical 448006—58 - 14 202 Department of Health , Education , and Welfare , 1957 and intrauterine pessaries are dangerous, serve no useful purpose, and are misbranded under any form of labeling. Subsequent inves¬ tigations indicated that manufacturers and distributors of these de¬ vices have discontinued them. Recalls. — Four manufacturers recalled 29 batches of digitoxin tablets having only 57 to 81.5 percent of the declared potency when FDA found subpotent stocks. The other three manufacturers recalled seven batches from more than 80 firms. Also at FDA’s suggestion, six manufacturers recalled digitalis tablets containing only 55 to 75 percent of their labeled potency. Another recall involved a batch of obstetrical posterior pituitary extract with practically zero potency. Twelve other recalls were based on defects that might have injured patients, such as non¬ sterility, fever-producing impurities, lost potency, and, in two cases, decomposition that caused bottles to explode on dealers’ shelves. Some vials of 40 mg. tablets of a drug used for high blood pressure were labeled as 20 mg. ; the manufacturer’s sales staff visited 27,000 wholesale and retail druggists searching for the misbranded tablets. Other mix-ups requiring recalls included a central nervous stimulant labeled as a tranquilizer, an epinephrine preparation labeled as an injectable liver preparation, turpentine labeled as castor oil, dextrose in saline labeled as invert sugar in saline, and “digestive tablets” that were actually desoxyephedrine. Two recalls involved products containing female sex hormones. One was a batch of vitamins probably contaminated from equipment that had been used for the estrogenic material; a small but definite amount of contamination was found. In the second there was deliberate addition of estradiol to a hair treatment by a firm unaware of the dangerous nature of the preparation until warned by FDA. Illegal Sales Of 114 drug prosecution cases filed, 100 were based on violative sales of prescription drugs. FDA investigations began after com¬ plaints were received from law-enforcement officials, physicians, social workers, and families of persons being injured by the drugs. In the 105 cases terminated in 1957, 145 individuals were convicted on their own pleas or by the courts. In about 10 percent of the cases the defendants were persons with no professional training who sold the drugs at truck stops, general stores, or through peddling. Seven individuals, some of them previous offenders, were sentenced to serve jail sentences ranging from 2 months to a year. On others, suspended jail sentences, probation periods, and fines were imposed. Food and Drug Administration 203 Adulterated and Misbranded Drugs and Devices After a 6- week trial in the Federal court at Pittsburgh a jury in November 1956 sustained the seizure of approximately one-half million red and black pills destined for national distribution in the treatment of cancer. At the trial the Government presented the testimony of about 80 witnesses, mostly physicians and scientists. Included were some of the country’s top medical and pharmacological authorities specializing in the field of cancer detection and therapy. By revealing the complete medical histories of the claimed cancer cures which the appellant presented at the trial and those described in the seized labeling, the Government showed that the so-called cures fall in the following categories: (1) The patient never had cancer, or (2) The patient was cured or adequately treated before going to the clinic, or (3) The “cured” patient died of cancer or still has it. In 1953 the Texas clinic was enjoined from further shipments of the drugs misbranded as an effective treatment for cancer. In deny¬ ing a motion for a new trial, the court in the Pittsburgh case said that the “medications have again been weighed and found wanting.” The Pennsylvania clinic is now under a temporary restraining order to prevent further distribution pending hearing in the fall of 1957 on the Government’s complaint for a permanent injunction. In January 1957 a “Public Beware” warning poster was distributed to post offices and other public buildings by the Food and Drug Admin¬ istration under section 705 (b) of the act, which provides for pub¬ licity to be given in matters involving imminent danger to health and gross deception of the consumer. The poster warned the public that the treatment was worthless for internal cancer and emphasized that cancer can be cured only by surgery or radiation. In an edi¬ torial at the time the posters went on display a leading metropolitan paper said, in part : The Government has taken its drastic action to protect the American people. The so-called cure is expensive ; its price is now to be advertised in every post office. Its price in bitter disappointment can be almost unbearable. And in plain words the poster says that death may be the price of neglecting proper treatment “because of the lure of a painless cure.” Previous reports have outlined the injunction and contempt litiga¬ tion based on persistent attempts to traffic in “orgone” devices for the cure of cancer and other serious conditions, and the fine and jail sen¬ tences imposed in May 1956. After the Supreme Court declined a review in February 1957, the district court refused arguments to set aside or reduce the penalties of 2 years in jail for the promoter and 1 for his distributor. 204 Department of Healthy Education , and Welfare, 1957 Another treatment for cancer, and nostrum for diseases in general, under the guise of a blood and kidney remedy, brought a conspiracy trial, injunction of the individuals and firms manufacturing and dis¬ tributing the drug, prosecution of the manufacturer for criminal con¬ tempt of the injunction, and jail sentences suspended on condition that they not manufacture, possess, or sell any remedy for the treat¬ ment of animal or human disease. Other drug injunctions granted during the year were against a naturopath who distributed from his clinic herbs with excessive thera¬ peutic claims; a manufacturer restrained from false and misleading claims for an ulcer “remedy” ; a distributor of homeopathic remedies seriously misrepresented by collateral literature ; and a distributor of “vim and vigor” proprietary remedies with promotion especially de¬ signed for the aging. Ten seizures were made of a vine and root imported without a new- drug application and promoted with claims that it was an effective aphrodisiac. Agents used reprints of a sensational magazine article entitled “The Vine That Makes You Virile.” Licensed drug chan¬ nels did not handle the product. The total of 122 seizure actions against drugs (excluding vitamin preparations) was fairly evenly divided between inherent defects and misbranding. Ten other shipments were seized because they had no effective new- drug applications. About half of them consist of untried products that may be dangerous and/or promoted with unfounded claims. The others were purchased by small distributors from recognized manufacturers and repackaged under their own names without filing new-drug applications. Included in misbranded devices seized were a number of low-grade uranium items bearing claims for arthritis and other ills. Other devices seized were stretching harnesses, electronic condensators, oscil¬ lators, and massagers. Six veterinary preparations were seized for false and misleading claims and violation of certification and new-drug requirements. New Drugs During the fiscal year 530 new-drug applications, including 85 for veterinary use, were received. On the condition of the submission of final printed labeling 334 for human use and 59 for veterinary use were permitted to become effective. Fourteen hundred supplemental applications for human and 596 for veterinary drugs became fully or conditionally effective. Revised new-drug regulations, effective August 24, 1956, required a period of readjustment for both industry and FDA. Food and Drug Administration 205 Among the new products considered during the year were tran- quilizing agents alone and in combinations with relaxants, an anti¬ histamine, and an estrogen; several products with delayed or pro¬ longed action because of slow disintegration in the intestinal tract; two new antibiotics, two iron preparations, an anticoagulant; two progesterone-like steroids for menstrual disorders; an estrogen with prolonged action; a new androgenic steroid; two sulfonamides; two antihistamines; a volatile general antidiuretic; and two narcotic analgesics. Many distributors’ supplements went into effect for parenteral noncrystalline vitamin B12 products prepared by new processes. When the first application of a drug used orally in the treatment of diabetes mellitus was permitted to go into effect, a re¬ lease was issued explaining the limitations of its uses. COSMETICS AND COLORS There were no court cases based on violation of cosmetic require¬ ments. A prosecution case was filed against a firm for making color mixtures from an uncertified batch of coal-tar color. 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 1957, 5,146 batches, representing 5,346,613 pounds, were certified, and 24 batches, representing 14,755 pounds, rejected. Insulin. — The act provides for predistribution testing and certifi¬ cation of all batches of insulin marketed. Examination of 388 samples resulted in the certification of 322 batches of insulin and 64 batches of materials for use in making insulin-containing drugs. Antibiotics. — The predistribution testing and certification of cer¬ tain antibiotics is also provided by amendments to the act. Examina¬ tions were made of 16,654 batches of penicillin, chlortetracycline, bacitracin, chloramphenicol, dihydrostreptomycin, streptomycin, tetracycline, neomycin, nystatin, erythromycin, novobiocin , poly¬ myxin, oleandomycin, and oxytetracycline during the fiscal year. The last 7 antibiotics are not included in the certification amend¬ ments, but are tested when they are mixed with those requiring certi¬ fication. Forty-three batches were rejected for failing to meet the following standards: Potency (27), sterility (9), and moisture (7). In addition, manufacturers withdrew their requests for certification of 19 batches because they failed to meet sterility and other standards. 206 Department of Health , Education , and Welfare , 1957 Enforcement of Other Acts A total of 105,728,289 pounds of tea was examined under the Tea Importation Act, in contrast with totals of approximately 104 million in the fiscal year 1956 and 97 million in 1955. Rejections for failure to measure up to the standards set by the United States Board of Tea Experts totaled 205,082 pounds, or 0.19 percent. Six rejections were appealed to the United States Board of Tea Appeals, which upheld the decision of the FDA examiner in four cases, and in one portion of one other. The appeal was sustained in the other portion of this case 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 ; all were bowl cleaners. 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 1957, but it denied six petitions for certiorari. Four were appeals from convic¬ tions where jail sentences were at stake, discussed in earlier sections of this report. The other two were appeals from decisions of the Court of Appeals for the Fifth and Seventh Circuits upholding the constitutionality of the Durham-Humphrey amendment which pro¬ hibits the dispensing of dangerous drugs without prescription. A seizure contest in which some of the tomato paste seized was re¬ leased while the rest was condemned by order of an appellate court was discussed in the 1956 report. Following this decision the claimant filed a motion that the Government pay all storage charges for the libeled material, not only for the period between seizure and adjudi¬ cation, but also for the time between sampling and seizure. The district court permitted this motion and the Government has appealed. The Court of Appeals for the Ninth Circuit upheld the district court’s decision, reported last year, that he did not have the power to order restitution in an injunction proceeding. The Court of Appeals for the Second Circuit affirmed the district court’s decision, also reported last year, in a suit under the Tort Claims Act seeking to recover damages involving importations of to¬ mato puree that were later seized. The district court had dismissed the suit on the grounds that the Tort Claims Act exempts the Gov¬ ernment from suit for the performance of discretionary powers. Food and Drug Administration 207 Defendants in a drug case filed a motion to dismiss the prosecution against the partnership on the grounds that the partnership was not a legal entity. The district court accepted the motion, basing his rul¬ ing on a divided Supreme Court decision in a case unrelated to the Food, Drug, and Cosmetic Act. The United States Court of Appeals for the Second Circuit affirmed the order of the Secretary delisting three colors from the list of coal- tar colors eligible for certification for use in foods. The order was based on evidence that these could no longer be regarded as harmless. Just after the close of the year, the United States Court of Appeals for the Fifth Circuit set aside the Secretary’s order delisting one of these colors (FD&C Red No. 32) and held that the Food and Drug Ad¬ ministration has authority to establish tolerances for colors. Since these two opinions appear to be in direct conflict, the Government filed a petition requesting the entire Fifth Circuit to rehear the case, which the court denied. It will be recommended that the appeal be carried to the Supreme Court. Changes in the Laiv and Regulations The only change in the Food, Drug, and Cosmetic Act in the 1st session of the 85th Congress was Public Law 250, amending section 304 (d). It permits under certain conditions the reexportation of seized articles imported into the United States, if the violation did not occur after import, if the articles are not dangerous to health, and if the importer was not aware that the goods were violative. Nine bills were before the House, presenting six new procedures for dealing with chemical food additives. The Department submitted its recommendations for a bill on April 8 but had not yet testified at hearings which were in progress before the 1st session adjourned. Each of the bills would provide that the promoter of a new food ad¬ ditive, before commercial marketing, test it to establish the safety of the proposed use and submit the results of the tests to the Government. Most of the proposals would exempt uses already approved by the Food and Drug Administration or, in the case of meats, by the Meat Inspection Branch of the Department of Agriculture. Each bill would exempt from its coverage chemical uses generally recognized as safe by appropriate experts. Principal areas of disagreement are whether the criteria of acceptance be based entirely on safety or be enlarged to include usefulness to the consumer, functional value, or necessity of use, in case of poisonous or deleterious chemicals, and what type of appeal procedures should be provided. 208 Department of Health , Education , and Welfare, 1957 Several bills were introduced to curb abuses occurring from indis¬ criminate use of barbiturates and amphetamine. They define who may engage in the production and distribution of these drugs, and re¬ quire such firms to maintain complete records of their handling of these compounds, which would permit improper sales to be detected by simple audit. The proposed law would grant Federal jurisdiction over the sale of such drugs regardless of their origin. It would also make unauthorized possession of these drugs an illegal act. Another bill introduced is intended to regulate the labeling of haz¬ ardous articles intended for household use. This bill, which would repeal the Federal Caustic Poison Act, would require the labeling to bear, among other things, warning statements concerning the article, instructions for safe handling and storage, and instructions for first aid in the event of injury where appropriate. Such legislation would be beneficial because the numerous articles commonly found in the cleaning department of the modern home bear little resemblance to the few in use 30 years ago when the present Federal Caustic Poison Act was passed to protect against accidental injury from such substances. A bill introduced toward the end of the session would authorize color certification on the basis that a color must be harmless under conditions of use specified in FDA regulations. Numerous other bills introduced have not yet received as much at¬ tention as those outlined above. REGULATIONS Coal-Tar Colors. — Appellant court decisions on the November 1955 order removing FD&C Red No. 32 and FD&C Orange No. 1 and No. 2 from eligibility for certification for food use are discussed under New Court Interpretations. Continued pharmacological evaluation of the safety of other colors on the FD&C list resulted in proposals in Jan¬ uary 1957 that four additional colors, FD&C Yellow No. 1, No. 2, No. 3, and No. 4, be removed from the list certifiable for internal use and added to the list of colors for external drug and cosmetic use only. Drugs. — The revised new-drug regulations outlined in the 1956 re¬ port were published in final form on July 25, 1956. A portion of the regulations dealing with investigational drugs was revised on April 20, 1957, to remove the requirements that shippers of new radioactive drugs obtain signed statements from investigators when the consignee has been licensed by the Atomic Energy Commission. During the fiscal year, 879 amendments and 41 new monographs were added to the antibiotics regulations. The third market milk survey to determine the presence and extent of antibiotics in milk was reported in 1956. It was obvious that some farmers were not heeding the required labeling warning on antibiotics for mastitis therapy to withhold milk from food use for 3 days after Food and Drug Administration 209 the last treatment. New regulations were issued in 1957 aimed at improving procedures following such therapy. One provided for the warning to be placed on the immediate container of the drug, rather than in accompanying literature. Provision was made for shortening the number of withholding hours after the last treatment in case the person requesting certification of the antibiotic presents to FDA con¬ vincing evidence that it will not be retained in the milk after the pro¬ posed time. These regulations were published on April 30, to become effective in 90 days. Another regulation concerning antibiotics in intramammary mastitis preparations limits the penicillin content to 100,000 units as a maximum dose. It was published on May 14, also to become effective in 90 days. Foods Standards. — Standards of identity were established for canned figs and for grated American cheese food. Standards of fill of container for canned tuna fish were made effective August 13, 1957 ; standards of identity will become effective February 13, 1958, except for two labeling provisions which were stayed pending a hearing. Standards of identity were promulgated for ricotta cheese and part-skim ricotta cheese. Importers filed objections on the grounds that the name ricotta was not properly applied to cheese made from cow’s milk. The order was stayed and a hearing may be required. Industry proposals and suggested alternate proposals were pub¬ lished for frozen concentrated orange juice and several related prod¬ ucts, and also for frozen lemonade concentrate. On the basis of a hearing held the previous year on an identity standard for partially creamed cottage cheese it was concluded that evidence in the record of the hearing failed to establish that the standard would promote honesty and fair dealing in the interest of consumers. A hearing was held on an objection to the prune juice order, since it did permit honey as an optional ingredient. No ruling had been made on the hearing record at the close of the year. Vitamins. — Available information with respect to riboflavin require¬ ments when hearings were held in 1940 on the minimum daily require¬ ments for vitamins and minerals under section 403 ( j ) , was based on observations relating to cure of deficiency. Later studies have made it apparent that the original estimates were too high. On June 1, 1957, the regulation was amended to lower the adult minimum daily requirement for riboflavin and establish minimum daily requirements for niacin. Pesticide Chemicals. — On July 22, 1956, the Pesticide Chemicals Amendment became fully effective. During the year, 46 petitions for tolerances or exemptions were received, of which 9 were incom¬ plete. Of the 37 accepted and some awaiting processing, 30 petitions resulted in the establishment of permanent tolerances, 5 in permanent 210 Department of Healthy Education , and Welfare, 1957 exemptions, and 4 in temporary tolerances. Since the amendment was enacted in 1954, over 1,450 tolerances or exemptions have been established for 87 pesticide chemicals. During the year it was discovered that certain organic phosphate pesticides possessed more than additive toxicity to test animals when administered together. This led to extensive investigation of the effect from feeding combinations of this class of pesticides. Greater than additive effect or potentiation has been observed with only a few combinations. Because of these findings FDA announced that in considering a petition for a tolerance or tolerances it will require experimental evidence showing the toxicity of the compound when fed to test animals with each of the other organic phosphate pesticides which has a tolerance at that time. Recent studies have revealed that certain pesticides when present in the food or when sprayed on cows will appear in the milk, for which there is no tolerance. The National Academy of Sciences has been requested to select a committee to make recommendations on a petition requesting a tolerance for a pesticide in milk. Scientific Investigations Reorganization of the scientific Divisions into the Bureau of Bio¬ logical and Physical Sciences — to strengthen FDA’s scientific re¬ search activities — was mentioned in the introductory chapter. Eval¬ uation of the safety of foods, drugs, and cosmetics offered to the public in this constantly changing period and the development and improvement of testing methods form the solid foundation of en¬ lightened enforcement activities. A major survey planned and reviewed by FDA scientists and carried on through inspection personnel throughout the country was concerned with the incidence of severe reactions to antibiotics from 1953 to early in 1957. It covered nearly one third of the beds avail¬ able in the general hospitals of this country and the observations of more than 1,600 physicians. The survey indicated that the great bulk of reported life-threatening reactions to antibiotics followed penicillin injection and that severe reactions to this drug have increased in frequency as more people have been treated with it. Other antibiotic studies included evaluation of the safety and effi¬ cacy of new antibiotics, laboratory and clinical results obtained by various combinations of antibiotics with each other and with other substances, and the development and improvement of assay methods. Another major survey, initiated in fiscal year 1957 and still under study, concerned the contamination of our foodstuffs resulting from the increasing applications of atomic energy, both civilian and mili¬ tary. While the resultant rise in radioactive background probably Food and Drug Administration 211 will not be significant by present concepts, a base line was needed for later orientation. To establish this, approximately 2,000 samples of staple canned food preserved prior to the explosion of the first atom bomb, were collected during the year, with the help of other Govern¬ ment agencies, industry, and consumers. The British and New Zealand Governments and the U. S. Antarctic Programs furnished samples left in the Antarctic in 1908-1913 and 1940. All of the sam¬ ples are being ashed, analyzed for their potassium content for cor¬ rection of normal residual radioactivity, then analyzed for basic radioactivity. A continuing survey will produce samples that may be checked against this authentic, pre-1945 data to check any increase in radioactive content. Pharmacological studies are in progress to study the safety of ingredients used to furnish depot injections of drugs; the toxicity of combinations of two or more organic phosphates, beyond their cumu¬ lative effects; neurological effects of chlorinated insecticides; and harmful effects of certain coal-tar colors included in the diet of ex¬ perimental animals; from the beginning of this study, 15 of the 19 coal-tar food colors have been tested, most of them quite exten¬ sively; 3 have been delisted, and 4 are under delisting proceedings. The preclinical pharmacology of a number of chemical compounds suggested as having some value in the treatment of cancer, has been under study in cooperation with the Cancer Chemotherapeutic Center of the National Institutes of Health. In addition to observation of the effects of these compounds on various systems and their acute and subacute toxicity, some observations have been made on the nature of their biological activity. Developing and adapting analytical methods to determine trace levels of toxic chemicals used or proposed for use in food production and processing demanded a very considerable part of the resources of FDA’s food chemists. Investigations were made into ways pesticides were entering the food supply, including whether and in what form aldrin, dieldrin, and endrin may be stored in the fat of cows fed with forage treated with these pesticides. Evalution of the residue con¬ sequences of pesticides proposed for tolerances is continuing. Indication that some preparations of cobalin or Bi2 for injection were not made from pure crystalline material according to U. S. P. standards led to the development of methods for regulatory action against impure preparations. The half million pernicious anemia patients who receive these injections will thus receive added protection. A veterinary study involved implantation or injection of chickens with diethylstilbestrol preparations. To determine the presence of estrogenic activity added by the drug, 1,500 chickens were treated, slaughtered, and edible tissues collected for bio-assay. 212 Department of Health , Education, and Welfare, 1957 During the year FDA drug chemists devised methods for the analy¬ sis of tablets of aspirin, phenacetin, and caffeine together and in ad¬ mixture with other drugs which reduced analysis time from 1 to 2 days to 1 to iy2 hours. In-vitro procedures were also devised for “sustained release” dosage forms for various drugs. Infrared spec- trophotometric methods were devised for belladonna alkaloids and for glyceryl trimitrate preparations. Studies are in progress with the Committees of Revision of the U. S. P. and N. F. to devise and revise official test methods for diethylstilbestrol, ergot alkaloids, curare alkaloids, Rauwolfia serpentina, reserpine, and digitoxin. A sensitive gas chromatographic procedure was developed for the determination of nail lacquer solvents. An overall procedure for the analysis of lipsticks was completed by means of partition chroma¬ tography. Some of the difficulties in analyzing shampoos containing alkyl sulfates were resolved through the use of ion-exchange resins. Microbiological research was concerned with problems of detection, prevention and control of food poisoning, and with studies relating to the sanitary quality of foods. Enforcement Statistics The 20,241 establishment inspections conducted by FDA were di¬ vided into 16,645 for foods, 3,058 for drugs and devices, 388 for cos¬ metics and colors, and 150 for miscellaneous products such as tea and caustic poisons. Of 18,831 domestic samples collected, 11,742 repre¬ sented foods, 6,890 drugs and devices, 123 cosmetics and colors, and 76 miscellaneous. Import samples collected totaled 9,042. In the 182 criminal actions terminated (or terminated for some de¬ fendants) in the Federal courts during 1957, the fines paid or assessed in cases pending on appeal, totaled $152,233.92. The heaviest fine in a single case was $7,500. In 59 actions the fines were $1,000 or more. Jail sentences were imposed in 35 cases involving 37 individual de¬ fendants. The sentences ranged from 1 month to 3% years, and aver¬ aged 9 months. Twelve individuals were required to serve the imposed sentences, and for 25 individuals they were suspended, on condition that violative practices be discontinued. Records of ac¬ tions terminated in the Federal courts were published in 1,280 notices of judgment. Food and Drug Administration 213 Table 2. — Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1957 Item Total Criminal prosecu¬ tions instituted Seizures accom¬ plished Injunc¬ tions requested Violative samples 1 Actions Violative samples Actions Violative samples Actions Total _ _ 1,970 1,014 784 192 1, 186 809 13 Foods - - - 1,202 757 221 77 981 672 8 Drugs and devices .. ... - 759 253 558 114 201 134 5 Cosmetics and colors . 5 1 5 1 Caustic poisons. _ _ 4 3 4 3 i 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 1957 Item Total Inspected and refused entry Inspected and released Total.. . . _ _ _ _ _ 29, 140 4, 974 24, 166 Foods _ _ _ _ 26,049 2, 981 110 2,890 2,059 25 23,159 922 85 Drugs and devices _ _ .. _ _ _ Cosmetics, colors, and miscellaneous Office of Vocational Rehabilitation Research- Demonstration Projects and Increased Community Interest Are Shaping Rehabilitation For the second consecutive year, a new record was set in 1957 1 in the number of handicapped persons prepared for employment and placed in jobs through the program of vocational rehabilitation. The total of 71,607 rehabilitations during the period was 8 percent more than that during 1956, and 23.5 percent more than in 1955. It included 70,940 persons rehabilitated through the State and Terri¬ torial agencies and 667 who entered employment after receiving serv¬ ices provided by other public agencies or voluntary community groups that received partial support from Federal funds. The increasing total of rehabilitations each year since enactment of Public Law 565, in August 1954, is evidence of the renewed vigor and increasing strength of the State-Federal partnership that is at¬ tacking the problems of disability. But another measure of progress is the emerging importance of elements of the program that were inaugurated or given greater impetus by the provisions of that legis¬ lation. The growth of these elements is significant, because it indi¬ cates trends that are giving shape to enlarged services to the disabled. One element is the sustained interest of State agencies, along with other public organizations and community groups, in the development of new local rehabilitation facilities and services and in improving existing ones. Another is the enlarged facilities for teaching and instruction in rehabilitation subjects and for training persons in re¬ habilitation work, made possible by grants to educational institutions through provisions of the new legislation. 1 Unless otherwise indicated, all subsequent references to 1957 will be to the fiscal year, that is, to the period between July 1, 1956, and June 30, 1957. 215 216 Department of Health , Education , and Welfare , 1957 Another element — and perhaps the most significant to the future of the program — is the increasing variety and broadening scope of research and demonstration projects in vocational rehabilitation, con¬ ducted by public and nonprofit organizations over the country, with the aid of Federal grants made by the Office of Vocational Rehabilita¬ tion under provisions of Public Law 565. In the 48 projects that were initiated during 1957, there was captured an increasing amount of the imagination that talented individuals, using the resources of able institutions and organizations, can bring to bear on the problems of disability and on new ways to administer and to improve the vocational rehabilitation program. REHABILITATIONS IN 1957 In the new record of 70,940 handicapped persons established in employment by the State vocational rehabilitation agencies in 1957, the major type of disability continued to be orthopedic impairments — amputations or other crippling conditions. About 39 percent (about 28,000) of the rehabilitants had this type of handicap, and, of these, about three-fifths were injured in accidents, and about one-fifth were handicapped by poliomyelitis, osteomyelitis, or arthritis. Referrals came from many sources, but the largest proportion (about 33 percent) was from physicians, health agencies, or hospitals. Another 14 percent were referred by public welfare agencies, and 8 percent by State employment service offices. About 12 percent applied for services on their own initiative. Half of the rehabilitants of 1957 had dependents, and about 65 per¬ cent were men. The average age at the time of disablement was 26, but the average age at the time the rehabilitation process was started was 36. The occupations in which rehabilitants were placed in 1957 included nearly all types of work. The proportions employed in the major occupational groups remain similar to those in recent years — skilled and semiskilled workers, 26 percent; clerical and sales, 19 percent; service workers, 18 percent; family workers and housewives, 12 per¬ cent ; professional, semiprofessional and managerial, 9 percent ; agri¬ culture, 9 percent; and unskilled, 7 percent. ECONOMIC VALUE OF THE PROGRAM The extent to which the public vocational rehabilitation program can improve the economic status of handicapped persons, increase the Nation’s productive potential, and relieve some of the dependency upon public assistance was strikingly shown in 1957. About 52,200 of the 70,940 handicapped persons prepared for and placed in employment during the fiscal year were unemployed when their rehabilitation began. The group that had been working at the Office of Vocational Rehabilitation 217 448006—5! -15 Tuberculosis 218 Department of Health , Education , and Welfare , 1957 time they were accepted for service were earning at the rate of $20.7 million a year and generally were employed in unsafe, unsuitable, or part-time work. In the first full year of employment for the entire group, it is estimated that they will have earnings at the rate of $141.1 million. More than 14,000 of those who were rehabilitated received public assistance at some time during the process, at the estimated rate of $12 million a year. The estimated total cost of the rehabilitation of these persons was about $11 million. It is estimated further that those who were established or placed in employment through the public rehabilitation program will pay, during the remainder of their working lives, about $10 in Federal income taxes for every Federal dollar invested in their rehabilitation, so that the conversion of so many persons from tax consumers to taxpayers is of pronounced economic benefit to the Nation. Research and Demonstration Projects Cover Diverse Problems of Disabled The Federal grants that help to support the widespread research and demonstration projects are made under a section of Public Law 565 which stipulates that the projects must hold substantial promise of contributing to the solution of vocational rehabilitation problems common to several or to all of the States. In making the grants, the Office of Vocational Rehabilitation has the counsel and advice of the National Advisory Council on Vocational Rehabilitation, which consists of 12 persons appointed by the Secre¬ tary for their outstanding interest or capabilities in rehabilitation matters. Miss Mary E. Switzer, Director of the Office of Vocational Rehabilitation, is chairman. The Council met three times during the year, to make recommenda¬ tions on 77 new and deferred applications and 43 continuation grants. All actions on grant applications were made in accordance with the Council’s recommendations. Forty-eight new projects were activated during 1957, approximately the same number as were started during the first 2 years of operation of the program under the new legislation. The total of the new 1957 project grants was $1,101,964. An addi¬ tional sum of $897,092 in grants for continuation of previously initi¬ ated projects was approved during the fiscal period, so that the total of Federal awards for such projects during the year was $1,999,056. The new projects brought the number that have been activated to a total of 95. Within that total — and especially among those that were started during fiscal 1957 — there is discernible a progressively awak- Office of Vocational Rehabilitation 219 ening nationwide interest in the problems of disability and a marked increase in diversity of the fields in which research is being projected. The range of projects presents the problems of disability from new angles. Those problems associated with rehabilitation of the mentally ill, for instance, are under wide attack. In Oregon there is a study of the effect that more closely coordinated activities among State rehabil¬ itation agencies and those devoted to health, welfare, and operation of mental hospitals will have on the vocational rehabilitation of mental hospital patients; projects in New York and Massachusetts have under study the vocational, social, and economic adjustments of persons released from mental hospitals; in Massachusetts there is a survey of employer attitudes toward the mentally ill in relation to hiring practices; and in Vermont and California there are demonstra¬ tions of the effectiveness of “halfway houses” to help persons dis¬ charged from mental hospitals to become conditioned to employment and to the outside world. STRIKING RESULTS IN EPILEPSY, CEREBRAL PALSY A project in California has strikingly demonstrated that more than two-thirds of a group of adults with epilepsy were reasonably good risks for rehabilitation. Working under supervision, with necessary counseling, these workers averaged $1.55 an hour during the demon¬ stration period, whereas they had been unemplo3’ed before. Their average loss of time from work was only one hour for every 91 days worked, and only half of the losses were due to seizures. Another tangible and realistic evaluation of the humanitarian and economic worth of the vocational rehabilitation program is in a study made in New York of 100 young people with cerebral palsy. After provision of adjustment services, 21 of them were sent directly to competitive jobs; 38 were sent into training for development of skills; 30 went to work in sheltered workshops; and only 8 remained for further study, so that 92 percent of this group of severely disabled are now enjoying the satisfaction of gainful employment. Further¬ more, 36 of these young people, who had been earning an average of $27 a month before receiving adjustment services, increased that average to $109 after a brief period of work. In New York City there is a survey among all current and former patients of a large rehabilitation center to evaluate the relationship of their attitudes toward their disabilities to social adjustments at home and at work. Another study in Oklahoma is looking into the psychological adjustments and work relationships of handicapped workers in industry and in sheltered workshops, and a pilot research project in New York City is gathering company experience in hiring the handicapped. 220 Department of Health , Education, and Welfare, 1957 STUDIES ON MANY FRONTS There is further diversity in projects, such as the one in California that has the objective of determining the extent to which a commu¬ nity workshop can rehabilitate hemiplegics whose employment poten¬ tiality has heretofore been considered low. Another in New York is demonstrating to employers the abilities of the handicapped to operate complex industrial machinery, and a Cleveland project is ex¬ ploring the extent to which adjustment to blindness can be acceler¬ ated by raising the hearing efficiency of newly blinded persons. There are projects to improve program administration. In Seattle there is a study of different methods of administrative organization in a rehabilitation agency office ; factors relating to the selection, train¬ ing, functions, and responsibilities of rehabilitation counselors are under study in Iowa, Illinois, and Arkansas; and a Florida univer¬ sity is demonstrating a concept of an organizational plan for a uni¬ versity for a comprehensive rehabilitation program. Other projects relate to new or improved services for those with speech disorders, for young people with neuro -muscular disorders, for the blind, the deaf, and for others. In the last month of the year the Office made public announcement that in fiscal 1958 it would initiate a program of grants for selected demonstration projects to put to practical use the new knowledge gained in research and thus accelerate vocational rehabilitation services for severely disabled per¬ sons — the mentally retarded, cerebral palsied, persons with emo¬ tional problems, epileptics, the homebound disabled, the blind and visually handicapped, the chronically ill, and older disabled work¬ ers — and to provide such services in areas where they are not available as widely as necessary. Projects under research and demonstration grant provisions were initiated in 15 States and the District of Columbia during 1955 and 1956. The 48 projects initiated in fiscal 1957 extended the geograph¬ ical range of the projects to 28 States and the District of Columbia, thus approaching more closely the basic purpose of these activities — the inclusion of more abilities, talents, and resources for research in the continuing battle against disability and its causes — and massive, widespread demonstration of the results to the employers of the Nation. Community Interest Reflected in Growth of Rehabilitation Facilities One of the most gratifying aspects of the expanding vocational re¬ habilitation program is the concurrent interest of States and com¬ munities in establishing and operating localized rehabilitation Office of Vocational Rehabilitation 221 facilities, in many of which there is increasing emphasis on vocational aspects. This increasing local interest can be attributed in considerable measure to the growing belief that services to the handicapped and disabled are most effective and successful when they can be per¬ formed in their own communities. Consequently, rapid strides are being made in all States to establish rehabilitation centers, most of which will provide comprehensive medical services. But there is also recognition of the need for vocationally oriented centers, and more and more States are operating, or have under serious contemplation, the establishment of centers which will place special emphasis on the rehabilitation problems of handicapped persons. Among the States that have established comprehensive rehabilita¬ tion centers with heavy vocational orientation, the most widely known continues to be the Woodrow Wilson center, at Fishersville, Virginia. The State of Pennsylvania has under construction a new center of similar type, to accommodate 300 persons. West Virginia opened a smaller center of the same type during the year, and Iowa sub¬ stantially expanded its center in Des Moines, which was established in 1952. FEDERAL AID TO CONSTRUCTION The construction of local rehabilitation centers has been stimulated greatly by the Medical Facilities Survey and Construction Act, which was passed in 1954 to amend the Hill-Burton hospital con¬ struction legislation, by including rehabilitation and other facilities. Under this Act, the Office of Vocational Rehabilitation and the Public Health Service during fiscal 1957 jointly approved 20 projects in 17 States for construction of rehabilitation centers. Virtually all of these accent heavily the medical aspects of rehabilitation. They brought to a total of 62 the construction projects that have been approved under the new legislation. Their cost will exceed $48 million, of which the Federal share will be approximately $10 million, and the projects will place rehabilitation facilities in 23 States that had none before the 1954 legislation. Of the 62 projects, 18 are in medical schools or teaching hospitals, 12 are in specialized hospitals, 10 in general hospitals, and 22 are community type centers. FEDERAL AID TO FACILITIES Rehabilitation centers and other facilities may be aided in their operations through Federal grants authorized by Public Law 565. During 1957, the Office made a total of 94 such grants to specialized facilities, usually for the purpose of strengthening their activities with new equipment or additional staff. 222 Department of Health , Education, and Welfare, 1957 The sum of $1,225,046 in Federal funds was allotted to these proj¬ ects, matched by expenditures of at least half as much in State or local funds, making a total of more than $1,837,569 for these purposes. NEW AIDS FOR CENTER PLANNING The resurgent interest in construction of rehabilitation centers brought an insistent demand for a consensus of current thought on the planning and operation of centers. In cooperation with the Office, the Conference on Rehabilitation Centers conducted a week-long Institute on Rehabilitation Center Planning in February. Out of the Institute there came 30 papers prepared by persons qualified by ability and experience to explain current trends in all phases of rehabilitation center operations. Efforts were made during the year to make sharper definitions of the needs of State rehabilitation agencies for services that can be provided by rehabilitation centers. Studies have been made of the working relationships among State agencies and rehabilitation centers for the purpose of increasing utilization. A study made in co¬ operation with the States’ Vocational Rehabilitation Council pointed up the sharp need for more vocationally oriented centers to comple¬ ment the medically oriented centers now in operation or under con¬ struction, as well as the need for increased services in the psychologi¬ cal and social aspects of the program. The increasing number of rehabilitation centers under many auspi¬ ces has given rise to increasing demands among professional groups in the field, by insurance companies, State agencies, and other public groups for increased recognition through some form of accreditation. Qualified staff for rehabilitation centers remains in very short supply, though it is being remedied somewhat by training grants under Public Law 565. During the year a second training course for rehabilitation center administrators was completed, making a total of 19 persons who have received intensive training for this work. SHELTERED WORKSHOPS A considerable expansion of community interest in rehabilitation is reflected in growing recognition that sheltered workshops are a basic part of the vocational rehabilitation program. Their services are essential to the rehabilitation of many severely disabled persons, as an interim step for those who cannot be absorbed readily in the labor market, or during such times as suitable competitive work opportunities are not available. The dearth of sheltered workshops that has existed for many years is being alleviated by the actions of many State rehabilitation Office of Vocational Rehabilitation 223 agencies in putting more of their resources into expansion of space, facilities, and content of workshop programs. In 1957, the sum of $465,746 was awarded in Federal expansion grant funds for 77 workshop projects in 35 States. In addition, 10 States used a total of $231,469 in basic support funds for 24 workshop projects, including 10 for the blind; and 9 States were awarded a total of $114,741 in extension and improvement grants for 12 workshop projects, including 4 for the blind. A deeper understanding of the functions and place of sheltered workshops in the vocational rehabilitation program, and of the services they offer, was provided during the year by issuance of a book of 15 chapters, each prepared by an authority in the field, and edited by the Office of Vocational Rehabilitation. The book is obtainable from the Government Printing Office under the title “Workshops for the Disabled — A Vocational Rehabilitation Resource.” During the year, the ground was laid for a resurgence of interest in the sheltered workshop field, through expansion of activities of the National Association of Sheltered Workshops and Homebound Programs. An intensive membership program is proposed, under revised standards, and a plan for an Institute on workshops was formulated, in which the Office will participate. Program of Training Is Augmenting Supply of Professional Personnel The program of grants for the expansion and improvement of the professional preparation of personnel in all fields concerned with rehabilitation of the disabled continued its progress in 1957. With the long-range objective of assuring a supply of trained, highly qualified personnel for the expanding State vocational reha¬ bilitation agencies, rehabilitation centers, workshops offering shel¬ tered employment situations, hospitals, and other agencies operating rehabilitation programs, about 200 grants were made to educational institutions, totaling slightly over $3 million. Nearly 90 percent of the total appropriated for training is granted for long-term training ; the rest was for short-term training. Grants were made to 112 colleges and universities to assist them in expanding or strengthening their instructional resources in the fields of medicine, nursing, occupational therapy, physical therapy, social work, rehabilitation counseling, prosthetics education, and other fields closely concerned with rehabilitation. Traineeship grants were made to educational institutions for scholarship assistance to about 650 full¬ time students engaged in obtaining basic or advanced professional training in the fields in which serious personnel shortages exist. 224 Department of Health , Education , and Welfare , 1957 During the year 10 medical schools received grants for training projects directed toward the teaching of rehabilitation principles and practices to graduate and undergraduate medical students, an effort which holds promise of materially affecting medical practice of the future in terms of preventing and treating disabling conditions and improving patient care. In addition, 101 physicians received stipends to permit them to undertake residency training in the medical spe¬ cialty of physical medicine and rehabilitation in 25 teaching hospitals. To meet urgent needs for trained vocational rehabilitation coun¬ selors for the State agencies and developing rehabilitation centers and workshops, 30 colleges and universities have established graduate cur¬ ricula with OVR financial assistance, and traineeships have been awarded to more than 350 rehabilitation counseling students. In view of the fact that OVR trainees constitute only 60 percent of the total enrollment of these curricula, additional graduates can be expected to be available for employment. In an attempt to make a partial appraisal of the effects of grants for rehabilitation counselor training programs, a followup study of those who had received traineeships in 1955 and 1956 was conducted early in the year, with the specific purpose of ascertaining the extent to which graduates had secured employment in rehabilitation agen¬ cies. Included in the questionnaire group were 92 trainees, of whom 88 percent responded. Reports indicated that 89 percent of the trainees who had completed the training program and had not left the labor market were employed, 72 percent of them working in State vo¬ cational rehabilitation agencies or in other rehabilitation programs. In addition to support of long-term training, OVR helped to finance over 80 short-term courses on various aspects of rehabilitation, which are designed to improve the knowledge and skills of personnel already engaged in rehabilitation services. These courses reached over 2,000 individuals. A major training effort has been in the field of prosthetics educa¬ tion, in which a series of courses has been held at two universities for the training of physicians, occupational therapists, physical thera¬ pists, and prosthetists in the techniques of limb manufacture, fitting, and training of the amputee in the use of the prosthetic device. Such courses have reached about 600 during the year, thereby enabling them to return to their home communities better equipped to deal with problems of persons who have sustained upper extremity or above- the-knee amputations. Still other short courses were held on techniques of work simplifica¬ tion for disabled homemakers, geriatric rehabilitation, and teaching of esophageal speech. OVR’s continuing interest in raising the level of State agency staff has prompted the devotion of considerable staff time and funds to con- Office of Vocational Rehabilitation 225 ducting orientation courses for newly employed counselors, seminars in administration of executive personnel, advanced courses in counsel¬ ing and placement of the blind, courses on administrative and clinical problems faced by State medical consultants, and training confer¬ ences designed to improve rehabilitation of psychiatric patients. Ad¬ vanced planning has been initiated for the stimulation and financing of organized, comprehensive staff development programs in State agencies. Services to Blind Persons Along with the general increase in the vigor of programs directed at meeting the problems of disability, there were several major aspects of progress in the provision of rehabilitation services to blind people. The most immediately productive were the increases in the number of blind people rehabilitated to self-support and, particularly, in the area of operating vending stands. The number brought to successful rehabilitation during the year increased to 4,005 from 3,765 in 1956. In the program of vending stand operations by blind people, the number of stands increased from 1,727 to 1,830; the number of opera¬ tors from 1,804 to 1,924; gross sales from $25,850,000 to $28,939,000; total earnings of operators and their blind assistants from $5,057,000 to $5,624,000, and the average net income to operators from $2,532 to $2,654. To acquaint business establishments of all kinds with the value of vending stands in their buildings, the Office issued a brochure consist¬ ing of testimonials from operators of businesses of varied types. This has been used widely in effecting the increase in the number of vend¬ ing stands. A further step to increase the number of vending stands on Federal property was taken during the year when preferential regulations for blind people in such operations were negotiated by the Departments of Agriculture and Interior and by the Government of the District of Columbia. These are in accordance with amendments of 1954 to the Randolph-Sheppard Act. The addition of the three units of govern¬ ment covered virtually all agencies with considerable Federal prop¬ erty under their control. Such regulations had been issued previ¬ ously by Departments of Health, Education, and Welfare; Treasury; Defense ; Commerce ; and Post Office ; and General Services Adminis¬ tration; Atomic Energy Commission; and Tennessee Valley Authority. The State agencies also took steps to continue the increases in the number of blind people served and in improving the services. In many States new staff was added and trained. New facilities were opened and others were improved as a general characteristic of program im¬ provement. At the same time there was considerable evidence of 226 Department of Health , Education , and Welfare , 1957 greater use of facilities, of raising the standards of service, and of higher goals. To contribute to the improvement of standards in re¬ habilitation facilities for the blind, recommendations formulated dur¬ ing a seminar in which many of the Nation’s outstanding experts on such facilities participated were published and made available throughout the country. In the expansion efforts of most States, the officials of the Office of Vocational Rehabilitation provided advice and technical assistance. A program for expansion of the use of newly developed optical aids for persons with extremely poor vision was actively launched by the OVR during the year. In furtherance of this, the Industrial Home for the Blind (Brook¬ lyn) cooperated with OVR in conducting three intensive training courses for State directors and their consulting ophthalmologists. Demonstrations of methods used in the few existing optical aids clinics were given to encourage establishment of such clinics in vari¬ ous parts of the country. At the end of the year, nine States had established or were planning establishment of the clinics. In recent years an upward trend in the sale and use of pianos has increased employment opportunities for qualified piano tuner techni¬ cians and has pointed up an urgent need for instructors of piano tuning. To help to meet these needs, and to raise and maintain the stand¬ ards of the profession for qualified blind persons, a 6-week training course for instructors was conducted cooperatively by the Office and Roosevelt University for the third year. Eight trainees from seven States attended the 1957 course and are now employed as instructors in schools teaching piano tuning to blind persons. Agriculture and related occupations as a source of employment for blind persons has, until recently, been undeveloped in rehabili¬ tation programs. Many blind persons, particularly those in rural communities, have interests in and aptitude for farm work. The Division of Services to the Blind during fiscal 1957 intensified its con¬ sultative services for States that needed guidance in formulating programs for the training and establishment of blind persons in agriculture and related pursuits. Six States received such services, which were provided with full consideration of their geographical location and the living condi¬ tions, interests, and aptitudes of the trainees. One of the most difficult problems in the rehabilitation of blind persons is placing them in competitive employment. The usual tech¬ niques for placing handicapped persons are not always adequate or appropriate for blind persons. Consequently, special training for counselors in placement of the blind is a necessity. To meet this need, Office of Vocational Rehabilitation 227 four special courses were conducted during the fiscal year under auspices of the Division of Services to the Blind, attended by 44 counselors from 30 States and Alaska. Mental Illness The growing nationwide interest in the problems of mental illness was reflected in the vocational rehabilitation program during 1957 by a marked acceleration among State agencies in their staffing and operational patterns for expansion of services to the mentally ill. An increasing number of State agencies have taken advantage of funds that are available to them under Public Law 565 for extending and improving this segment of their operations. Thirty-one States now have specialized counselors who work only in this field. Several States have instituted vocational training facilities in their mental hospitals. One State agency is operating two “half-way” houses where patients discharged from mental hospitals are given opportu¬ nity to learn a trade or to sharpen old skills, at the same time learning to live again as members of the community. In the continuing efforts to strengthen working relationships among professional personnel working in the field of mental health, three conferences were held during the year for mental health per¬ sonnel at the State level, and for staff from mental hospitals and State agencies. These workshops, cosponsored by the Office of Vocational Rehabilitation, the National Institute of Mental Health, and a univer¬ sity in each region, have resulted not only in stronger programs and an increased number of rehabilitations but have served to stimulate interest in initiating several research and demonstration projects in the field of mental illness. In several States the workshops were followed by short-term training conferences at State universities for the benefit of counselors wdio work with the mentally ill. Staff from the Office provided a variety of consultative services to State agencies during the year and participated in State and re¬ gional conferences on the subject of mental illness and the emotional problems of the physically handicapped, as well as in several national conferences of large voluntary organizations devoted to mental health. Program Expenditures Indicate Growth and Activity Throughout the Nation The total of Federal expenditures for vocational rehabilitation in 1957 came to $41,988,872. This sum was matched by State and other public and private non¬ profit groups in the approximate amount of $24 million, so that the 228 Department of Health , Education, and Welfare, 1957 total expenditure in the nationwide vocational rehabilitation program amounted to approximately $66 million. The bulk of the Federal expenditures was in grants to States and Territories in support of their basic programs. These grants amounted to $34,847,954, almost $5 million more than in the previous period. The States’ contribution to basic funds was $21,227,432, about 17 per¬ cent more than in the previous year. The Federal expenditures included $1,999,046 for research and demonstration projects, which was matched by an estimated $900,000 from the States and other sources; and $2,938,076 for training grants, which was matched by about $1 million from sources other than Federal. Federal grants to States for extension and improvement of their rehabilitation sevices amounted to $1,206,356 during the period. This sum was matched by $402,119 in State and other funds. The authority in Public Law 565 for grants to States and other public and private nonprofit agencies, for planning, preparing, and activating substantial expansions of their programs was to expire on June 30, 1956, but the Congress extended this authority for one more year. Federal grants for expansion purposes totaled $997,440 during fiscal 1957 and were matched by almost $500,000 in State and other funds. These expansion grants totaled 149, in 51 States, during the period. Public and private nonprofit organizations received a total of $907,674 for 143 projects developed in cooperation with State agencies. The remaining six were State projects. Fifteen projects totaling $120,209 were for expansion of services to the blind. STIMULATING EMPLOYMENT FOR THE HANDICAPPED An increasing number of large business organizations are responding to the efforts of the Office and State agencies, in cooperation with the President’s Committee on Employment of the Physically Handi¬ capped, to widen employment opportunities for the disabled. An outstanding example of a nationwide business organization’s development of a firm policy for utilizing the abilities of the handi¬ capped is that of Sears, Roebuck and Co. Through participation in activities of the President’s Committee, company officials became interested in the State rehabilitation pro¬ grams as a source of workers in many departments of their stores. Company officers made visits to several rehabilitation centers in the eastern part of the country, and, after viewing the training courses and investigating the performance records of persons who had been rehabilitated, instituted a company program for the hiring of handi¬ capped persons in all of their installations, a program that has proved eminently satisfactory. Office of Vocational Rehabilitation 229 Another large company that has instituted a similar program is Kaiser Aluminum and Chemical Corporation, which requested con¬ sultative services from the Federal Office, the U. S. Employment Service, and the West Virginia rehabilitation and employment serv¬ ices during the year, for appropriate methods of finding and hiring handicapped workers for a new plant in that State. A developing nationwide opportunity for employment of the hand¬ icapped is in a telephone answering service being prepared for opera¬ tion in about a thousand communities, to be supported by merchan¬ disers and manufacturers, to supply information about their products. It has been indicated that handicapped persons will be given pref¬ erence for this employment. The aircraft and airline industries, as a whole, continued their long-time policy of giving handicapped persons equal opportunity to compete for jobs, and during the year a number of trade associa¬ tions recommended such policies to their constituent members. NEW PROGRAMS STARTED Each State and Territory participating in the State-Federal part¬ nership in vocational rehabilitation is required, under Public Law 565, to have a Plan of Operation that bears the approval of the Office. Those States that have separate agencies for the blind are required to have two Plans, one for the general agency and another for the blind agency. The Plans set out the organization, major policies, and procedures that will govern the operations. Approval of a Plan for the Virgin Islands during the year brought the total of approved plans to 89 for the vocational rehabilitation programs operating in each of the States, Alaska, Hawaii, Puerto Rico, the Virgin Islands, and the District of Columbia. Following the passage of Public Law 896, in 1956, which extended the full bene¬ fits of the Vocational Rehabilitation Act to Guam, officials of that Territory began preparatory work for establishment of a vocational rehabilitation program there. A new Plan for vocational rehabilitation of the blind in Nevada, to be administered in the State’s Department of Welfare under a 1957 law, was submitted before the close of the year. In Massachusetts and South Carolina the vocational rehabilitation agencies which had been in the State boards of vocational education were set up as independent agencies during the year. By the end of 1957, 44 State agencies had Plan provisions for the establishment of rehabilitation facilities, and 38 had provisions for establishment of sheltered workshops. Also by that time, State agency-managed business enterprise programs for the blind, or for all types of the severely handicapped, were authorized by Plan provi¬ sions in 44 States. 230 Department of Health , Education , and Welfare , 1957 PROGRAM DEVELOPMENT The growth of State rehabilitation programs since enactment of Public Law 565 has brought into sharp focus the needs of State agen¬ cies for expansion of their operations and staffs, in keeping with in¬ creased demands for rehabilitation services and for the executive development of administrators. The Office, in response to this indicated need for executive training, with consultation from a Committee on Administration of the States’ Vocational Rehabilitation Council, contracted during the fiscal year with Harbridge House, Inc., a private agency specializing in execu¬ tive training, to develop and conduct a series of training courses for State administrators. The first seminar on administration was held in June 1957, under cosponsorship of Boston University. Four others are planned for 1958. Several State agencies requested consultative services from the Fed¬ eral Office during the year in readjusting their programs for expanded services. Such a study was undertaken in Ohio, on request of the State Board of Education. A final report to the Board presented a comprehensive appraisal of the State’s rehabilitation agency and sug¬ gested steps for a more effective program. A special study of the Minnesota Division of Vocational Rehabilitation was completed in September 1956, with recommendations for strengthening its opera¬ tions. Studies of the programs in New Jersey, Oregon, Kentucky, Washington, and West Virginia were made during the year, consist¬ ing primarily of consultation on specific phases of management, organization, and administration. The Office, in cooperation with the States’ Vocational Rehabilita¬ tion Council during the fiscal year, participated in a study of salaries paid to rehabilitation workers. The study was sponsored by the Bulova Watch Company Foundation, Inc., and makes available for the first time a comparison of salaries paid to people who are trained for rehabilitation work with those paid to workers in other occupa¬ tions and professions. The status of vocational rehabilitation as a State activity was ele¬ vated by several actions during the year. Massachusetts and South Carolina established independent commissions for administering their programs. The legislatures of Idaho, Utah, and Wyoming enacted self-contained rehabilitation legislation. New positions of Assistant Commissioners for rehabilitation were established in the New York and Minnesota agencies. STATE STAFF IMPROVEMENT The year marked a decade of the annual Guidance, Training and Placement Workshop, sponsored by the Office, for the formulation Office of Vocational Rehabilitation 231 and improvement of standards of casework performance among State supervisory and consultative personnel. From year to year, Workshop committees gather information and develop reports on various phases of rehabilitation practice and present them to the annual Workshop meeting for discussion and recommendation. In the 1957 Workshop, its committees, assisted by outstanding special consultants in rehabilitation, presented reports on utilization of rehabilitation facilities, counselor service, development of small business enterprises for the severely handicapped, and job-finding methods. Seventy-seven workers from 63 State agencies participated. The 1957 Workshop gave final approval to a Handbook and Guide, which was developed for the use of rehabilitation counselors in ex¬ panding employment opportunities for the handicapped, and in techniques of job-finding. CASH DISABILITY BENEFITS BROADEN PROGRAM In addition to the 1954 “disability freeze” amendment to the social security law, which was designed to protect the rights of disabled workers who are covered by that law, other amendments enacted dur¬ ing 1956 further broadened the scope of the rehabilitation program. One provision of the 1956 legislation became effective July 1, 1957, authorizing payment of cash benefits to disabled workers who are 50 years of age or more. Another provision, effective January 1, 1957, directed payments of cash benefits to disabled and dependent children of retired or deceased workers entitled to old-age benefits, provided the disability existed before the age of 18. Both amendments necessitated very close working relationships with the Bureau of Old-Age and Survivors Insurance. A basic requirement of these amendments is that persons receiv¬ ing such benefits must have disablements to the extent that they cannot engage in substantial gainful employment. Under arrange¬ ments existing in 47 States or Territories during fiscal 1957, State rehabilitation agencies make determinations of disability in these applicants, to find whether they are disabled within the definition of disability as prescribed by law and to assess their capacities for rehabilitation, to the end that the maximum number may, through rehabilitation services, be returned to gainful employment. During 1957, the State agencies made approximately 155,000 dis¬ ability determinations, screened 154,000 applicants for rehabilitation potential, and accepted almost 19,000 for further consideration of rehabilitation services. 232 Department of Health , Education , and Welfare, 1957 STATE-FEDERAL RELATIONSHIP The practices of State rehabilitation agencies in placing handi¬ capped persons continued under study during the fiscal year. The Office and the United States Employment Service initiated a series of joint studies of cooperative State agency relationships, with the aim of improving placement practices. Two such studies were con¬ ducted in 1957, one in Florida and another in Maryland, as demon¬ strations to encourage the adoption of improved practices in those States. The Florida study was particularly effective, as it brought much closer relationships between the staffs of the rehabilitation and em¬ ployment services. A description of the Florida study was being prepared late in the fiscal year for publication in a Fall issue of the Employment Security Review of the Department of Labor. The sum of these experiences in placing day-to-day operations un¬ der observation and study is providing increased understanding of the placement problems of these State agencies, a knowledge which in turn will be shared by other States. COOPERATION WITH PUBLIC ASSISTANCE For several years there has been increasing emphasis on rehabilita¬ tion services aimed toward restoration to employment of disabled persons whose major support came from public assistance funds. In 1957 the number of rehabilitations of those who had been de¬ pendent to some extent upon public assistance prior to their rehabili¬ tation was 14,000. This contrasts with 11,355 in 1953. The emphasis on this phase of the nationwide program reached the point in 1957 whereby cooperative projects for the rehabilitation of recipients of public assistance were conducted among the rehabilitation and public assistance agencies of 10 States, over and above the basic and usual services offered in their rehabilitation programs. Some of the closer working relationships that have developed among State agencies through this cooperation have been of such demonstrable value as to be continued in some States’ basic programs. Under the 1956 amendments to the Social Security Act, the States have even greater opportunity to increase the number of rehabilita¬ tions within this category. They provide ways for further strength¬ ening of cooperative relationships among State rehabilitation agencies and those concerned with public assistance, all aimed toward the helping of needy persons to achieve the greatest degree of independence. A Committee of the States’ Council on Vocational Rehabilitation studied the possibilities for cooperative services under the amend¬ ments, during the fiscal year, and, after consultation with the Office Office of Vocational Rehabilitation 233 of Vocational Rehabilitation and the Bureau of Public Assistance, made recommendations to the Council, designed to give impetus to State agency actions under the new legislation. The recommendations have been adopted. INFORMATIONAL ACTIVITIES As required by Public Law 565, the Office continued its dissemina¬ tion of information about vocational rehabilitation, and at an ac¬ celerated pace. Numerous speeches were made by the Director and other members of the staff to a variety of audiences, and several appearances were made on television and radio programs. A number of press releases were issued reporting various accomplishments, un¬ dertakings, and events. A variety of special reports, radio announcements, and other infor¬ mational materials were issued during the fiscal year. One publica¬ tion of general circulation was completely rewritten and three others were substantially revised. In addition, assistance "was given on various professional publications mentioned elsewhere. In its continuing effort to help the State rehabilitation agencies establish and maintain sound public information programs, the staff of the Division of Publications and Reports conducted one tri- regional and three bi-regional public information institutes for State staffs. Sixty-one employees from 45 agencies in 34 States participated in the institutes, which were held in New Orleans, Salt Lake City, Chicago, and Washington. In each of the institutes, considerable emphasis was placed upon the joint informational responsibilities inherent in new provisions of the Social Security Act, involving cash disability and disability “freeze” determinations of rehabilitation potentialities of applicants for benefits under the old-age and survivors insurance program. Con¬ sequently, personnel from that Bureau participated as part of the faculty. Additional faculty work was done by various State informational representatives and by personnel from the Veterans Administration, the President’s Committee on Employment of the Physically Handi¬ capped, and the National Rehabilitation Association, though the bulk of the teaching load was carried by Office staff. INTERNATIONAL ACTIVITIES A reflection of the worldwide interest in the vocational rehabilita¬ tion program of the United States is in the increasing number of trainees and visitors from other countries for whom the Office plans and supervises training in rehabilitation activities. During 1957 more than 160 persons — 50 percent more than during the previous fiscal period — came from 50 countries for long-term 448006—58 - 16 234 Department of Health , Education, and Welfare, 1957 training or short-term observation. The programs arranged for them were conducted with cooperation of the United Nations and its specialized agencies, the International Cooperation Administration of the Department of State, other Federal departments, educational institutions, and rehabilitation facilities. A highlight of the year was a program planned for a team of 10 professional persons from Mexico, composed of physicians, an ortho¬ pedic surgeon, a physical therapist, and specialists in the psycho-social phases of rehabilitation. Their program emphasized the “team” ap¬ proach to rehabilitation of the individual, relationships among public and voluntary agencies, and methods of coordinating services and re¬ sources to achieve the rehabilitation goal. There also was evidence of increasing interest of industrialists, engineers, and other professional persons from foreign countries, in the problems of the disabled and in methods of rehabilitating them. In the interests of worldwide rehabilitation, the United Nations and nongovernmental affiliates aided or sponsored rehabilitation fa¬ cilities or demonstration projects in 17 countries, designed to spread further the available knowledge that is helping the disabled to health and independence. The United Nations also devoted the second issue of its “International Social Service Review” to rehabilitation activi¬ ties throughout the world. Recruitment activities were carried on to find rehabilitation special¬ ists and workers in related fields for service in Brazil, Indonesia, Mexico, and France. Through its membership on the Interdepartmental Committee on International Social Policy, the Office was active during the year in support of the meeting of the Social Commission of the Economic and Social Council under the United Nations. Office of Vocational Rehabilitation 235 Table 1. — Number of referrals and cases, by agency, fiscal year 1957 Agency 1 Referrals Cases During fiscal year Re¬ maining at end of year 3 During fiscal year Re¬ maining at end of year 8 Total Ac¬ cepted for serv¬ ices Not ac¬ cepted for serv¬ ices 2 Total active load (re¬ ceiving serv¬ ices) Closed from active load Reha¬ bili¬ tated After rehabili¬ tation plan initi¬ ated * Before rehabili¬ tation plan initi¬ ated 8 United States, total _ 320, 025 104, 125 101, 656 114, 244 238, 592 70, 940 7,230 15,833 144, 589 Alabama _ _ 7,734 2,983 920 3, 831 7, 447 2, 070 181 262 4,934 Alaska- _ _ 613 125 69 419 270 81 7 3 179 Arizona: General . . 1,909 647 587 675 1, 195 413 45 45 692 Blind _ 113 44 41 28 118 26 14 5 73 Arkansas _ ... 5, 134 1,864 2, 044 1,226 3,765 1,501 120 129 2,015 California _ _ 19, 060 3, 787 10, 252 5,021 8, 706 1,567 507 1, 078 5, 554 Colorado: General _ 2, 498 1,103 647 748 2,007 653 181 84 1, 089 Blind _ 229 66 16 147 165 43 1 3 118 Connecticut: General.. . .. 2, 769 1,560 586 623 3,756 966 287 167 2, 336 Blind _ 192 63 94 35 158 50 18 1 89 Delaware: General.. . ... 1,297 612 487 198 1, 213 485 7 52 669 Blind _ 53 30 16 7 57 17 9 2 29 District of Columbia _ 2,681 656 1,581 444 1,506 340 156 159 851 Florida: General _ 8,495 2,800 2, 977 2, 718 6, 188 1, 854 251 517 3, 566 Blind _ 3, 199 377 1,623 1, 199 852 260 42 22 528 Georgia.. .... 19, 355 6, 296 5,231 7, 828 11, 875 5, 326 258 713 5, 578 Hawaii: General _ 1, 011 270 526 215 610 202 41 11 356 Blind _ 35 15 11 9 77 13 3 2 59 Idaho: General. . 1,538 275 630 633 599 165 24 14 396 Blind _ 31 12 2 17 34 8 4 0 22 Illinois. . . 15, 478 6, 557 4,678 4, 243 13, 549 4,207 320 1, 615 7,407 Indiana: General _ ... 2,600 1,445 524 631 4,111 1, 138 88 349 2,536 Blind _ 238 88 85 65 255 43 14 35 163 Iowa: General... ... 5, 372 1,584 1,438 2, 350 3, 710 1,065 122 200 2, 323 Blind. . 194 48 75 71 97 12 0 0 85 Kansas: General . . 3,234 855 824 1, 555 2, 093 576 60 118 1,339 Blind _ 323 78 65 180 190 49 10 2 129 Kentucky _ 6,006 1, 543 2, 557 1,906 3, 127 871 64 380 1, 812 Louisiana: General _ 4,734 2, 480 1,110 1,144 6, 157 1,602 87 349 4,119 Blind _ 663 153 142 368 543 110 12 19 402 Maine: General _ 2,615 454 1, 106 1, 055 1,137 228 25 100 784 Blind _ 163 29 69 65 86 19 7 1 59 Maryland _ _ 4, 666 1,813 1, 153 1,700 4,633 1,218 142 440 2, 833 Massachusetts: General. . ... 4, 149 1, 654 1,082 1,413 3,401 965 76 184 2, 176 Blind _ 327 126 35 166 327 62 5 12 248 Michigan: General.. 9, 850 4, 145 2,017 3,688 9, 221 3,255 384 125 5,457 Blind. . . 336 169 84 83 402 100 41 42 219 Minnesota: General _ .. 6,031 1,522 1, 929 2, 580 4, 388 967 141 119 3,161 Blind _ 688 140 277 271 381 78 13 20 270 Mississippi: General - 2,834 1,099 934 801 2, 750 912 58 250 1,530 Blind _ 841 343 357 141 905 272 42 33 558 Missouri: General _ 4,533 1, 717 1, 203 1, 613 3, 468 1,297 56 126 1,989 Blind _ 674 163 232 279 504 123 18 14 349 Montana: General _ 1,784 510 582 692 1, 176 400 15 30 731 Blind _ 366 24 236 106 54 21 2 2 29 Nebraska: General _ 1,427 847 168 412 2,052 615 43 33 1,361 Blind _ 183 60 56 67 141 57 2 2 80 See footnotes at end of table. 236 Department of Health , Education, and Welfare, 1957 Table 1. — Number of referrals and cases, by agency, fiscal year 1957 — Con. Referrals Cases During fiscal year During fiscal year Agency 1 Re- Total Closed from active load Re¬ Total Ac¬ cepted for serv¬ ices Not ac¬ cepted for serv¬ ices 2 maining at end of year 3 active load (re¬ ceiving serv¬ ices) Reha¬ bili¬ tated After rehabili¬ tation plan initi¬ ated 4 Before rehabili¬ tation plan initi¬ ated 5 6 maining at end of year ® Nevada _ . 519 75 329 115 189 54 13 4 118 New Hampshire: General _ 583 267 173 143 530 103 53 17 357 Blind _ 48 27 11 10 84 15 6 12 51 New Jersey: General - 5, 159 1, 435 1, 839 1, 885 2, 992 781 146 317 1, 748 Blind . . 736 102 137 497 410 96 14 3 297 New Mexico: General - 1, 430 294 662 474 604 285 26 10 283 Blind _ 183 32 26 125 91 18 13 2 58 New York: General - 18, 013 6, 132 6,681 5,200 13, 496 4,485 498 1, 220 7,293 Blind _ 1,022 346 252 424 803 218 34 71 480 North Carolina: General - 8, 230 4, 207 2,366 1, 657 9,795 2, 930 218 452 6, 195 Blind _ 1,326 507 520 299 1,478 368 25 95 990 North Dakota _ 1, 498 417 336 745 938 274 14 17 633 Ohio: General - 5,821 1, 726 1, 556 2, 539 3, 780 1, 250 85 213 2, 232 Blind _ 472 199 111 162 662 128 43 30 461 Oklahoma _ 5, 088 2,501 1, 590 997 7,038 1, 396 101 713 4,828 Oregon: General - 5, 538 1, 044 1, 905 2,589 2, 718 650 97 314 1, 657 Blind _ 171 54 54 63 155 43 2 3 107 Pennsylvania: General - 25, 360 9, 869 7,412 8, 079 18, 999 5, 794 706 1, 173 11, 326 Blind _ 5, 235 339 2, 943 1,953 1,079 230 76 143 630 Puerto Rico . 6, 553 1, 470 1, 108 3, 975 3, 357 868 53 193 2, 243 Rhode Island: General - 1, 756 802 354 600 1, 253 436 36 14 767 Blind _ 44 41 0 3 188 28 3 6 151 South Carolina: General... . 6, 233 1,936 1,413 2, 884 4, 822 1, 529 66 222 3,005 Blind _ 389 157 151 81 284 94 7 25 158 South Dakota: General _ 892 200 169 523 825 171 4 37 613 Blind _ 194 30 84 80 67 17 1 0 49 Tennessee: General _ 6,252 2,476 1, 487 2, 289 4, 994 2, 028 129 208 2,629 Blind _ 1, 011 257 184 570 680 171 12 14 483 Texas: General _ 10, 401 2,678 2,543 5,180 8,947 2,106 101 511 6,229 Blind _ 1, 099 371 488 240 810 334 19 21 436 Utah _ 1, 165 466 233 466 1, 197 347 35 15 800 Vermont: General _ 1, 009 269 244 496 662 171 29 45 417 Blind _ 60 30 20 10 70 19 4 7 40 Virginia: 4,192 General _ _ 12, 793 3, 510 5,307 3, 976 7,369 2,271 109 797 Blind _ 539 138 191 210 258 80 18 10 150 Virgin Islands _ 37 3 0 34 3 0 0 0 3 Washington: 2, 127 General _ 4, 827 1, 397 1,849 1,581 3, 538 1, 007 145 259 Blind _ 215 70 86 59 163 37 9 13 104 West Virginia _ 12, 879 3, 061 3,274 6,544 8,335 2, 171 71 663 5,430 Wisconsin: General _ 5,567 1,690 1, 612 2,265 4,796 1, 377 173 76 3, 170 Blind _ 158 67 43 48 178 57 9 6 106 Wyoming _ 1, 265 202 555 508 499 201 24 13 261 1 In States with 2 agencies, the State division of vocational rehabilitation 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. 4 Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 5 Closed prior to initiation of rehabilitation plan because of indifference of individual, probable increase in degree of disability, loss of contact, etc. 6 In process of rehabilitation on June 30, 1957. Office of Vocational Rehabilitation 237 Table 2. — Vocational rehabilitation grants, 1957 , State divisions of vocational rehabilitation State or Territory Total. . . Alabama _ _ Arizona _ Arkansas _ California _ Colorado _ Connecticut . . Delaware - Florida . . Georgia - Idaho . . Illinois . . . Indiana - Iowa _ Kansas _ Kentucky . . Louisiana _ Maine - Maryland _ Massachusetts . - Michigan _ Minnesota - Mississippi _ Missouri - Montana _ Nebraska _ Nevada _ _ New Hampshire _ New Jersey . . New Mexico _ New York _ North Carolina _ North Dakota _ Ohio _ Oklahoma _ Oregon _ Pennsylvania . . Rhode Island . . South Carolina _ South Dakota _ Tennessee _ Texas . . Utah _ _ Vermont _ Virginia _ _ _ Washington _ West Virginia _ Wisconsin _ Wyoming _ Alaska _ Hawaii . . . . Puerto Rico _ Virgin Islands _ District of Columbia. Support grants Extension and im¬ provement grants Expansion grants 1 Total $30, 466, 162 $1, 043, 793 $887, 220 $32, 397, 175 1, 271, 534 26, 885 20, 022 1, 318, 441 246, 190 8, 689 5,855 260, 734 866, 735 15, 862 5,892 888, 489 2, 071, 732 115, 541 79, 239 2, 266, 512 213, 665 8, 091 16,581 238, 337 322, 827 15, 895 13, 390 352, 112 145, 000 5, 000 3, 648 153, 648 783, 558 30, 606 22, 493 836, 657 1, 883, 882 32, 104 23, 528 1, 939, 514 73, 896 2, 858 76, 754 1, 516, 896 36, 120 55, 420 1, 608, 436 414, 551 24, 980 14, 960 454, 491 530, 257 21, 993 14, 850 567, 100 261, 967 14, 072 9,842 285, 881 358, 306 26,642 13,376 398, 324 900, 537 12, 000 912, 537 181, 748 8,024 3, 964 193, 736 389, 062 17, 025 406, 087 532, 013 43, 872 33, 399 609, 284 1, 124, 720 64, 155 55, 362 1, 244, 237 641, 854 22, 428 3, 200 667, 482 342, 245 10, 085 352, 330 529, 522 18, 563 23, 255 571, 340 143, 922 5,612 149, 534 173, 073 7,275 12, 598 192, 946 30, 603 5, 000 35, 603 64, 779 5, 000 4, 200 73, 979 683, 102 15, 700 2, 925 25, 863 724, 665 132, 822 16, 519 152, 266 1, 945, 851 89, 272 36, 270 2, 071, 393 896, 509 37, 991 25, 117 959, 617 224, 696 2, 630 227, 326 494, 820 27, 523 24, 981 547, 324 707, 599 17, 322 5, 427 730, 348 374, 292 11,877 9, 974 396, 143 2,419, 991 68, 550 87, 152 2, 575, 693 193, 595 7, 492 5.049 206, 136 587, 891 12, 000 9,100 608, 991 112, 700 4, 800 3, 260 120, 760 667, 782 21, 000 18, 560 707, 342 819, 364 46, 701 45, 021 911,086 200, 538 6,925 3,731 211, 194 137, 576 132, 576 5,000 948, 201 31, 731 26, 922 1, 006, 854 500, 371 15, 315 515, 686 768, 014 17, 750 9,515 795, 279 700, 206 93, 824 101, 938 29, 320 22, 071 751, 597 93, 824 107, 938 5,000 1, 000 150, 635 3, 000 1, 721 155, 356 344, 465 6, 682 242, 624 16, 875 10, 740 372, 080 6,682 249, 494 6,870 1 Includes grants to nonprofit agencies for projects developed in cooperation with State divisions of voca¬ tional rehabilitation. 238 Department of Health , Education, and Welfare, 1957 Table 3.— -Vocational rehabilitation grants, 1957, agencies for the blind State commissions or State or Territory Support grants Extension and improve¬ ment grants Expansion grants 1 Total.... _ -- $4, 381, 792 $162, 563 $110, 220 27,542 70, 464 40, 564 38, 218 329, 414 11, 012 54, 875 22, 615 92, 866 117, 185 45, 444 89, 195 110, 925 163, 663 220, 527 197, 600 29, 987 64, 068 24, 063 145, 304 29, 014 327, 834 535, 672 196, 512 47, 222 560, 260 35, 387 45, 219 33, 020 201, 830 213, 689 27, 787 61, 462 74, 006 69, 484 27, 863 3,433 3, 877 1,500 1, 875 4, 192 Maine _ _ _ - Massachusetts _ _ _ _ 600 Michigan _ Minnesota _ - 15, 000 Mississippi _ _ - . Missouri _ _ - _ 6, 100 Montana. _ Nebraska . _ 4,897 New Hampshire _ _ _ _ New Jersey _ _ New Mexico _ 4,000 42,206 New York _ 53, 683 North Carolina _ Ohio _ 7,500 2, 920 30, 385 28, 565 Oregon Pennsylvania. _ . . _ _ _ __ _ Rhode Island _ _ _ _ South Carolina _ South Dakota _ 1, 200 Tennessee _ _ 3, 265 10, 600 Texas _ _ _ 23, 250 Vermont _ ... _ _ Virginia _ _ _ _ Washington _ _ _ _ _ _ _ _ 17, 820 3, 431 2, 000 Wisconsin _ _ _ _ _ Hawaii _ _ _ 484 Total $4, 654, 575 27,542 73, 897 44, 441 38, 218 329, 414 11, 012 56, 375 24, 490 97, 058 117, 185 45, 444 89, 795 110, 925 178, 663 220, 527 203, 700 29, 987 68, 965 24, 063 145, 304 33, 014 423, 723 535, 672 232, 577 50, 142 590, 645 35, 387 45, 219 34, 220 205, 095 247, 539 27, 787 61, 462 91, 826 72, 915 30, 347 i Includes grants to nonprofit agencies for projects developed in cooperation with State commissions or agencies for the blind. Saint Elizabeths Hospital In the past year many improvements have been made in the treat¬ ment of patients as well as in the areas of education and research. That this has occurred in the face of continuing problems of shortage of staff and overcrowding of patients is a tribute to every employee in the hospital. Only through dedicated purpose and a confident belief in the integrity of the hospital administration and its function could such a magnificent job have been done by the overworked staff — both administrative and medical. In the area of physical facilities there have also been many changes — all of which have had to be programmed and planned by the staff as a part of their daily responsibilities. As our physical plant is com¬ posed of buildings up to one hundred years old, the problems of continuing maintenance are very complex and time consuming as well as expensive. In the hospital treatment program, continued interest has centered in the further development of ataractic (tranquilizing) drug therapy and in the use of the “climate” of the hospital as a treatment tool with special interest in more permissive attitudes on the part of all supervisory personnel. All of these have been stimulating changes, and the vim and vigor thus developed has resulted in increased morale of staff and improved treatment of patients. The development of new drugs — both ataractic and stimulating — goes on apace. At the close of the year more than 2,000 patients in the hospital were under treatment by ataractic drugs. As a part of the problem of overcrowding of patients, hospital operation is much complicated by the continuing increase in the average age of our patients. Aging produces a need for more and more nursing services as patients become more feeble and debilitated. A self-evaluation study of the hospital operation unit by unit, 239 240 Department of Health , Education , and Welfare , 1957 done with care, indicates that more than a 50-percent increase in staff is needed to enable us to give adequate treatment to patients, provide modern psychiatric hospital education to trainees, and carry on a small amount of good research. The budget request for only a 10- percent increase was not approved by Congress last year. The hospital continues to have many visitors representing psy¬ chiatry and allied disciplines from many foreign countries as well as from America. An extensive program in education in psychiatry and the related disciplines was carried out during the year. Training was continued in psychiatry, psychology, social work, medicine, surgery, pathology, occupational therapy, nursing, and clinical pastoral work. Students from the three local medical schools received a part of their clinical training in psychiatry at the hospital. Inservice training was also carried out in many areas. Eesearch was of necessity limited by shortage of staff and what research was completed was largely clinical in nature. The hospital operation received a severe blow with the death on May 4 of the First Assistant Physician, Dr. Jay L. Hoffman. His untimely death leaves a void which is difficult to fill. Division of Medical Services CLINICAL BRANCHES Three clinical branches carry the responsibility for general care and treatment. A Medical and Surgical Branch takes primary responsibility for the acute medical and surgical treatment of all patients and emergency attention to employees. The hospital will miss the excellent services through retirement during the year of Dr. Watson W. Eldridge, who served for more than 30 years as the Director of this Branch. As in previous years, the shortage of staff constituted the greatest operational problem. Second in importance was the overcrowding of patients. In addition, two other major factors enter into the staff shortage problem. The first of these is a direct result of the use of ataractic drug therapy which produced a return to reality in many long-term care patients, without improvement to the point where they could be released from the hospital. With their improved reality contacts, these patients began to seek normal diversions in activity programs, which obviously should be provided. This, together with the increased time required to give patients their new medications, results in additional shortage of nursing services. In the second place, the average age of patients in the hospital is gradually increasing in line with increased normal age incidence in Saint Elizabeths Hospital 241 the general population. Also, more patients in the upper age groups are being admitted. The burden of these increased nursing service demands has required a reduction in nursing service for the younger patient with good prognosis, and this of course tends to reduce the percentage of recoveries in this latter group. With an increase in staff to an adequate level there would seem to be little doubt that the number of discharges would also increase. New admissions showed an increase over the previous year of 288 patients — 1,327 to 1,615. Keadmissions constituted 25 percent of this total and is considered average. One thousand fourteen patients were discharged during the year — 130 more than the previous year. A policy of increasing permissiveness resulted in more privileges being given to patients. At the end of the year 278 patients enjoyed city privileges, 428 were on visit, and approximately 1,800 patients enjoyed privileges of the hospital grounds. Several buildings were changed from locked to open-type units during the year. An overall reduction in accidents and injuries was noted. No prefrontal lobotomies were performed during the year, very few patients were treated with electro-shock therapy, and one patient committed suicide. An interesting therapeutic development was the organization of patient ward committees and an overall patients’ congress which permitted greater participation in the operation of the hospital by patients than ever before. Patients received this change with great enthusiasm and cooperative understanding. The pressure for additional maximum security type facilities increased during the year. This situation will not be entirely cor¬ rected until the completion of the new security building now under construction and approximately 25 percent completed. All forms of therapy are used in the hospital which give hope of improvement for the patients. Continuing emphasis is placed on group therapy methods, particularly in view of staff shortages. New approaches to rehabilitation of more patients through cooperative efforts with the local departments of rehabilitation, welfare, and health are under consideration for the coming year. PSYCHOTHERAPY BRANCH Here the services to the patients include individual psychotherapy, group psychotherapy, psychodrama, dance therapy and art therapy. Art therapy was carried out through the services of volunteers, which is a rather unique and unusual arrangement. 242 Department of Health , Education, and Welfare, 1957 PSYCHOLOGY BRANCH In April 1957 the Psychology Branch celebrated 50 years of psycho¬ logical services at the hospital. An interesting scientific program was presented in addition to an exhibit of psychological apparatus used in 1907. During the year the Psychology Branch was approved by the American Psychological Association for professional psycho¬ logical training. A new psychological research laboratory was insti¬ tuted during the year, and 94 patients participated in a beginning research program. LABORATORY BRANCH Laboratory function was improved during the year by the addition of new equipment. Staff shortages are in evidence in this Branch, and pathologists and technicians are difficult to obtain. Two hundred and ninety-six autopsies were completed, representing 60 percent of hospital deaths. This Branch will be again handicapped through the resignation in the near future of Dr. Franklin Martin, the able director. NURSING BRANCH Hospital staff shortages are probably felt most acutely in the Nurs¬ ing Branch. This is unfortunate for it is here that the staff has a most important personal contact with the patient 24 hours of each day. The graduate nurse has assumed some of the service formerly per¬ formed by the physician, and this has meant that a nursing assistant has had to assume some of the responsibilities of the graduate nurse. Steps have been taken to improve the qualifications of the nursing assistant through inservice education and training, and this in turn has thrown more work on the Nursing Education Unit. It is un¬ fortunate that our graduate nurses have so much of their time con¬ sumed in the giving of medicines, including the ataractic drugs, so that they have no time left to exercise and apply their skills in psychiatric nursing. This is a tragedy which can only be relieved through the addition of nursing staff to overcome present shortages. Sixteen schools of nursing are affiliated with Saint Elizabeths Hos¬ pital in the training of student nurses, and a postgraduate course in psychiatric nursing is offered once each year to graduates of ap¬ proved schools of practical nursing. OCCUPATIONAL THERAPY Occupational therapists continue in scarce supply, and this has re¬ sulted in some reduction in service during the year. There has also been some shift in emphasis from the administration of occupational therapy in shops to a plan which takes this therapy directly to the Saint Elizabeths Hospital 243 patient in his own nursing unit. This serves to bring the patient into therapy more quickly than in the previous plan. Emphasis has con¬ tinued to be placed on industrial therapy for the long-term care patient as well as for patients who will soon leave the hospital for jobs in the community. A successful trial was made during the year of assignment of patients to the several offices in the Department of Health, Education, and Welfare as clerks, typists, or stenographers, and this plan has been quite successful. It has served as a stepping stone to patients for rehabilitation and return to a self-supporting job. SOCIAL SERVICE The workload of this Branch was sharply increased during the year through the improvement of patients on ataractic drug therapy. Special attention was given to the increasing number of teen-age patients admitted to the hospital. A shortage of Social Service staff results in a lack of service to patients who are ready to leave the hospital. This is obviously poor economy. CHAPLAIN SERVICES BRANCH The new Saint Elizabeths Chapel fulfilled a great need and has been used to the fullest extent during the year. The many patients who have improved through ataractic drug therapy have enjoyed their return to religious participation in the chapel. Unfortunately, details of purchasing requirements have delayed the procurement of a suitable organ. Many services by the several faith groups are conducted on the various wards in the different buildings for those patients who are unable to come to the chapel. LIBRARY BRANCH A medical library for the use of the staff and a general library for the use of patients continued to give needed services during the year. Approximately 1,000 volumes were added to the Medical Li¬ brary, bringing the total up to about 18,600. The Patients’ Circulating Library continues its very active services with one paid librarian and approximately 15 participating patients. At present there are more than 54,000 books in this library, and new accessions being received — largely through gifts — each year. SPECIAL SERVICES Through social activities and recreation programs, this Branch served more than 3,000 patients each week, even though the staff was limited to five individuals. Attention to patients’ music needs re- 244 Department of Health , Education , and Welfare , 1957 suited in the organization of a chorus, a symphonet, a Protestant choir, and a dance band. Sports programs carried out included soft ball, volley ball, touch football, ping-pong, tennis, and gym¬ nasium activity. VOLUNTEER SERVICES The total hours of contributed volunteer service increased approxi¬ mately 100 percent during the year. Over 16,600 hours of volunteer service was contributed by an average of 332 persons per month. The Director is the only paid staff person in this program. Volun¬ teer services assist materially in keeping the two-way street open between the hospital and the community. MEDICAL RECORDS BRANCH The Medical Records Section was reorganized during the year into a Branch and transferred to the Division of Medical Services from the Division of Administration. A qualified Medical Record Librarian was appointed as Director, and organizational studies have been carried on during the year, looking to further improvements in function. Close cooperation is maintained with the Statistical Unit, and plans are going forward for improvement in the form and content of patients’ records. Division of Administration BUSINESS MANAGEMENT BRANCH Special attention was directed during the year to the problems concerning improved management procedures. A statistical section was instituted which will assist in meeting long felt needs. Difficulty is still being experienced in recruitment of various types of profes¬ sional staff, most of whom can secure higher salaries in non- Governmental positions. Special attention was given to the improve¬ ment of diets and the serving of food with welcome physical improve¬ ments being made in several kitchens. MAINTENANCE AND INDUSTRIAL BRANCH The planning and construction of new buildings as well as the continuing problems of general maintenance of hospital grounds and buildings constitutes the major assignment to this Branch. Here, too, there are acute staff shortages, and it is virtually impossible for the Branch to carry out its responsibilities with the limited staff available. Principal contract projects are the construction of the new maximum security building, the renovation and extension of street lighting, the rewiring of old buildings, the installation of coal- Saint Elizabeths Hospital 245 handling equipment, and the extension of electrical facilities in food- serving areas. Needs of the Hospital In conclusion, it should be emphasized that the major need of the hospital is increased personnel, both medical and administrative. Until this is forthcoming every effort will be made to use existing personnel to the greatest advantage. The new security building now under construction will adequately meet a long- felt need. Additional space for the Medical Library and for medical records is now in the planning stage. This applies also to a new continuous treatment (CT-9) patient building with a cafeteria which would serve present buildings CT-7 and 8. The hospital staff looks forward with eagerness to the new Clin¬ ical Research Center in the William A. White Building which will get under way during the coming year under the combined auspices of the hospital and the National Institute of Mental Health. Table 1. — Movement of patient population , fiscal year 1957 Total Male Female White Colored Total White Colored Total Total number under care and treatment, fiscal year 1957 . - 8, 987 2, 600 1,845 4,445 2,697 1,845 4,542 Remaining on rolls June 30, 1956 7, 372 1,615 2, 178 1, 502 343 3,680 765 2, 169 528 1, 523 322 3,692 850 Admitted during year _ 422 Total discharged and died _ _ . . 1, 521 436 306 742 490 289 779 Discharged - - _ _ 1, 014 285 209 494 322 198 520 Discharged as: Recovered _ _ _ .. 114 28 32 72 60 31 23 54 Social recovery - 367 70 142 126 99 225 Improved- .. _ 376 127 64 191 124 61 185 Unimproved 101 32 24 56 36 9 45 Worse 0 No mental disorder 56 28 17 45 5 6 11 Unknown .. . . _ _ 0 Died _ _ _ 507 151 97 248 168 91 259 Remaining on rolls, June 30, 1957... . 7,466 0 2, 164 1.1, 539 +1 1, 540 62 3, 703 2, 207 +2 2,209 172 1, 556 3, 763 —7 Change in sex and color +6 2, 170 95 +7 -9 Adjusted on rolls, June 30, 1957 _ On visit and elopement- - - _ _ _ - 7,466 463 3,710 157 1, 547 134 3, 756 306 In hospital _ _ . _ _ _ 7, 003 2, 075 1,478 3,553 2,037 1, 413 3,450 Table 2. — Consolidated statement of movement of patients , by classification , fiscal year 1957 246 Department of Health , Education , and Welfare , 1957 Nonreimbursable patients spunisi UI2JTA 1 5 : 1 ~ : I" 4 3 142 1 a 142 149 eoiAjeg oqqng *S ’jCI ^ ! ^ i CO CO O l ^ sjouosud *g CM CM CO CM CO O CM © o © © © © © CM sjauosud OC < CM i i ' ' II 00 : :lh OC CM 00 CM 00 CM (sqjnd -oqoAsd xas) siauosud ‘o *ci CM CM CM II || M CM © CO CM Tt« CO sjauosud 'o -q 00 CO CM rji CO i—4 S3 05 388 -7 381 15 © © CO I s : co C<5 O II O || 05 © CO © 00 CO © sdioQ aminjy CM | CM CM CM CM suaqn pemejuj T*< ! 1 ^ 1 T*< * 90TAJ9g uST9I0j[ | CO CO 00 O 00 U- 1 + © CM eo CM suoi'1'baj9S9j jniapag | 2 2 o oo ! 00 T-H -1 © CM SJU9PTS9JU0U *0 •(! CM ^ CM © o CM C5 CO 05 60 +195 255 22 CO CO CM © 8 pjnno isnoo I CO i - r—i © IIs © © | 2 9uoz inuno 2 || in : : Is © © © 9UBSUT UBipBUBQ J 1-H O l ^ © © 2§ sgmoH I'euoijnjsf jo nnamg ec ! i i : ; Ih 1 “ CO CO 90IAJ9g UOUBZ pun ubiinaSiunni 1 CM i i CM CM CM CM uoijnsuad -moo S99^oidmg jo nnamg - Ih - ^ I CM Auijy 00 1 CO i CM i CM O CM © 1 CM CM © CM CM © CM CM 00 CO CM iniojqng 1, 386 227 05 CO CO 41 328 1,244 +189 1,433 48 © 00 CO 1,613 Reimbursable patients jgqiO — | ; i il 1 N i CM ! CM CM uoijnJ^STmrapy moj, 7, 372 1,615 1,521 507 1,014 7, 466 0 7,466 463 7,003 | 8,987 1 On rolls, June 30, 1956 _ Admitted to June 30, 1957. - - Separated fiscal year 1957 _ Deaths.. . . . Discharges. . . . .. On rolls, June 30, 1957 _ Changes in class _ _ Adjusted on rolls, June^O, 1957 _ On visit and elopement, June 30, 1957 _ In hospital, June 30, 1957 _ Total treated, fiscal year 1957. American Printing House for the Blind As the official schoolbook printery for the blind in the United States, one of the principal functions of the American Printing House for the Blind, in Louisville, Kentucky, is the provision of special educational books and supplies for the blind school children throughout the coun¬ try through the Federal Act “To Promote the Education of the Blind.” This act, originally passed in 1879, authorizes an annual appropriation to the Printing House for this purpose. Allocations of books and materials are made on a per capita basis. Only those pupils may be registered whose vision comes within the accepted definition of blind¬ ness as follows : “Central visual acuity of 20/200 or less in the better eye with correcting glasses, or a peripheral field so contracted that the widest diameter of such field subtends an angular distance no greater than 20 degrees.” The Printing House maintains large catalogs of Braille books, Talk¬ ing Books, recorded tapes, Braille music publications, large-type texts, and tangible apparatus. A rich collection of educational material is thereby provided for the kindergarten through the high school grades. A total of 6,459 blind pupils was enrolled in the residential schools for the blind and 4,724 in public schools — a total of 11,183 blind pupils being served by the Printing House — for the fiscal year ending June 30, 1957. During the 1957 fiscal year, Braille books, educational periodicals, and music made up approximately 56 percent of the materials required by the schools ; Braille slates, Braillewriters, maps, and other mechani¬ cal devices about 19 percent; Talking Books about 4i/> percent; re¬ corded educational tapes about 2 percent ; and large-type books about 171/2 percent. Approximately 2 percent was used for miscellaneous items. 247 Gallaudet College Gallaudet College is devoted to the education of deaf persons who because of their handicap would have difficulty in schools and colleges for hearing students. The college, located in Washington, D. C., is the world’s only college for the deaf. It was accredited last May by the Middle States Association of Colleges and Secondary Schools. In addition to education, it conducts research into the educational problems of deafness. It consists of the Kendall School and the col¬ lege proper. KENDALL SCHOOL Primary and secondary schooling is provided for deaf children in the Kendall School, which also serves as a laboratory school for teachers training in the college. The oral method of instruction is used for all pupils except those who make no progress under it. En¬ rollment last year was 75, of which 63 came from the District of Columbia. GALLAUDET COLLEGE The college, established in 1864 by act of Congress, offers the associ¬ ate’s degree after 2 years of study, and a bachelor’s degree in the liberal arts and sciences. The Preparatory Department provides the senior year of high school for students who are unable to obtain it in the State schools for the deaf. The Graduate Department of Education offers a master’s degree and a professional diploma in the education of the deaf to students with normal hearing, and offers a four- week training course to vocational counselors who wish to acquire a deeper understanding of deaf persons. Total enrollment in the college last year was 324 with students from 42 States, Hawaii, the District of Columbia, and 7 foreign countries. 249 448006-58 - 17 ' Howard University Howard University, located in the District of Columbia, was char¬ tered by act of Congress on March 2, 1867. The university offers programs of higher education on the undergraduate, graduate, and professional levels. Undergraduate students are registered in the college of liberal arts; graduate students seeking the master’s and doctor of philosophy degrees are registered in the graduate school; professional students are registered in the colleges of medicine, dentis¬ try, pharmacy, and the schools of engineering and architecture, music, social work, law, and religion. (The school of religion re¬ ceives no support from Federal funds.) The educational program of Howard University is conducted in keeping with the democratic purposes of the land-grant colleges and State universities with the low tuition fees and living costs which characterize these State institutions and with an educational program resting upon and permeated by the content and spirit of a general or liberal education. The university admits students of both sexes, from every race, creed, and national origin, but it accepts and under¬ takes to discharge a special responsibility for the admission and training of Negro students. ENROLLMENT OF STUDENTS During the school year 1956-57, the university served a total of 5,787 students as follows : 4,604 during the regular academic year and 1,183 in the summer session of 1956. The net total enrollment, exclud¬ ing all duplicates was 5,020, distributed in the ten schools and colleges as follows : liberal arts, 2,297 ; graduate school, 490 ; engineering and architecture, 679; music, 290; medicine, 297; dentistry, 527; phar¬ macy, 140; law, 100; social work, 150; and religion, 50. This en¬ rollment included a larger body of Negro professional students than 251 252 Department of Health , Education , and Welfare, 1957 all other universities of public support in all the Southern States combined. GEOGRAPHICAL DISTRIBUTION OF STUDENTS Of a total of 4,604 students enrolled during the regular school year, 4,115 or 89.4 percent came from 40 States and the District of Colum¬ bia, while 489 students, or 10.6 percent, came from outside the con¬ tinental United States including 43 foreign countries and 4 possessions of the United States. The 4,115 students who came from the United States were distrib¬ uted as follows: New England States, 81; Middle Atlantic States, 628; East North Central States, 204; West North Central, 69; South Atlantic States, 2,530; East South Central States, 297; West South Central States, 268; Mountain States, 6; and Pacific States, 32. The 489 students from outside the continental United States came from 43 foreign countries, including 9 countries in Africa, 8 coun¬ tries in Asia, 12 countries in Europe, 7 countries in Central America, 5 countries in South America, and 13 island countries in the British and Netherlands West Indies. VETERANS There were 821 veterans enrolled at Howard University during the school year 1956-57. These veterans were distributed among the 10 schools and colleges as follows: 363 in liberal arts, 153 in engineer¬ ing and architecture, 18 in music, 46 in pharmacy, 54 in dentistry, 46 in law, 51 in medicine, 7 in religion, 15 in social work, and 68 in graduate school. ARMY AND AIR FORCE ROTC Army ROTC. — Two hundred and eighty-five students were en¬ rolled in Army ROTC during the school year 1956-57, of whom 216 were in the first and second year courses. Air Force ROTC. — A total of 287 students was enrolled in Air Force ROTC. Two hundred and forty-two of these were in the first and second year courses. THE FACULTY There were 528 teachers serving the university during the year 1956-57. Of this number, there were 295 full-time teachers and 233 part-time teachers. The full-time equivalent of the teaching staff was 348.6. Of this number 307 were teaching in the ranks of instruc¬ tor and above as follows: 69 professors, 68 associate professors, 73 assistant professors, and 97 instructors. From the beginning of the university’s work in 1867, the Founders invited to the faculties of the university learned and able men and Howard University 253 women, on the basis of their ability and character as individuals and without discrimination as to sex, race, creed, color, or national origin. It was a major purpose of the Founders to employ Negro teachers, among others, on every faculty. Today the Negro members of the professional faculties of Howard University constitute together a group of professional teachers larger by far than all the Negroes so employed in all other American universities combined. The existence of this group of Negro university teachers at Howard University has been a standing inspiration to the Negro people for more than three- quarters of a century, and membership on one of these faculties has been the first employment of many of the outstanding Negroes in the public life of America. From them came the founder and operator of the first blood plasma bank in the world, the first Negro governor of an American possession, the first Negro in the Secretariat of the United Nations (Nobel Prize Winner), the first Negro member of the bench of the United States Court of Appeals, and the first Negro Cultural Attache in the diplomatic service of the United States to a major European nation. THE BUILDING PROGRAM In 1956-57 the following new buildings were completed and occu¬ pied: the School of Law Building, the Biology Building, and the Administration Building. The occupancy of the Administration Building permits the university for the first time to bring together all the offices involved in university- wide administration. Near the end of the school year 1956-57, work was completed on a new building for the preclinical branches of medicine. This structure con¬ stitutes an extension of the previously existing building provided for the College of Medicine. The old building is now being remodeled. The new building has five stories and a basement. It contains the classrooms required for teaching the preclinical branches of medicine, in addition to laboratories and the service spaces related to them. It is designed to provide for 200 preclinical medical students and 200 preclinical dental students and dental hygienists and to render service to 60 pharmacy students. In J anuary 1957 work was begun on a new men’s dormitory. The new dormitory will provide for 304 students and is expected to be completed in time for occupancy for the opening of the fall term in 1958. GRADUATES During the year 1956-57, there were 560 graduates, compared with 554 graduates during the year 1955-56. These 560 graduates came from 31 States, the District of Columbia, the Virgin Islands, Puerto 254 Department of Health, Education, and Welfare, 1957 Rico, and the following foreign countries: Egypt, Liberia, Nigeria, Sierra Leone, China, India, Barbados, Bermuda, Grenada, Jamaica, Trinidad, Cuba, Spanish Honduras, Albania, Germany, Latvia, Poland, Brazil, and British Guiana. These 560 graduates were distributed among the 10 schools and colleges as follows : liberal arts, 237 ; engineering and architecture, 41; music, 22; graduate school, 60; social work, 28; medicine, 72; dentistry, 51; dental hygiene, 8; pharmacy, 17 ; law, 19; and religion, 5. The university also awarded three honorary degrees. Since its establishment in 1867, Howard University has graduated 19,823 persons. By far the large majority of these graduates have been Negroes. Among their number is a larger body of graduates in medicine, dentistry, pharmacy, engineering, music, law, and social work than the entire output of Negro professional graduates in all universities and colleges of public support in the entire group of Southern States. These graduates are at work in 43 States and 27 foreign countries. In every population center in the United States they constitute the largest and most diversified group of trained Negro public servants related to any single institution in the world. The largest number of graduates have entered the field of teaching, primarily in the Southern States. Two thousand eight hundred and seventy-three have entered the practice of medicine; 2,365 have entered the practice of dentistry and dental hygiene; 2,325 have en¬ tered the practice of law; 768 have entered the ministry; 824 have entered the field of pharmacy; 583 have gone into engineering and architecture; and 357 have entered the field of social work. SERVICE IN FOREIGN COUNTRIES In recent years, teachers from Howard University have served in Burma, Brazil, Egypt, Ethiopia, Germany, India, Israel, Iraq, Italy, British Guiana, and Japan. Fulbright scholars from the university have worked in Egypt, Ghana, Iraq, Japan, Norway, Sweden, Den¬ mark, Italy, France, Greece, England, and India. The responsible leaders in Government and the friends of America again and again have acknowledged their services as being of the greatest value to their country and to the cause of democracy in the world. The most recent testimony from the Government affects work done by the Head of our Department of Architecture in British Guiana. “Dr. Mackey has made a magnificent contribution which transcends his outstanding technical competence. Dr. Mackey has established a relationship with the people of the country based on trust and mutual respect which creates an environment that is uniquely recep¬ tive to the ideas he has to convey.” Detailed Contents THE SECRETARY’S REPORT Page Health _ 2 Research _ 3 Medical Services _ 4 Services to the States _ 5 Food and Drugs _ 7 Education _ 9 Old-Age, Survivors, and Disability Insurance _ _ 11 Public Assistance _ 12 Services for Children _ 13 Vocational Rehabilitation _ _ __. _ 14 Special Planning for the Aged. _ _ 15 Table 1. — Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1957 _ 16 SOCIAL SECURITY ADMINISTRATION SOCIAL SECURITY IN 1957 _ 17 Program Emphasis _ 17 Program Operations _ 18 Program Administration in 1957 _ 20 International Activities _ 22 OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE _ 23 What the Program Is Doing _ 24 Beneficiaries and Benefit Amounts _ 24 Disability Provisions _ 25 The Protection Provided _ 26 The Coverage of the Program _ 27 Income and Disbursements _ 27 Administering the Program _ 28 Legislative Developments During the Year _ 31 Provisions of the 1957 Amendments _ 32 Combined Reporting for Social Security and Income-Tax Withholding Purposes _ 35 255 256 Department of Health , Education , and Welfare , 1957 Page Coordination of the TVA Retirement System With Old-Age, Survivors, and Disability Insurance _ 36 Retirement System of Federal Home Loan Banks _ 37 Simplification Study _ 37 Financing the Program _ 37 Old-Age and Survivors Insurance Benefits _ 37 Disability Insurance Benefits _ 38 PUBLIC ASSISTANCE _ 38 Effect of the 1956 Amendments _ 38 Trends in Caseloads and Expenditures _ 39 Old-Age Assistance _ 40 Aid to Dependent Children _ 40 Aid to the Blind _ 40 Aid to the Permanently and Totally Disabled _ 41 General Assistance _ 41 OASI Beneficiaries Receiving Supplementary Assistance Payments _ 41 Program and Administrative Developments _ 42 Improving Medical Care for Public Assistance Recipients _ 43 Strengthening Social Services for Needy People _ 46 Efforts To Increase Availability of Qualified Staff _ 49 Other Administrative Developments _ 50 Defense Welfare Services _ 52 Services for Repatriated Americans _ 52 CHILDREN’S BUREAU _ 53 Some Facts and Figures About Mothlrs and Children _ 54 Children With Special Needs _ 55 Federal Interdepartmental Committee on Children and Youth _ 56 Programs of the Bureau _ 56 Research in Child Life _ 56 Maternal and Child Health Services _ 58 Crippled Children’s Services - 60 Child Welfare Services - 63 Juvenile Delinquency Services _ 68 International Cooperation _ 69 FEDERAL CREDIT UNIONS _ 70 Research and Development _ 71 Table 1. — Social Security Administration: Funds available and obliga¬ tions incurred, fiscal years 1957 and 1956 _ 72 Table 2. — Financing social insurance under the Social Security Act: Con¬ tributions collected and trust fund operations, fiscal years 1955-57 _ 73 Table 3. — Old-age, survivors, and disability insurance: Estimated number of families and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of June 1957 and 1956 _ 74 Table 4. — Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings, by State, for specified periods, 1954, 1956, and 1957 - 75 Table 5. — Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers, and taxable earnings for specified periods, 1955-57 _ 76 Detailed Contents 257 Page Table 6. — Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average payment, June 1957, and total payments to recipients, by program and State, fiscal year 1957 _ 77 Table 7. — Special types of public assistance under plans approved by the Social Security Administration: Federal grants to States and total expenditures and percent from Federal funds, by program and State, fiscal year 1957 _ 79 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 1957 _ 81 Table 9. — Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding, Dec. 31, 1935-56__ 82 Table 10. — Federal credit unions: Assets and liabilities, Dec. 31, 1956, and Dec. 31, 1955 _ 82 PUBLIC HEALTH SERVICE HEALTH OF THE NATION _ 83 Health Record _ 84 Births, Marriages, and Divorces _ 85 Influenza _ 85 Poliomyelitis _ 87 Funds and Personnel _ 88 National Library of Medicine _ 88 Board of Regents _ 89 New Building _ 89 Public Health Methods _ 90 Analysis of Illness and Disability _ 90 Education for Health Professions _ 91 Studies of Health Services _ 91 Consultative Services _ 91 NATIONAL INSTITUTES OF HEALTH _ 92 Clinical Center _ 93 Division of Biologics Standards _ 94 Division of Research Grants _ 94 Central Services _ 95 Institute of Allergy and Infectious Diseases _ 95 Grant-Supported Research _ 96 Institute of Arthritis and Metabolic Diseases _ 97 Grant-Supported Research _ 98 Cancer Institute _ 99 National Chemotherapy Program _ 99 Grant-Supported Research _ 100 Biostatistical and Field Investigation Studies _ 100 Cancer Control and Research Training _ 101 Institute of Dental Research _ 101 Heart Institute _ 103 Grant-Supported Research _ 105 258 Department of Health , Education, and Welfare, 1957 Page Institute of Mental Health _ 106 Psychopharmacology _ 106 Mental Health Research _ 107 Grant-Supported Research _ 108 Institute of Neurological Diseases and Blindness _ 108 Grant-Supported Research _ 109 BUREAU OF MEDICAL SERVICES _ 110 Hospitals and Outpatient Facilities _ 110 Volume of Services _ 111 Training and Clinical Investigations _ 112 Medicare _ 113 Evaluation of Hospital Care _ 113 Freedmen’s Hospital _ 114 Foreign Quarantine _ 115 International Traffic Volume _ 116 Medical Examinations _ 116 Other Quarantine Activities _ 117 Health Services for Indians _ 118 Therapeutic Services _ 119 Preventive Health Services _ 119 Tuberculosis Control _ 120 Dental Services _ 121 Services to Mothers and Children _ 121 Training of Indians _ 122 Construction _ 122 Legislation _ 122 Health Facilities Construction Program _ 123 Deficit of Hospital Beds _ 124 Research in Hospital Services _ 124 Dental Resources - 124 Dental Manpower _ 125 Prepaid Dental Care _ 125 Nursing Resources _ 126 Research Grants and Fellowships _ 126 Traineeships _ 126 Studies of Patient Care _ 127 How Nurses Spend Their Time _ 127 Turnover of Nursing Personnel _ 128 Medical Services for Federal Agencies _ 128 Office of Vocational Rehabilitation _ 128 Bureau of Old-Age and Survivors Insurance, Social Security Administra¬ tion _ 129 Bureau of Public Assistance, Social Security Administration _ 129 Office of Education _ 129 United States Coast Guard, Treasury Department _ 129 Maritime Administration, Department of Commerce _ 130 Foreign Service, Department of State _ 130 Bureau of Prisons, Department of Justice _ 130 Bureau of Employees’ Compensation, Department of Labor - 131 Detailed Contents 259 Page BUREAU OF STATE SERVICES _ 131 Division of General Health Services _ 132 State Grants _ 132 Poliomyelitis Vaccine Activity _ 132 Arctic Health Research Center _ 133 Emergency Health Services _ 133 Program Development _ 134 Public Health Education _ 134 Public Health Nursing _ 135 Training _ 135 National Office of Vital Statistics _ 135 Division of Special Health Services _ 136 Accident Prevention _ 136 Air Pollution Medical Program _ 137 Chronic Disease Control _ 137 Heart Disease Control _ 138 Occupational Health _ 138 Radiological Health Medical Program _ 139 Tuberculosis Control _ 140 Division of Sanitary Engineering Services _ 141 Robert A. Taft Sanitary Engineering Center _ 141 Air Pollution Engineering _ 141 General Engineering _ 142 Milk and Food Sanitation _ 142 Radiological Health _ 143 Water Supply and Water Pollution Control _ 143 Engineering Resources _ 144 Communicable Disease Center _ 144 Epidemic and Disaster Aid _ 145 Representative Field and Laboratory Investigations _ 145 Poliomyelitis _ 145 Respiratory Diseases _ 145 Venereal Diseases _ 145 Viral Encephalitis _ 146 Diphtheria _ 146 Rabies _ 146 Psittacosis _ 147 Typhoid Fever _ 147 Staphylococcus Diseases _ 147 Laboratory Activities _ 147 Vector Control Problems _ 148 Training _ 148 Division of Dental Public Health _ 148 Fluoridation _ 148 Other Services _ 149 Division of International Health _ 149 Table 1. — Statement of appropriations, authorizations, obligations, and balances, fiscal year 1957 _ 150 Table 2. — Commissioned officers and civil service personnel as of June 30, 1957 _ 153 Table 3. — Research grants and awards, fiscal year 1957 _ 155 Table 4. — Payments to States, fiscal year 1957 _ 156 260 Department of Health , Education , and Welfare , 1957 OFFICE OF EDUCATION Page Introduction _ 159 Legislation _ 161 Organization and Administration of Education _ 164 State School Administration _ 164 Local School Administration _ 165 School Finance _ 165 Schoolhousing _ 166 Services to Local Schools _ 167 Elementary Education _ 167 Secondary Education _ 168 Adult Education _ 169 Exceptional Children _ 170 Audiovisual Education _ 171 Radio-Television Services _ 171 Guidance and Student Personnel _ 172 Vocational Education, r _ 172 Higher Education _ 175 Cost of Going to College _ 175 Statewide Planning and Coordination of Higher Education _ 176 College Student Retention and Withdrawal _ 176 College and University Facilities Survey _ 176 Survey of Organized Occupational Curriculums _ 177 College Staffing Study _ 177 Institutional Financial Aid to Students _ 177 College Housing Program _ 178 Administration of Grants _ 178 International Education _ 178 Research and Studies _ 179 Far East Unit _ 179 Evaluation of Foreign Credentials _ 180 Educational Clearinghouse _ 180 International Conferences _ 180 Educational Materials Laboratory _ 181 Teacher Exchange Program _ 181 Teacher Education Program _ 182 Technical Training Program _ 182 Technical Cooperation Program _ 182 Nonprogram Visitors _ 182 Research and Statistical Services _ 183 Cooperative Research _ 183 Statistical Services _ 184 New Surveys _ 184 Assistance to Schools in Federally Affected Areas _ 186 Library Service _ 187 Public Libraries _ 187 Detailed Contents 261 Page Education for Librarianship _ 188 Public School Libraries _ 188 Advisory Committees _ 188 The President’s Committee on Education Beyond the High School - 189 Major Publications Off the Press in Fiscal Year 1957 _ 190 Table 1. — Enrollment in the continental United States, 1955-56 and 1956-57 _ 191 Table 2. — Supply and demand for elementary and secondary public and nonpublic school teachers, 1956-57 _ 191 Table 3. — Grants to States: Office of Education, fiscal year 1957 _ 192 FOOD AND DRUG ADMINISTRATION Food, Drug, and Cosmetic Act _ 195 Disaster and Defense Activities _ 195 On the Food Front _ 196 Potential Health Hazards _ 196 To Keep Food Clean _ 197 Pocketbook Protection _ 199 Seafood Inspection Service _ 200 Products of Special Dietary Significance _ 200 Drugs and Devices _ 201 Illegal Sales _ 202 Adulterated and Misbranded Drugs and Devices _ 203 New Drugs _ 204 Cosmetics and Colors _ 205 Certification Services _ 205 Enforcement of Other Acts _ 206 New Court Interpretations _ 206 Changes in the Law and Regulations _ 207 Regulations _ 208 Scientific Investigations _ 210 Enforcement Statistics _ 212 Table 1. — Actions on foods during the fiscal year 1957 _ 198 Table 2. — Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal year 1957 _ 213 Table 3. — Import inspections and detentions during the fiscal year 1957_ 213 OFFICE OF VOCATIONAL REHABILITATION Research-Demonstration Projects and Increased Community In¬ terest Are Shaping Rehabilitation _ 215 Rehabilitations in 1957 _ 216 Economic Value of the Program _ 216 Research and Demonstration Projects Cover Diverse Problems of Disabled _ 218 262 Department of Health , Education , and Welfare , 1957 Page Striking Results in Epilepsy, Cerebral Palsy _ 219 Studies on Many Fronts _ 220 Community Interest Reflected in Growth of Rehabilitation Facilities _ 220 Federal Aid to Construction _ 221 Federal Aid to Facilities _ 221 New Aids for Center Planning _ 222 Sheltered Workshops _ 222 Program of Training Is Augmenting Supply of Professional Per¬ sonnel _ 223 Services to Blind Persons _ 225 Mental Illness _ 227 Program Expenditures Indicate Growth and Activity Throughout the Nation _ 227 Stimulating Employment for the Handicapped _ 228 New Programs Started _ 229 Program Development _ 230 State Staff Improvement _ 230 Cash Disability Benefits Broaden Program _ 231 State-Federal Relationship _ 232 Cooperation With Public Assistance _ 232 Informational Activities _ 233 International Activities _ 233 Table 1. — Number of referrals and cases, by agency, fiscal year 1957 _ 235 Table 2. — Vocational rehabilitation grants, 1957, State divisions of voca¬ tional rehabilitation _ 237 Table 3. — Vocational rehabilitation grants, 1957, State commissions or agencies for the blind _ 238 Chart 1. — Disabilities and major occupational groups _ 217 SAINT ELIZABETHS HOSPITAL Division of Medical Services _ 240 Clinical Branches _ 240 Psychotherapy Branch _ 241 Psychology Branch _ 242 Laboratory Branch _ 242 Nursing Branch _ 242 Occupational Therapy _ 242 Social Service _ 243 Chaplain Services Branch _ 243 Library Branch _ 243 Special Services _ 243 Volunteer Services _ 244 Medical Records Branch _ 244 Division of Administration _ 244 Business Management Branch _ 244 Maintenance and Industrial Branch _ 244 Detailed Contents 263 Page Needs of the Hospital _ 245 Table 1. — Movement of patient population, fiscal year 1957 _ 245 Table 2. — Consolidated statement of movement of patients, by classifica¬ tion, fiscal year 1957 _ 246 AMERICAN PRINTING HOUSE FOR THE BLIND Services to Schools and Classes for the Blind _ 247 GALLAUDET COLLEGE Kendall School _ 249 GaJlaudet College _ 249 HOWARD UNIVERSITY Enrollment of Students _ 251 Geographical Distribution of Students _ 252 Veterans _ _ _ 252 Army and Air Force ROTC _ 252 The Faculty _ 252 The Building Program _ 253 Graduates _ 253 Service in Foreign Countries _ 254 U. S. GOVERNMENT PRINTING OFFICE: 1958 '• M | p r U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE v| m i . depahtmojt of ■min EDUCATION, AN3 WElfARE UORAliy MAY 1 - 1959 EDUCATION COUECTION For sale by the Superintendent of Documents, U. S. Government Printing Office Washington 25, D.C. - Price 75 cents; (paper) U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1958 Marion B. Folsom, Secretary Vacancy, Under Secretary OFFICE OF THE SECRETARY Elliot Lee Richardson . Assistant Secretary for Program Analysis. Edward Foss Wilson . Assistant Secretary for Federal-State Relations. Aims C. McGuinness . Special Assistant for Health and Medical Affairs. John R. Mackenzie . Legislative Liaison Officer. Homer D. Babbidge . Assistant to the Secretary. Charles F. Barrett . Assistant to the Secretary. Robert H. Hamlin . Assistant to the Secretary. Parke M. Banta . General Counsel. Rufus E. Miles, Jr . Director of Administration. Chester B. Lund . Director of Field Administration. Harvey A. Bush . JMrector of Publications and Reports. Frederick H. Schmidt . Director of Security. SOCIAL SECURITY ADMINISTRATION Charles I. Schottland . Commissioner of Social Security. William L. Mitchell . Deputy Commissioner of Social Security. Victor Christgau . Director , Bureau of Old-Age and Survivors Insurance. Jay L. Roney . Director, Bureau of Public Assistance. J. Deane Gannon . Director, Bureau of Federal Credit Unions. Katherine B. Oettinger . Chief, Children's Bureau. PUBLIC HEALTH SERVICE Leroy E. Burney . Surgeon General. John D. Porterfield . Deputy Surgeon General. James V. Lowry . Chief, Bureau of Medical Services. Charles E. Burbridge . . . Superintendent, Freedmen's Hospital. David E. Price . Chief, Bureau of State Services. James A. Shannon . Director, National Institutes of Health. OFFICE OF EDUCATION Lawrence G. Derthick . Commissioner of Education. Wayne O. Reed . Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION George P. Larrick . Commissioner of Food and Drugs. John L. Harvey . Deputy Commissioner of Food and Drugs. ii OFFICE OF VOCATIONAL REHABILITATION Mary E. Switzer . Director of Vocational Rehabilitation. E. Emory Ferebee . Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL Winfred Overholser . Superintendent. Addison M. Duval . Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Finis Davis . Superintendent , American Printing House for the Blind. Leonard M. Elstad . President , Gallaudet College. Mordecai W. Johnson . President, Howard University. REGIONAL DIRECTORS Lawrence J. Bresnahan .... Region I, Boston , Mass. Joseph B. O’Connor . Region II, New York, N. Y. Edmund W. Baxter . Region III, Charlottesville, Va. Richard H. Lyle . Region IV , Atlanta, Ga. Melville H. Hoscii . Region V, Chicago, III. James W. Doarn . Region VI, Kansas City, Mo. James H. Bond . Region VII, Dallas, Tex. Albert H. Rosenthal . Region VIII, Denver, Colo. Fay W. Hunter . Region IX, San Francisco, Calif. 111 Letter of Transmittal Department of Health, Education, and Welfare, Washington , D. C ., December 1 , 1958. Dear Mr. President: 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, 1958. Respectfully, The President, The White House, W ashing ton, D. C. Secretary. Contents Page The Secretary's Report . 1 Social Security Administration . 17 Public Health Service . 83 Office of Education . 153 Food and Drug Administration . 195 Office of Vocational Rehabilitation . 215 Saint Elizabeths Hospital . 239 American Printing House for the Blind . 247 Gallaudet College . 249 Howard University . 251 fA detailed listing of the contents of this report, by] \topic headings, will be found on pages 255-262. J vii * The Secretary’s Report A changing attitude toward problems in social welfare is increas¬ ingly making its mark on our times. We are less and less inclined to accept as inevitable some of the age-old burdens of illness and ignorance and poverty which have limited man’s lot through the centuries. There is a growing determi¬ nation to uncover new hope for that which once seemed hopeless. We have often heard it said, for example, that the poor wre will always have with us. But today, more and more, wre are asking : is poverty really necessary ? Or at least we are asking : can’t we further reduce, somewhat dramatically, the extent of poverty? Similarly, diseases such as cancer and mental illness and heart afflictions — once considered all but insoluble — are now under vigorous attack. This changing attitude arises in part from our increasing store of knowledge and our greater economic resources. Each new success against disease, ignorance, and poverty lifts our vision to the possi¬ bility of a further victory. We know now that much more is possible than man once would have dreamed. The rising tempo of advances against age-old social ills also arises in part, I believe, from a heightened sense of responsibility and concern for our fellow man, a growing sense of intolerance of preventable human suffering. And it arises in part from a clearer understanding that continued advances in national prosperity, in national security, in our quest for world peace, rest in the final analysis on the development of human resources — on the physical energies, the knowledge and intelligence, the freedom from fear of want, of the American people. 1 2 Department of Health, Education, and Welfare, 1958 The progress we have made this past year against illness and igno¬ rance and poverty reflects this growing determination to break new ground in social welfare. The Department of Health, Education, and Welfare is the principal instrument of the Federal Government in this advance. But inter¬ woven throughout this report of the Department’s activities is strong evidence of another element in our national progress. This is a grow¬ ing disposition on the part of the American people to adapt to our complex modern society the old-fashioned habit of cooperation. In earlier times, among neighbors, families, towns, or movers on a westbound trail, cooperation often was something of a necessity for survival. In today’s increasingly complex society, cooperation be¬ comes more involved, but it is no less necessary and the benefits that stem from it are even more far-reaching. We have found that if our free society is to progress, Federal, State, and local governments must work more closely together, in cooperation with American in¬ dustry, private colleges and universities, voluntary organizations, and individuals. In our system of free private enterprise, as cooperation becomes more and more necessary to progress, we must never lose sight of the fact that the individual’s efforts on his own behalf are still paramount. The fundamental purpose of all our cooperative action is to enlarge the opportunities of the individual to better his own lot. Progress and Cooperation for Economic Security Few actions ever taken by the American people have made a greater contribution to economic security of more people, over a longer period of time, than the enactment of legislation creating the social security system. Over the years the system has become increasingly sound and strong, despite stresses of war, rapid economic changes, and an unpredicted and unprecedented growth in population. In recent years the growth of the old-age, survivors, and disability insurance program has been almost spectacular. Coverage has been broadened to include additional millions of people and now extends to nine-tenths of the work force. And the number of beneficiaries has increased almost 4 times in the past 8 years. At the end of the fiscal year, 11.9 million people were receiving bene¬ fits at an annual rate of $8 billion. Most of the beneficiaries (9.7 mil¬ lion, or 81 percent) were men and women who had reached the age of retirement. Of the remaining 2.2 million, almost 1.6 million were chil¬ dren, some 430,000 were mothers, and 200,000 were disabled workers aged 50 to 65. The Secretary’s Report 3 For the fiscal year 1958 the average benefit for a retired worker and his wife was $109.90 a month. The average for a widowed mother and two children was $148.70. The relationship between the social security system and the Nation’s economy was emphasized anew during the middle months of the fiscal year when a downturn in business activity occurred. By April pay¬ ments under social security, public assistance, unemployment insur¬ ance, workmen’s compensation, veterans’ pensions and compensation, railroad and government employee retirement, and temporary disa¬ bility insurance, reached a new high rate of $24 billion annually. Thus, not only were millions of people protected in the recession period but purchasing power was bolstered, and the whole economy was strengthened. Social insurance, related payments, and public assist¬ ance at the end of the year accounted for 6.6 percent of the total per¬ sonal income in the United States, compared with 5.4 percent the pre¬ ceding year. This jump was due largely to the increased number of old-age, survivors, and disability insurance beneficiaries and to in¬ creased unemployment insurance payments. Under the 1956 amendments more than a half million women aged 62 to 64, and more than 200,000 disabled men and women were receiv¬ ing benefits by the end of the fiscal year. To keep abreast of public needs, 26 additional district social security offices were opened during the year in agricultural communities and in areas where industrial expansion has created new population concen¬ trations. There are now 584 district offices. In October 1957, an Advisory Council on Social Security Financ¬ ing was appointed to review the status of the OASI Trust Fund and the recently established Disability Trust Fund, in relation to their long-term commitments. Composed of outstanding representatives of employers, employees, the self-employed, and the public, the Council will contribute knowledge and experience to assure that the social security system will continue to operate on a sound financial basis. A group of business consultants, appointed by the Secretary to sur¬ vey operations of the Bureau, made a number of recommendations for improved administration. The consultants generally praised the ef¬ ficiency of OASI operations and reported they were “well impressed with the way the Bureau personnel met and dealt with the public and with the impression of both efficiency and friendliness.” Soon after the close of the fiscal year, significant legislation was enacted. Among other provisions, old-age, survivors, and disability insurance benefits are increased and benefits provided for the depend¬ ents of disabled workers. The legislation raised the amount of total earnings that may be credited for benefit purposes, and provided for an increase in tax contribution rates and a stepped-up schedule for future tax increases. 4 Department of Health , Education , and Welfare , 1958 Progress and Cooperation for the Needy Today’s concept of social work is moving to a wider horizon where dependency is regarded more and more as a problem to be solved, and not merely a condition to be ameliorated. As this concept is applied more broadly and effectively, social work will move still closer to the ultimate objective — that of preventing dependency. This goal may never be attained in full for a whole society; but we can speed our progress by improved services, and more joint planning and coordina¬ tion among both public and private agencies. A great deal of this teaming up to solve the problems of human want is already taking place, and gaining impetus all the time. Dur¬ ing the year efforts from many directions were made to learn more about dependency, and what causes it; about what kind of persons become dependent, and how they can be helped toward independence. In June 1958, 5.6 million needy persons were receiving monthly payments under Federal-State programs of public assistance. These included 2,460,000 persons 65 and over, 2,733,000 persons receiving aid to dependent children, 313,000 permanently and totally disabled persons, and 108,000 blind persons. Total expenditures for public assistance from Federal, State, and local funds, including payments for medical care, were $2,911,000,000 during the year. Of this, $1,642,000,000 were Federal funds, representing 60 percent of the total budget of the Department. In addition, more than a million people in June 1958 were receiv¬ ing State or locally financed general assistance, a 71-percent increase over the previous year. Most of the increase came in the winter and spring, to include a number of unemployed men and women who had exhausted rights to unemployment insurance benefits. There was a steady decline in the number of people receiving old- age assistance, even though the population over 65 is increasing. In June 1950 about 226 of every thousand older persons were receiving public assistance. By the end of fiscal 1958 the figure was 162 per thousand — a decline of 28 percent. This decline reflects the progress of the social insurance system in providing greater economic secu¬ rity — as an earned benefit — for more and more older people. At the other end of the age scale, there was a substantial increase in need — among our children. In June 1958 nearly 2,733,000 persons received payments under the program of aid to dependent children — the largest number in any month since the beginning of the program, and 334,000 more than in J une 1957, an increase of more than 12 per¬ cent. Children now represent the largest group of needy people in the Nation. The economic recession caused part of this increase — but a major long-term factor has been the increasing breakdown of the family The Secretary’s Report 5 unit. Most of these dependent children have been deprived of normal family life and normal support as a result of divorce, deser¬ tion, or unwed parenthood. In August 1958 amendments to the Social Security Act were en¬ acted to increase the amount of Federal funds available to States for public assistance, and to simplify State bookkeeping methods for claiming Federal funds. In addition, the legislation related part of the Federal share of funds to the financial abilities and needs of the States, and thus provides more assistance in low-income States where human needs are often greatest. These amendments became effective on October 1, 1958. Progress and Cooperation for Children The United States soon will cross a new population frontier. By 1965 the number of children under 18 years of age is expected to reach 70 million — and we will have then more children than there were people in the country less than 60 years ago. Even now our 59 million children represent one-third of the population. Every social resource in the Nation will be challenged to provide services when and where they are required, and to keep abreast of new needs of children in a world of change. Planning to meet future demands is a continuing need. An im¬ portant means of planning and communication is offered by the White House Conference on Children and Youth, which has been held every ten years since 1909. The President has called the sixth such conference for March 1960. In preparation, special commit¬ tees in each State will take stock of the problems of their young people. The Children’s Bureau during fiscal 1958 gave increasing attention to a number of problems of urgent nationwide concern. One of these pressing problems is that of juvenile delinquency. Preliminary data for 1957 indicate that more than a half million children appeared before courts on delinquency charges. Another urgent social problem rises from the increasing number of births out of wedlock — 193,500 in 1956. About 77,000 of these unmarried mothers were under 20 years of age. The Children’s Bureau also intensified its activities in accident prevention, the chief cause of death to children and young people. F ollowing the close of the fiscal year, new amendments to the Social Security Act authorized an increase of $5 million in future appro¬ priations for each of the three grant programs administered by the Children’s Bureau. For maternal and child health services, $21.5 million is authorized; for crippled children’s services, $20 million; and for child welfare services, $17 million. 6 Department of Health, Education, and Welfare, 1958 As a major step forward, the new amendments authorized child welfare services for children in urban areas on the same basis as services for rural children. Progress and Cooperation for the Disabled The fiscal year 1958 brought further progress in our efforts to re¬ store the disabled — and particularly the severely disabled — to inde¬ pendent lives. During the year more than $50 million in Federal funds, granted through the Office of Vocational Kehabilitation, became available for State rehabilitation programs for research and demonstration proj¬ ects, and for training grants to colleges and universities to increase the Nation’s supply of professional workers in rehabilitation. State legislatures increased their own expenditures for the handicapped to $25 million or 17 percent over 1957. For the third year in a row, a new record in the numbers of men and women rehabilitated was achieved this year. More than 74,000 disabled people were rehabilitated into employment, and in addition, more than 18,000 others were prepared and available for employment at the end of the fiscal year. Increasingly, disabled men and women, all over the country, seek the services of rehabilitation agencies. Some are crippled by acci¬ dent or disease, some are blind or deaf, others suffer from chronic illness or mental impairment. They hear of this source of hope from their doctors, from hospitals, from health agencies, from public wel¬ fare offices, or from State employment offices. But there are far more disabled men and women who need help than present facilities — public and private — can accommodate. Every year, it has been estimated, some 250,000 persons come to need, and could profit by, vocational rehabilitation programs. During the past decade, almost 635,000 disabled people have been rehabilitated into successful employment. Taking their places on farms, in factories and shops, in homes, or as professional workers, these men and women are now active members of the American labor force. About two-thirds of those rehabilitated in 1958 had been un¬ employed when their rehabilitation began — the others worked only part time, or in unsafe, low-paying jobs. Those working had earned altogether about $21.7 million a year, an average of only $1,000 per person. The entire group will earn, during a full year of employ¬ ment, an estimated $147.8 million. Nearly 15,000 men and women rehabilitated last year had been re¬ ceiving public assistance at a rate of about $14 million a year, which is $1 million more than the entire cost of their rehabilitation. Obvi¬ ously, this program pays for itself, in increasing the Nation’s produc- The Secretary’s Report 7 tive potential, in tax revenues, and in relieving dependency upon public assistance. But even more important than these monetary considerations are intangible values inherent in rehabilitation. These values lie in the fostering of an atmosphere of healthy self-reliance and accomplish¬ ment for those who have overcome their handicaps — and for their families. An expanded research program — as varied as the needs of the dis¬ abled — was well under way during the year. Altogether, 177 research and demonstration projects, including special ones for the severely disabled, have been conducted since the beginning of the research program in 1955. More than 80 new research programs were begun this past year to develop new and better methods of rehabilitation. Increasing emphasis was placed last year on selected categories of severe disability including mental retardation, chronic illness, cerebral palsy, and epilepsy. Thirty demonstration projects in 22 States were in full operation in these fields by the end of the year, to show that these severely disabled persons can be rehabilitated with modern methods and techniques. Each of these was based upon a successful research project. The 1954 amendments to the Medical Facilities Survey and Con¬ struction Act authorized Federal aid for the construction of much needed rehabilitation centers. Since then 82 such centers have been built at a total cost of more than $60 million, the Federal share being about $13.5 million. Federal funds for this work amounted to $2,185,- 835 during fiscal 1958. The bulk of the funds came from State, com¬ munity, and private sources. Each center serves a wide geographical area. And each is a valuable, tangible witness to the worth of the intangible factor of cooperation. Progress and Cooperation for Education Stimulated in part by the launching of the first earth satellite by the U. S. S. R., interest in American education increased dramatically during the year. There were indications that the American people generally were beginning to be more concerned about weaknesses in education and more responsive to today’s needs in education. A number of events in the past few years had helped lay a basis for stepped-up progress in education. The White House Conference on Education in 1955 was a major step toward identifying educational problems in the elementary and secondary schools and setting a course toward overcoming them. The President’s Committee on Education Beyond the High School, appointed in 1956, made a comprehensive survey of the present status and future needs of our colleges and universities. Composed of dis- 8 Department of Health , Education , and Welfare , 1958 tinguished educators and laymen, the Committee in two separate re¬ ports to the President made recommendations for positive action to help our colleges and universities meet the mounting and changing needs of today’s world. In addition to these nationwide studies, in communities all over the country, parents, teachers, and citizens groups began to focus new attention on problems in their own schools. Business and labor, pri¬ vate foundations and organizations, began to increase their interest and support. And, as problems and soft spots in American education came in for critical, wide-scale examination, many people also found new appreciation for strengths inherent in our schools. THE PROBLEMS Shortage of teachers. — One of the most serious single problems con¬ fronting education is the shortage of teachers who train the scientists, researchers, social workers, businessmen, doctors, and workers in many other fields upon whom our national security and our future progress as a nation depend. The President’s Committee on Education Beyond the High School reported that by 1969 somewhere between 180,000 and 270,000 new college teachers must be recruited — between 15,000 and 22,500 an¬ nually. As it stands now, no more than 3,500 of the 9,000 students annually awarded Ph. D.’s in our graduate schools become college teachers. In our public grade and secondary schools we were short last year by more than 130,000 qualified teachers. This means that several mil¬ lion children were being short changed in their educational oppor¬ tunities. The generally low salaries paid teachers at all levels of instruction are unquestionably one of the chief blocks to progress in education. At the beginning of the school year in 1957, the average grade school teacher earned only $4,325; the average high school teacher only $4,840; and the nationwide average for college teachers was only $6,120 annually. This is a shockingly low return in view of the re¬ sponsibilities vested in teachers and the large investment of time and money involved in their preparation for teaching. Classroom shortage. — In the fall of 1957, the States reported almost 2 million pupils were enrolled in excess of the normal capacity of the public elementary and secondary schools. The school year began with a shortage of 142,000 classrooms. By the end of June 1958, the overall shortage was reduced to an estimated 135,000, a decrease of only 5 percent. The shortage was about evenly divided between the number of rooms needed to accommodate pupils in excess of normal capacity and the number needed to replace unsatisfactory facilities. The Secretary’s Report 9 Lack of emphasis on science and mathematics. — While Americans want their schools to offer a balanced program of education in all fields of learning, there is no doubt that the teaching of science — • and its essential base, mathematics — needs greater emphasis. A 1956 survey by the Office of Education showed that of the 2,776,000 students enrolled in the 11th and 12th grades of public high schools, only 830,000 were studying science; and 659,000 were studying mathematics. At that time 100,000 seniors were in public high schools where no advanced mathematics of any kind was taught. Fourteen States did not require so much as a single course in either science or mathematics for high school graduation. Of the men and women who are prepared to teach science and mathematics, only about 6 out of 10 actually go into teaching. Lack of language teaching. — The United States is weaker in the teaching of foreign languages than any other major country in the world. Some two billion people speak languages that are rarely — • if ever — taught in the United States. Of the 24 major languages, each spoken by more than 20 million people, only Spanish and French are studied to any degree in this country. The foreign language courses that are offered are studied in any one year by less than 15 percent of high school students, and not more than 15 percent of college students. An estimated 10 million Russians study English, but as the school year 1957 began, less than 8,000 Americans were studying Russian. This weakness in language teaching seriously handicaps our re¬ lationship with the peoples of the world, and places us at a serious disadvantage in our efforts to build a durable world peace. Loss of talent through school dropouts. — Much of the talent in¬ herent in our young people is lost because many potentially capable students drop out of high school and college before graduation. This represents a tragic waste of human resources, particularly in view of our Nation’s need for broadly educated men and women in science, engineering, teaching, business, government, medicine, and other professions. While studies vary, it is generally believed that every year 200,000 of the able students drop out of high school or end their formal education with a high school diploma. Some drop out of school because they need money — others because they lack interest in continuing their education. Federal aid to education. — In the summer of 1957 a Task Force, composed of staff members from the Office of Education and the Of¬ fice of the Secretary, was appointed to make specific recommenda¬ tions as to just what the role of the Federal Government should be in helping the Nation’s schools overcome their basic problems. The Task Force had the benefit of Congressional studies, the White House 487270—59 - 2 10 Department of Health , Education , and Welfare , 1958 Conference on Education, the President’s Committee on Education Beyond the High School, and studies by many other groups con¬ cerned with education. The proposal, submitted by the President to Congress in January 1958, dealt with priority national needs in education, while safeguarding the diversity, freedom, and independ¬ ence that are the hallmark of American education. The National Defense Education Act of 1958, setting up a four year program of about $900 million in Federal aid to education, fol¬ lows generally the proposals made by the President. It became law on September 2, 1958. The Act provides Federal support for testing, guidance, and counseling programs to help identify the talents of our young people and encourage their fullest development. It provides support for expanded and improved teaching of science, mathematics, and foreign languages in elementary and secondary schools. It supports area vocational training programs to develop more technicians in fields important to national defense. It provides for the training of more college teachers and language specialists and for more research in the use of television and other modern media. And it will make funds available for loans to help deserving students complete their college education. Progress and Cooperation for Health The Nation continued its cooperative drive toward better health. Never before have the American people shown a greater interest in medical research and medical service. Federal, State, and local gov¬ ernments, the medical and health professions, the numerous voluntary organizations concerned with health — all continued to increase their efforts. Research for better health . — During the fiscal year 1958 Congress appropriated $211 million, an increase of $28.2 million, for the medi¬ cal research and training activities of the Public Health Service’s National Institutes of Health at Bethesda, Maryland. More than two- thirds of the Institutes funds for research projects — $99 million — went for support of more than 7,000 projects in nearly 700 institutions in every State in the Nation and in 28 foreign countries. Grants totaling $30 million were awarded on a matching basis to 134 medical schools, universities, hospitals, and other institutions to help build, equip, or expand their health research facilities. More than 2,000 scientists were awarded research fellowships total¬ ing over $6 million. Eighty-four United States scientists studied abroad on fellowships — and 16 from other countries were awarded fellowships for study in the United States. The Secretary’s Report 11 During the year new facilities for specialized study or treatment were opened, including a residence treatment center for disturbed children, a center to evaluate tranquilizing drugs, and a field labora¬ tory in Panama to study tropical diseases of virus origin. As part of a worldwide program to wipe out malaria, the National Institutes of Health began an accelerated search for new methods of administer¬ ing anti-malarial drugs, and for finding a more effective combination of drugs so that their potency will be extended. At the beginning of the fiscal year the Secretary appointed a group of prominent medical educators and industry research executives to advise him on long-term needs in medical research and medical edu¬ cation. The consultants, under the able chairmanship of Dr. Stan¬ hope Bayne-Jones, reported their findings in July 1958. By 1970, the consultants reported, expenditures for medical research in this country should be tripled to reach a billion dollars a year ; and, in order to conduct medical research of this magnitude, the numbers of physicians and other scientists engaged in medical research should increase from the present 20,000 to 45,000. The consultants expressed the opinion that “it would not be in the public interest for the number of physicians in the Nation to fall below the ratio of 132 for each 100,- 000 persons in the population,” a ratio that has remained constant for the past thirty years. To maintain this ratio, the report states, would involve the construction of from 14 to 20 new medical schools at the cost of between $500 million and $1 billion. Gains from health research. — The research attack against diseases of the heart and blood vessels, which kill more than 800,000 people every year, was greatly intensified, and notable gains were made. Heartening advances in the field of cancer came through studies in virology, chemotherapy, and cytology. The relationship between viruses and cancer offers one of the more promising areas of study, and important advances were made in basic research into the nature of normal and malignant cells. Basic research was strengthened in the attack on arthritis and other rheumatic diseases, and metabolic diseases such as diabetes and gout. During the year an oral antidiabetic drug was developed, and is now available on prescription, used by an estimated one of four diabetics. Another oral antidiabetic drug is in experimental trial stage. Two new pain killing drugs were developed, one probably addicting but ten to twelve times more potent than morphine, and the other — nonaddicting — more effective than codeine or demerol. A new method was developed for rapid diagnosis of influenza, which led researchers to the uncovering of two previously unknown viruses apparently prevalent in young children. Tranquilizing drugs, which came into general use by 1956, have established a definite place for themselves in psychiatric treatment 12 Department of Health , Education , and Welfare , 1958 programs, particularly in mental hospitals. Recently developed drugs with apparent effectiveness in treating depressive states point to a promising new area for drug treatment in mental illness. During the year, a number of studies in mental health were directed toward gain¬ ing more knowledge of the physiological and psychological roles of chemical agents in the body. Scientists are also studying the differ¬ ences in the way normal people and the mentally ill react to drugs. Community health services. — Last year an all-time high of $54 mil¬ lion, from all sources, was spent on developing community health pro¬ grams. U. S. Public Health Service funds represented only 7.4 per¬ cent of this sum. Research in air and water pollution, and in radiological health prob¬ lems, was intensified during the year. In March 1958 a new Division of Radiological Health was created. Through research and by providing technical assistance, it helps the States deal with problems related to radiation exposure from indus¬ trial, medical, and other sources. Programs authorized by 1956 legislation to help overcome pollu¬ tion in the Nation’s streams and rivers were well under way. By June 30, 1958, Federal grants for sewage treatment facilities of more than $85.3 million had been made to more than a thousand cities and towns — which added an additional $356.5 million of their own funds. Important progress was made under Federal enforcement proce¬ dures to help clean up pollution of interstate streams. During the fiscal year seven interstate enforcement conferences were called by the Public Health Service. Hospitals. — During the fiscal year $120 million in Federal funds were granted under the Federal-State program for the construction of hospitals and other health facilities. This is substantially the same amount as for fiscal 1957, and is nearly double the amount granted 5 years ago. Today’s larger expenditures reflect the growing emphasis on the construction of nursing homes, rehabilitation centers, and other facilities for long-term care authorized by the 1954 amendments. At the end of the fiscal year 1,330 projects were in the construction or preliminary planning stages to provide 53,362 beds for inpatient care and 418 health units for outpatient care. These units include di¬ agnostic and treatment centers and rehabilitation facilities, public health centers, and State health laboratories. The most urgent need today is for the construction of hospitals for the mentally ill and for patients with chronic diseases. Only 14 per¬ cent of the hospital beds needed for chronic disease care are provided now ; and mental hospitals today have fewer beds, in relation to the need, than they had 10 years ago. The Public Health Service last year gave intensive study to the or¬ ganization of hospital services to more nearly fit the medical and nurs- The Secretary’s Report 13 ing needs of the individual patient. A pattern of hospital service known as “progressive patient care” is under intensive study. Under this approach facilities and services may be more precisely matched with the particular needs of each individual patient. Intensive care is given critically ill patients; intermediate care is given those who need only moderate service; ambulatory patients take care of many of their own needs; and long-term care is provided in a homelike atmosphere, with periodic check-ups and rehabilitation services offered. Health survey. — The U. S. National Health Survey, conducted by the Public Health Service, completed its first year of operation in June 1958. Preliminary reports have been published on the extent of disability in the population, the numbers of persons injured, dental care, physicians’ visits, and the prevalence and incidence of acute up¬ per respiratory diseases. This continuing study will prove invaluable in planning future health needs of the Nation. Asian influenza. — From early May, when word first reached the United States that a new variant of the Type A influenza virus was causing widespread epidemics in the Far East, until the end of the year when the crest of the epidemic wave had passed, the Public Health Service gave firm leadership to a nationwide, cooperative joint effort to combat Asian influenza and to alert — without unduly alarming — the public. Armed Forces medical personnel, officials of the American Medical Association and State Medical Societies, the Association of State and Territorial Health Officers, the American Hospital Association, the Nation’s drug manufacturers, and a host of other professional and voluntary organizations — all worked together to reduce the impact of the epidemic. As a result, more than 30 million doses of vaccine were produced and distributed in the 5 months between isolation of the virus and the arrival of the epidemic, and more than 80 million doses by the end of the year. The epidemic reached its peak in mid-October when — according to the National Health Survey — some 12 million people were in bed during the week with respiratory illness, chiefly influenza. The 1957 Asian influenza epidemic offers an almost unparalleled example of cooperation among the health agencies of the Nation. Without this cooperative effort, the effects of the epidemic undoubt¬ edly would have been much more severe. International health. — During the fiscal year the Division of Inter¬ national Health in the Public Health Service scheduled and super¬ vised the training in this country of about 600 foreign health workers from 76 countries, including 387 sponsored by the International Cooperation Administration and 110 by the World Health Organiza- 14 Department of Health , Education, and Welfare, 1958 tion. More than 100 visiting scientists, research guest workers, and post doctoral research fellows carried on their health research with assistance from the National Institutes of Health. The Public Health Service worked closely with the Department of State in preparation for the Eleventh World Health Assembly, which met in Minneapolis from May 28 to June 14, 1958, and for the special 2-day commemorative session marking the tenth anniversary of the World Health Organization. The Assembly adopted a United States proposal for a study of ways in which the World Health Organization can intensify its role in stimulating and coordinating international medical research, and accepted a special United States grant to WHO of $300,000 from Department funds to pay for this study. At the end of the fiscal year some 160 Public Health Service officers were providing technical assistance to underdeveloped countries in all phases of public health as members of ICA overseas health missions. Progress and Cooperation for Pure Food and Drugs During the year the Food and Drug Administration increased its activities in a number of important areas. This progress — and gains made the previous year — followed recommendations made by the Citizens Advisory Committee in 1955 that staff be increased, facilities enlarged, and techniques improved, in order to give better protection to the consumers of foods, drugs, and cosmetics, and better service to American industry. Staff has been increased from 806 people, when the study was undertaken, to 1,215 at the close of the fiscal year. Plans are under way for a new headquarters building in Washington, a new District Office in Detroit, and one to serve the Dallas-Fort Worth area in Texas. Inspections of establishments increased from 16,287 in fiscal year 1956 to over 26,000 in 1958, and the numbers of samples of indi¬ vidual items collected for laboratory testing increased from about 17,000 to 25,000. Major progress throughout the year was made in a number of specific areas, resulting in cleaner wheat for food, protection of dairy products from contamination by pesticides, prevention of bacteriologic contamination on frozen foods, and the further development of codes of labeling for drugs and cosmetics, to prevent misleading claims. The passage by the 85th Congress of the food additive amendment represents one of the most important advances in many years in health protection under the Food, Drug and Cosmetics Act. Effec¬ tive March 5, 1959, the amendment requires the manufacturer or promoter of a new food additive to submit to the Food and Drug The Secretary* s Report 15 Administration evidence that its safety has been tested and estab¬ lished — before the product can be put on the market. The safeguarding of foods, drugs, and cosmetics to assure a high degree of purity and quality is becoming more complex every year. Hundreds of drug products are developed annually, and frozen, pre¬ pared, and packaged food becomes more and more a part of the Amer¬ ican diet. Last year the time spent in ensuring the safe use of pesticides increased by 28 percent. The fight against quackery in “health foods” and devices continued, and regulations were rigidly enforced regarding food for special diets of infants, old people, pregnant women, and those who are ill. Work continued in analyzing radio¬ activity found in food today for comparison with food produced before the first atomic explosions 13 years ago. Every year more than $56.4 billion wTorth of food products, $3.9 billion worth of drugs and medical devices, and $1.4 billion in cos¬ metics move through some 83,692 factories and warehouses, subject to Federal inspection. In carrying out its programs, the Food and Drug Administration works closely in specific areas with the American Medical Association, the Pharmaceutical Manufacturers Association, representatives of the food manufacturing and food producing industries, the National Better Business Bureau, agricultural leaders, consumer organizations, and State and local food and drug officials. From this cooperative effort and planning on the part of a number of people comes every year increased safety for all Americans in the foods, drugs, and cos¬ metics essential to life and well being. ******* The spirit of cooperation does not stop at our own shores and borders. Growing closer and closer in terms of time and distance, the basic interests of the peoples of the world have become increas¬ ingly intertwined. Better health, better education, improved eco¬ nomic and social well being — the particular concerns of this Depart¬ ment — represent values and goals common to all humanity. And so, in a mutually helpful exchange of information and ideas, co¬ operation has become a meaningful factor in our relations with the peoples and governments of other countries. 16 Department of Health , Education , and Welfare , 1958 Table 1. — Grants to States: Total grants under all Department of Health, Education, and Welfare programs, fiscal year 1958 [On checks-issued basis] States, Territories, and possessions Total Social Security Administra¬ tion Public Health Service 1 Office of Education Office of Vocational Rehabili¬ tation Ameri¬ can Printing House for the Blind2 Total - $2, 263, 155, 658 $1, 835, 409, 720 $158, 941, 915 $227, 676, 648 $40, 789,375 $338, 000 Alabama _ 63, 612, 483 51, 021, 509 5, 377, 256 5, 866, 313 1, 341, 934 5, 471 Arizona _ . - - 17, 218, 902 11,662, 412 2, 018, 046 3, 153, 971 382, 660 1,813 Arkansas... _ 39, 955, 928 32, 627, 758 3, 252, 898 2, 961, 128 1, 108, 704 5,440 California _ _ 248, 277, 816 205, 298, 208 8, 025, 843 32, 482, 923 2, 447, 569 23,273 Colorado _ _ 42, 996, 432 34, 575, 661 2, 697, 463 5, 413, 342 306, 974 2, 992 Connecticut _ . 19, 775, 532 15, 427, 085 1, 232, 803 2, 731, 548 376, 903 7, 193 Delaware _ . 3, 582, 872 2, 644, 338 317, 612 436, 454 183, 380 1,088 District of Columbia.. 7, 259, 800 6, 102, 703 799, 699 120, 481 235, 587 1,330 Florida.. . - 65, 952, 345 53, 178, 254 3, 752, 301 7,459, 207 1, 551, 702 10, 881 Georgia _ 75, 072, 992 62, 037, 119 3, 721, 138 7, 141, 017 2, 164, 983 8,735 Idaho _ 8, 828, 472 5, 796, 486 1, 145, 817 1, 746, 686 138, 516 967 Illinois - - 92, 966, 531 80, 003, 830 6, 571, 408 4, 688, 914 1, 686, 572 15, 807 Indiana... _ _ 30, 442, 539 22, 598, 688 5, 184, 198 2, 132, 662 520, 100 6,891 Iowa . . _ _ 28, 615, 903 23, 921, 602 2, 603, 956 1,369, 043 717, 131 4, 171 Kansas... .. . _ 30, 584, 187 22, 641, 043 2, 323, 315 5, 156, 774 458, 944 4,111 Kentucky. . . 46, 353, 713 38, 641, 919 5, 045, 937 2,209,073 451, 646 5, 138 Louisiana _ _ _ 94, 505, 592 86, 564, 089 3, 635, 704 2, 963, 055 1, 337, 455 5,289 Maine _ . - 14, 076, 212 11, 636, 022 867, 846 1, 309, 683 261, 996 665 Maryland . 25, 859, 952 13, 704, 217 2, 794, 741 8, 915, 036 439, 158 6,800 Massachusetts .. 72, 121, 387 63, 848, 574 3, 723,095 3, 768, 402 763, 514 17, 802 Michigan. .. . . . 72, 915, 638 58,083, 526 5, 684, 707 7, 784, 773 1, 348, 789 13,843 Minnesota . . . 38, 656, 710 32, 832, 545 3, 460, 879 1, 553, 766 801, 420 8, 100 Mississippi... - 44, 148, 072 37, 623,393 3, 680,466 2, 314, 833 525, 300 4,080 Missouri - - 91, 922, 539 84, 026, 622 3, 254, 487 3,853,112 781, 910 6,408 Montana _ 8, 714, 178 6, 536, 307 736, 001 1,239,408 200, 195 2,267 Nebraska. . __ . 14, 943, 889 11,597, 485 1,212, 314 1, 802, 649 328, 932 2,509 Nevada . _ . 4, 449, 103 2, 359, 411 511, 576 1, 536, 932 41,154 30 New Hampshire.. . 6, 443, 660 4, 122, 093 1, 220, 266 1,022, 323 77,618 1,360 New Jersey. ... 27, 092, 402 19, 950, 414 3, 147, 682 3, 061, 034 923,026 11,246 New Mexico... . 21, 377, 958 12, 235, 910 1, 485, 015 7, 471, 872 181, 715 3,446 New York _ _ . .. 145, 446, 642 129, 084, 431 7, 929, 583 5, 519, 377 2,878, 976 34, 275 North Carolina. . 55, 042, 686 43, 147, 317 5, 926, 381 4, 323, 336 1, 633, 864 11, 788 North Dakota _ 8, 376, 205 5, 913, 039 1, 440, 121 810, 191 211, 947 907 Ohio _ 87, 036, 161 74, 933, 439 5, 032, 031 6, 228, 099 822, 795 19, 797 Oklahoma.. . . . 78, 701, 470 69, 102, 277 2, 180, 798 6, 487, 662 928, 345 2,388 Oregon _ . . . 21,072,801 16, 829, 042 2, 197, 857 1, 540, 122 501, 246 4,534 Pennsylvania.. . 71, 581, 370 59, 036, 670 5, 666, 804 4,080,123 2, 775, 467 22, 306 Rhode Island. - 11, 386, 757 8, 294, 349 758, 608 2, 085, 441 248, 299 60 South Carolina _ 28, 975, 326 21, 662, 783 2, 505, 298 4, 119, 892 683, 545 3,808 South Dakota _ 10, 520, 958 7, 099, 818 1, 327, 587 1, 858, 329 233, 985 1,239 Tennessee . . 45, 469, 037 37, 690, 870 3, 385, 856 3, 017, 071 1, 367, 714 7, 526 Texas _ 137, 161, 688 112, 256, 832 9, 344, 256 14, 113, 121 1, 436, 266 11, 213 Utah _ 13, 034, 097 8, 676, 050 1, 905, 716 2, 271, 261 179, 770 1,300 Vermont _ _ 6, 191, 845 4, 314, 901 1, 329, 468 363, 916 182, 804 756 Virginia _ _ — 35, 936, 949 15, 626, 654 4, 120, 742 15, 158, 354 1, 022, 343 8, 856 Washington _ 52, 623, 643 39, 901, 729 3, 756, 015 8, 223, 281 738, 628 3, 990 West Virginia _ .. 28, 980, 972 24, 664, 637 2, 282, 118 983, 741 1, 046, 668 3, 808 Wisconsin... _ _ . 33, 589, 312 27, 865, 795 3, 237, 775 1, 540, 223 939, 021 6,498 Wyoming... 4, 674,995 2, 910, 022 646, 017 1, 013, 290 105, 334 332 Alaska 3 _ 6, 893, 810 2, 064, 000 175, 333 4, 548, 579 105, 898 Hawaii.. . 9, 851, 643 4, 128, 677 1,863, 218 3, 691, 957 166, 008 1,783 Puerto Rico _ . 10, 162, 175 6,502,071 2, 368, 889 804, 956 483, 871 2, 388 Virgin Islands _ 547, 045 405,094 55, 150 76, 105 10, 394 302 Guam 1, 174, 332 21, 825 1, 151, 807 700 1 Excludes $248,613 paid to water pollution interstate agencies. 2 Includes permanent annual appropriation of $10,000. * Additional payments were made to Alaska of $638,000 for disease and sanitation investigation and $1,000,000 for the mental health program. Social Security Administration Social Security in 1958 The importance or social security in providing basic economic pro¬ tection for its beneficiaries was again demonstrated during the down¬ turn in business activity that marked the middle months of fiscal year 1958. Total social security payments reached a peak by April, when they approached an annual rate of $24 billion. Old-age, survivors, and disability insurance benefits accounted for almost one-third of the total, unemployment insurance (administered by the Department of Labor and State employment security agencies) for more than one- fifth, and public assistance payments for about one-seventh. Benefits paid under other public programs such as Federal, State, and local employee retirement systems, railroad retirement, veterans’ programs, workmen’s compensation, and temporary disability insurance ac¬ counted for the remainder. At fiscal year’s end, 11.9 million persons were receiving monthly benefit checks under the old-age, survivors, and disability insurance program; 5.6 million were receiving assistance payments under fed¬ erally aided programs for the needy aged, dependent children, blind persons, and persons permanently and totally disabled; 1.2 million persons were on State and local general assistance rolls ; and 2.8 mil¬ lion unemployed workers were collecting weekly compensation checks to help tide them and their families over while they sought new jobs. And under new legislation, unemployed workers who had exhausted their rights to benefits were beginning to get payments from temporary programs for extended benefits. During July 460,000 persons received their first checks under the temporary programs. Our social security system protected not only these millions of in¬ dividuals but also — particularly in the recession period — assisted ma- 17 18 Department of Health , Education, and Welfare, 1958 terially in sustaining purchasing power. In June 1958, social insur¬ ance, related payments, and public assistance accounted for 6.6 percent of total personal income in the United States compared with 5.4 per¬ cent a year earlier. The increase was due mainly to increases in bene¬ fits paid under the growing old-age, survivors, and disability insurance program and to increased unemployment insurance payments. Legislation liberalizing old-age, survivors, and disability insurance benefits and revising formulas for Federal grants to the States for public assistance and child welfare was in the process of enactment as the fiscal year closed. The legislation increases old-age, survivors, and disability insurance benefits by about 7 percent in recognition of rises in wages and living costs since benefits were last increased in 1954. To pay for the higher benefits and to help maintain the system on a self-supporting basis, contributions to the system are increased one- fourth percent of taxable earnings each for the worker and his em¬ ployer and three-eighths percent for the self-employed in 1959 and, beginning in 1960, scheduled increases are accelerated to take place at 3-year intervals instead of 5, as before. The amount of taxable earn¬ ings counted for benefits was raised from $4,200 to $4,800. The disability insurance provisions of the Social Security Act are amended in a number of ways. Most important is the regulation providing the same benefits for dependents of disabled beneficiaries as are now provided for dependents of old-age insurance beneficiaries. Amendments to the public assistance titles of the Act furnish a new formula for Federal participation in public assistance payments that will provide additional funds to all the States and more flexibility in meeting individual needs, including medical care needs. The formula also recognizes the limited fiscal capacity of the lower income States and will enable these States, in particular, to raise assistance levels. New provisions for child welfare services remove the requirement that Federal funds allotted to the States be used in predominantly rural areas or other areas of special need. This permits extension of services under the program to children in urban areas on the same basis as to children in rural areas. Appropriate changes in allotment and matching provisions take into account the total child population of each State and the State’s per capita income. The authorization for grants for child welfare services is increased from $12 million to $17 million a year. Authorizations for grants for maternal and child health services go from $16.5 million to $21.5 million and for crippled children’s services from $15 million to $20 million. The increases are not mandatory but depend on annual appropriations until the new ceilings are reached. Amendments to the Act also establish two advisory councils. One will review the status of the public assistance programs. The other Social Security Administration 19 will be concerned with the extension of child welfare services beyond rural areas. The councils are scheduled to report by the beginning of 1960. The 1958 amendments touch the lives of practically all Americans. About 75 million people are now building a basic foundation of economic security for themselves and their families by contributions at some time during the year to old-age, survivors, and disability insur¬ ance. Almost 12 million — about 1.6 million more than in the preced¬ ing J une — received benefits that insured ivorkers had earned by work¬ ing in covered jobs. Of these, 9.7 million — about 81 percent — are men aged 65 or over and women aged 62 or over; 1.9 million are dependent children and widowed mothers, and 200,000 are disabled workers aged 50-64. Benefits paid in fiscal year 1958 totaled more than $8 billion, as compared with $6.5 billion in the previous year. A measure of the significance of this program in the lives of bene¬ ficiaries is revealed by a national survey made in the autumn of 1957. Highlights of the study show that benefits paid provide — • practically the only money income — that is, other than $75 or less a year — of about one-fourth of aged beneficiaries, • practically all the independent retirement income for more than half of the aged beneficiaries, • virtually the sole income of one-eighth of widowed mothers with entitled children, • practically all the income expected to continue until the youngest child grows up for more than three-fifths of the widows with entitled children. With the old-age, survivors, and disability insurance program pro¬ viding greater economic security for more and more of our older citizens, the number of aged persons receiving payments under the federally aided assistance program continued to decline even though the number receiving both benefits and assistance increased. But as the old-age assistance caseload diminished, the number of persons receiving aid to dependent children climbed. In December, for the first time since the programs began, persons receiving aid to dependent children outnumbered those receiving old-age assistance. The number of recipients increased 334,000 over the year to reach 2.7 million. The increase was attributed in part to economic conditions, but long-term factors such as the growth of the child population, the number of family breakdowns and the rising rate of illegitimacy were also responsible. The economic situation was also reflected in State and local general assistance programs where the number of cases rose 54 percent over the June 1957 total to reach the year’s high in April 1958 of 454,000 cases, and then declined to 418,000 at fiscal year’s end. 20 Department of Health, Education, and Welfare, 1958 The caseload in the program of aid to the permanently and totally disabled increased 10 percent over the year — from 284,000 to 313,000 — while the number of needy blind receiving assistance remained prac¬ tically unchanged at 108,000. The Children’s Bureau began its 47th year of service in promoting the well-being of our Nation’s children. Programs of the Bureau continued to promote child welfare services for neglected children, children with physical or mental handicaps, runaway children, chil¬ dren born out of wedlock, and others with a wide variety of problems. Figures from the States show that the number of children served by State and local agencies under the crippled children’s program reached a new peak in 1957, when about 313,000 were given diagnostic services or treatment. These services are being extended to an in¬ creasing number of children with nonortliopedic conditions, such as congenital heart ailments. Under the 1957 program of maternal and child health services, 210,000 mothers received maternity medical clinic services and 447,000 received maternity nursing service. About 1.3 million infants and other children received well-child conference services and 2.9 million received child health nursing service. Preliminary figures from the States show that public child welfare agencies were providing services to nearly 340,000 children at the end of March 1958. State health departments are now administering 44 programs for mentally retarded children with about $2 million, most of which represents Federal funds allocated to maternal and child health. Three years ago there were only four such programs. Actual expenditures by States for the programs for maternal and child health, child welfare, and crippled children’s services rose $23.2 million to a total of $271.9 million during 1957. The Federal share amounted to $38.1 million. The growing problem of juvenile delinquency continues to be a major concern of the Children’s Bureau. The upswing in the number of juvenile court delinquency cases is one indication of the seriousness of the problem. The number of cases increased for the ninth con¬ secutive year in 1957. The increase was 16 percent, while the child population increased only 7 percent. Bureau staff provided expert consultant service and worked with a wide range of agencies on de¬ linquency-related matters. Federal credit union assets, after registering steady growth over the years, dipped seasonally in January 1958, then recovered and went on to a record $1.9 billion in June, an increase of 14 percent over the year. At the end of June there were 8,992 active Federal credit unions with about 5 million members. Social Security Administration 21 To carry on its programs of service dedicated to the economic and social welfare of the American people, the Social Security Adminis¬ tration had 23,540 employees at the end of June, slightly more than 1,000 over the previous year. The great majority of these employees were in district offices and other offices of the Bureau of Old-Age and Survivors Insurance. International Activities Growing interest in promoting the social welfare of the peoples of the world was evident from the expansion of international programs concerned with social services and social security. The Social Security Administration participated in the activities of organizations such as the United Nations Economic and Social Council, the United Nations Children’s Fund, the International Labor Organization’s Committee of Social Security Experts, the International Social Security Associa¬ tion, and the Inter- American Children’s Institute of the Organization of American States. The Social Security Administration continued active cooperation with other international organizations by participating in the work of the International Conference of Social Work of the Pan American Congress of Social Service. Staff members served on the international committees of the National Social Welfare Assembly, the National Association of Social Workers, and the Council on Social Work Education. During the year the Social Security Administration was assigned responsibility for representing the Department of Health, Education, and Welfare on the Interdepartmental Committee on International Social Welfare Policy and the Interdepartmental Committee on Inter¬ national Labor Policy. The Committee on International Social Wel¬ fare Policy participated in preparing papers for the United Nations General Assembly, the United Nations Children’s Fund, and sessions of the United Nations Economic and Social Council. The Committee on International Labor Policy formulated positions for the United States delegation on items on the agenda of the June 1958 International Labor Conference and the May- June session of the International Labor Organization Governing Body. A reciprocal exchange of social workers with Austria, Belgium, Norway, Sweden, and Yugoslavia was worked out in cooperation with the Department of State. The Social Security Administration fur¬ nished administrative services for the program and for a proposed committee to assist in selecting the first group of Americans to study abroad and to advise on training resources for Europeans in this country. During fiscal year 1958 the Social Security Administration arranged for training for 1,057 from foreign countries, a 37 percent increase 22 Department of Health, Education, and Welfare, 1958 over the previous year. Of the 66 nations represented by the trainees, 21 were Latin American countries, 18 were European, 15 were Asian, and 8 were African. The remaining countries were Australia, Canada, New Zealand, and the Philippines. Most of the 606 participants whom the International Cooperation Administration referred to the Social Security Administration for training were interested in social welfare administration, program development in public assistance, social insurance, and family and child welfare. Forty-six United Nations fellows and scholars came to study social welfare administration and education, social work methods, com¬ munity organization and development, and child welfare programs ; 24 World Health Organization fellows and scholars were concerned with maternal and child health. The notable increase in the number of foreign persons seeking train¬ ing with the Social Security Administration under sponsorship other than the International Cooperation Administration, the United Na¬ tions, and the World Health Organization continued. They num¬ bered 378, or 51 percent more than in fiscal year 1957. These visitors were sponsored by various governments and embassies, the Asia Foundation, Atlantique, the Carnegie Corporation, Eisenhower Ex¬ change, Reciprocal Exchange, the Ford Foundation, the National Council of Jewish Women, the Rockefeller Foundation, and others. The growing number and variety of requests created further need for developing fresh resources for training and study in social wel¬ fare agencies and community development projects. Current and prospective needs for new resources were outlined in conferences with State and local social welfare leaders and with regional representa¬ tives and the central office staff of the Children’s Bureau and the Bureau of Public Assistance as well as in visits to schools of social work. Fiscal year 1958 saw a decline in the number of experts assigned to overseas technical missions of the International Cooperation Ad¬ ministration in the fields of social welfare, social insurance, and ma¬ ternal and child welfare — fields in which the Social Security Ad¬ ministration is responsible for nominations and technical support. The number on duty this year was 11 experts in 9 countries, com¬ pared to 25 experts in 13 countries during 1957. New requests for experts under the International Cooperation Ad¬ ministration program came from Chile, Peru, Tunisia, Pakistan, and Paraguay. During the year, as a result of meetings with United Nations and International Labor Organization experts, the Social Security Ad¬ ministration undertook the recruitment in its various fields of com¬ petence for international positions overseas. Candidates were recom- Social Security Administration 23 mended for social work or social security vacancies in Indonesia, Liberia, Pakistan, and Libya. The Administration also made ar¬ rangements to include international organizations in the provision of current technical materials assembled for use of social welfare personnel in overseas missions. Old-Age, Survivors, and Disability Insurance During the fiscal year 1958 the old-age, survivors, and disability insurance program continued to provide an increasing degree of protection for the American worker and his family against loss of income resulting from retirement, disablement, or death. Almost 12 million persons were drawing monthly benefits at the end of the fiscal year, and 75 million persons who worked sometime during the year made social security tax contributions under the system. A most significant development was the enactment soon after close of the fiscal year of the Social Security Amendments of 1958. This new legislation increased benefits for all beneficiaries, raised the amount of total earnings that could be taxed and credited for benefit purposes, provided benefits for certain dependents of disabled work¬ ers, and provided an increase in 1959 contribution rates and a stepped- up schedule for future rate increases. The amendments also included provisions relative to the disability freeze and disability benefits, the retirement test, adopted children, remarriage of certain beneficiaries, duration-of -marriage require¬ ments, and minor coverage changes. In addition, many simplifica¬ tions in the program were accomplished through these amendments. The changes made by legislation resulted in a program which, on bal¬ ance, is easier to administer, explain, and understand than the program before the legislation was enacted. Considerable attention was directed during the year to the program’s financing. For the first time more was paid out from the Federal Old-Age and Survivors Insurance Trust Fimd than was taken in. Estimates toward the close of the year indicated that, under the schedule of taxes then in the law, outgo would continue to exceed income in most, if not all, years until 1965. After careful considera¬ tion, Congress included in the 1958 amendments a new schedule of contribution rates which significantly improves the relationship be¬ tween trust fund income and outgo over the next few years and substantially strengthens the long-range financial basis of the program. During the year, the first Advisory Council on Social Security Financing, authorized by the 1956 amendments, was appointed and began its study of the status of the trust funds in relation to long¬ term commitments. 24 Department of Health , Education , and Welfare, 1958 The Bureau of Old-Age and Survivors Insurance during the year faced the second greatest workload in its history and overcame many difficulties in maintaining high standards of operation and of per¬ sonal service to the people served by the program. The impact of the 1956 amendments on the Bureau was evidenced by the more than 500,000 benefit awards to women age 62 to 64 under the lower-retire¬ ment-age provisions, and by the more than 200,000 disabled bene¬ ficiaries who were drawing benefits by the end of the fiscal year. The Bureau continued to make good progress in the automation of its machine processes — it extended its use of electronic machines and magnetic tape in the maintenance of social security records and in the benefit payment processes. Service to the public was improved by the opening of twenty-six additional district offices, bringing the total of these local service offices to 584. As a step toward achieving better over-all disability insurance operations, plans were completed for opening a seventh payment center in Baltimore, Maryland. A significant development in Bureau management during the year was the issuance of a “Statement of Bureau Objectives,” to be used as a guide for planning, and as a yardstick against which to measure adequacy of performance. The objectives relate to the Bureau’s responsibility to the public in administering the program, its respon¬ sibility for helping to improve the program, its obligation to con¬ tribute to the Government as a whole, and its responsibility as an employer to its own employees. Although most of the ideas in the statement are general principles and goals already governing the Bureau’s operation, the formal statement of the objectives has major advantages, particularly in view of the size and geographic distribu¬ tion of the Bureau’s staff and the large number of new employees. What the Program Is** Doing Beneficiaries and benefit amounts . — The number and amount of monthly benefits being paid under the program continued to rise sharply in fiscal year 1958. In June 1958, 11.9 million persons were receiving benefits at a monthly rate of $659.7 million — increases from June 1957 of almost 1.6 million in number and $105.0 million in amount. Men aged 65 or over and women aged 62 or over made up 9.7 million (81 percent) of the beneficiaries — 6.6 million of them re¬ tired workers and 3.1 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 2.2 million (19 percent) , almost 1.6 million were children, some 435,000 were mothers, and 200,000 were disabled workers aged 50-64. Almost 2.5 million monthly benefits (including disability insurance benefits for the first time) were awarded in fiscal year 1958, only Social Security Administration 25 200,000 less than the record number of awards made in the preceding year. New highs were reached for awards of mother’s and of child’s benefits. Decreases from the number of benefits awarded in fiscal year 1957 occurred in old-age, wife’s and husband’s, widow’s and widower’s, and parent’s benefits. (The record number of awards of these types of benefits in 1957 reflected the large number of claims filed by self- employed farmers and other workers who qualified on the basis of work newly covered under the 1954 amendments and by women who qualified under the provision in the 1956 amendments lowering the retirement age for women from 65 to 62.) Awards in 1958 of old-age, wife’s or husband’s, and widow’s or widower’s benefits were, however, much larger than in any fiscal year other than 1957. A record number of 737,000 lump-sum death payments were awarded in the 1958 fiscal year. In J une 1958, the average old-age insurance benefit paid to a retired worker who had no dependents also receiving benefits was $61.80 a month. When the worker and his wife both received benefits, the aver¬ age for the family was $109.90. Families consisting of a widowed mother and two children received on the average $148.70. Among beneficiaries on the rolls at the end of June 1958 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 $72.50, for an aged couple about $121.50, and for a widowed mother and two children about $180.00. Disability provisions. — During the fiscal year, a period of disability under the disability freeze provisions that have been in effect since 1955 was established for almost 207,000 workers at all ages. A worker for whom a period of disability has been established has his insurance rights preserved during the period in which permanent and total dis¬ ability prevents him from performing any substantial gainful work. Thus, such periods will not count against him in determining whether he or his survivors are eligible for benefits or in calculating the amount of the benefits. At the end of June 1958, 200,000 disabled workers aged 50-64 were receiving disability benefits at a monthly rate of $14.9 million. About 178,000 of the beneficiaries were receiving full-rate benefits averaging $81.05 a month. Almost 23,000 beneficiaries who were also receiving a workman’s compensation benefit or another Federal benefit for dis¬ ability — other than compensation payable by the Veterans Adminis¬ tration for a service-connected disability — had their disability insur¬ ance benefit reduced by the amount of such benefit. As a result, their reduced-rate benefits averaged only $22.37 a month. The disability insurance benefits for almost 14,000 additional workers were completely offset by other benefits that they were receiving because of disability. 487270 — 59 - 3 26 Department of Health , Education , and Welfare , 1958 By the end of December 1957 about 50,900 persons were receiving old-age benefits that had been increased by an average of $9.54 a month as a result of having had a period of disability established. The higher benefits were partly attributable to dropping 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 16,800 wives and young children of retired workers and about 11,100 widows, children, and dependent parents of workers who had established a period of disability before death were also receiving larger monthly benefits because of the freeze. For the same reason, lump-sum death payments during the calendar year ended December 1957 based on the earnings records of 10,800 deceased workers were increased by an average amount of $24.90 per worker. Child’s monthly benefits are payable to totally disabled persons aged 18 or over — dependent children of deceased or retired insured workers — whose disability began before age 18. About 28,000 persons met the disability requirements for these benefits during the fiscal year and 6,000 applications were denied. By the end of June 1958, such child’s benefits were being paid to 39,500 persons at a monthly rate of $1.5 million. About 6,700 women — who would not otherwise receive benefits — were receiving wife’s or mother’s benefits as the mothers of disabled persons receiving child’s benefits. The 'protection provided. — Of the population under age 65, an esti¬ mated 66.7 million were insured at the beginning of the calendar year 1958. Some 29.7 million of these people were permanently insured — that is, whether or not they continued to work in covered jobs they will be eligible for some benefits when they reach retirement age, and their families are assured of protection in the event of their deaths. Included in this total were some 0.7 million women aged 62-64 who were already eligible for old-age benefits. The remain¬ ing 37.0 million were insured but would have to continue in covered work for an additional period to make their insured status permanent. Nine out of ten mothers and young children in the Nation were assured that they would receive monthly benefits in case of the family earner’s death. An estimated 7 million insured persons under age 65 also met the work requirements for protection against the risk of long¬ term and severe disability. Of the 15.1 million people aged 65 or over in December 1957, 67 percent were eligible for benefits under the program. Fifty-five per¬ cent were actually receiving benefits, and 12 percent were not receiv¬ ing benefits because they or their husbands were receiving substantial income from work. The percentage of eligible aged persons is ex¬ pected to rise to more than 70 percent by 1960. The coverage of the program. — Approximately 75 million workers were under old-age, survivors, and disability insurance coverage dur- Social Security Administration 27 ing the course of the calendar year 1958. An additional 1 million people employed in the railroad industry were assured, through the close coordination of the railroad retirement and old age, survivors, and disability insurance programs, benefits at least equal in amount to those that would have been payable if their railroad employment had been covered under the Social Security Act. Altogether, includ¬ ing State and local government and nonprofit employees for whom coverage is available on a group-election basis ; clergymen, for whom coverage is available on an individual voluntary basis ; and members of the Armed Forces, nine- tenths of all persons in paid employment or self-employment were covered or could have been covered by old- age, survivors, and disability insurance in June 1958. Of the workers not eligible for coverage, about one-third were cov¬ ered by other public retirement programs — Federal, State, or local. The remaining two- thirds — 7 percent of the Nation’s paid employ¬ ment — were not covered by any public retirement program. Those without retirement protection under a public system consisted prin¬ cipally of self-employed persons whose annual net earnings were less than $400, of domestic and farm workers who did not earn sufficient wages from any one employer to meet the minimum coverage require¬ ments of the law, and of self-employed doctors of medicine. Income and disbursements. — Expenditures from the Federal Old- Age and Survivors Insurance Trust Fund during the fiscal year totaled $8,041 million, of which $7,875 million was for benefit pay¬ ments and $166 million, including Treasury Department costs, for administrative expenses. Total receipts were $7,824 million, includ¬ ing $7,267 million in net contributions, $556 million in interest on investments, and $2 million in transfers from the railroad retirement account. Disbursements exceeded receipts by $216 million, the amount of the decrease in the trust fund during the year. At the end of J une 1958 this fund totaled $22.8 billion. Total assets of the old-age and survivors insurance trust fund, ex¬ cept for $1,048 million held in cash, were invested in United States Government securities as required by law; $3.2 billion were invested in public issues (identical with similar securities owned by private investors), and $18.6 billion were invested in securities of varying maturities issued for purchase by the trust fund. The average inter¬ est rate on all investments of this fund at the end of the fiscal year wTas 2.54 percent. The Federal Disability Insurance Trust Fund was created by the Social Security Amendments of 1956. Contributions to this fund be¬ came payable in January 1957. Benefit disbursements began in Au¬ gust 1957. Expenditures from the disability insurance trust fund during the fiscal year totaled $181 million, of which $168 million was for benefit payments and the remainder — some $12 million — was for 28 Department of Health , Education , and Welfare , 1958 administrative expenses. Total receipts were $942 million, including $926 million in net contributions and $16 million in net interest. Ke- ceipts exceeded disbursements by $762 million, the amount of increase in the fund during the year. At the end of June 1958, the fund totaled $1,099 million. Assets of the disability insurance trust fund consisted of $1,054 million in United States Government securities and a cash balance of $45 million. The invested assets consisted of $59 million in public issues and $996 million in securities of varying maturities issued for purchase by the trust fund. The average interest rate on all in¬ vestments of this fund at the end of the fiscal year was 2.54 percent. Administering the Program The primary objective of the Bureau of Old-Age and Survivors Insurance in advance planning for fiscal year 1958 was a shift in emphasis from the enforced emergency processing of peak workloads in 1957 to careful and systematic review and evaluation of its manage¬ ment programs and methods of operation. This emphasis appeared feasible in the spring of 1957 since it seemed then that the Bureau, for the first time since 1950, would not soon be faced with sharp workload increases due to program amendments. Looking ahead to a more stable level of operations the Bureau planned to direct its ef¬ forts to improving the quality of its work, the effectiveness of its processes and the efficiency of its people with the aim of making good progress toward an optimum level of public service in a program which has been greatly expanded by a series of amendments. How¬ ever, the economic recession and some delayed impacts of the amend¬ ments of 1954 and 1956 resulted in workload pressures greater than anticipated and made it necessary for the Bureau to direct its re¬ sources to work processing and reduction of backlogs to a greater degree than planned, while at the same time working to make reason¬ able progress in the long range effort of evaluation and improvement. A few key figures illustrate the dimensions of the Bureau’s operat¬ ing task in processing the workloads received during the year. Approximately 2,680,000 claims for old-age and survivors benefits were filed ; about 473,000 claims for disability insurance benefits and the disability “freeze” were received. Quarterly receipts of retire¬ ment and survivor claims were heaviest during the January-March 1958 quarter and the number pending in the district offices increased during that quarter to a high point of over 263,000. By the end of June 1958, this pending load was reduced to an approximately normal in-process figure of 155,000. The disability operation was an area of particular concern during the year. The first disability insurance benefits were paid early in Social Security Administration 29 August (for the month of July) to about 100,000 disabled workers. By the end of the year, 200,000 beneficiaries were receiving payments. The backlog of disability claims (resulting from the 1956 amend¬ ments) on hand in the district offices, the State agencies (which make determinations of disability under agreements with the Department), and the Bureau’s Division of Disability Operations, was reduced from about 200,000 in January 1958 to 124,000 by the end of June. In addition to a large number of cases to process, the Bureau had to over¬ come the delay in completing action on disability claims which are generally more complex than claims for retirement or survivors bene¬ fits and take a correspondingly longer time to process. During the year processing time was reduced from 5 or 6 months to 2 y2 to 3 months. New social security accounts were established for approximately 3.2 million persons and a total of almost 3 million duplicate account number cards were issued during the year. Approximately 250 mil¬ lion earnings items were received for posting to individual accounts. In addition, 1.9 million requests for a change in records were processed, and 960,000 statements of earnings were issued. To cope with workloads which exceeded estimates, the Bureau in¬ creased its staff by 890 from 21,471 to 22,423 employees and used over 1,500 man-years of overtime. The total of 22,423 included 520 tem¬ porary employees. In line with expanded needs for serving the public, 26 additional district offices were opened in various parts of the country during the fiscal year. The new offices were located in areas requiring increased facilities for agricultural communities and in growing population concentrations developing from industrial expansion. In addition, 3,665 contact stations were serviced on a regularly scheduled part-time basis by the local offices. During the year a decision was made to establish a payment center in Baltimore to consolidate the disability claims functions performed by the other six payment centers and to assume the service, control, and files activities of the Division of Disability Operations. The new payment center, opened in September 1958, will also perform all func¬ tions related to the review and certification for payment of retirement and survivors claims for residents of foreign countries. A number of activities during the year were aimed toward improv¬ ing the recordkeeping processes. A study to determine the feasibility of microfilming the huge National Employees Index file of account number holders in the Division of Accounting Operations resulted in a decision to convert the entire file of 160 million strips to microfilm with quarterly updating by the use of electronic tape and electronic data processing equipment. This will result in net savings of about $1,450,000 over a 10-year period. 30 Department of Health , Education , and Welfare , 1955 The use of electronic equipment in the earnings record process has been extended successfully with substantial savings. The first IBM Type 705 electronic data processing system was introduced in fiscal year 1957. Early in fiscal year 1958, a second such system was in¬ stalled. As a result of these two installations, operating costs for fiscal year 1959 will be at a level some $1.8 million less than if con¬ ventional equipment were used. Plans are being developed for the introduction in fiscal year 1960 of a third electronic data processing system in the earnings report process. When this has been completed, practically all of the earn¬ ings records operations, after initial key punching, will be performed by electronic equipment at an estimated additional annual savings of about $250,000. In another area of operations, magnetic tapes have been prepared containing data from the payee punch cards used in the payment center processes. This tape will be used to prepare the annual tabu¬ lations of beneficiaries and benefits by State and county, and will make available a wider range of statistics in shorter periods of time. Initial savings are estimated to be approximately $50,000 a year. The magnetic tapes were also set up so that they could be used for con¬ version of monthly benefit amounts. This will greatly expedite proc¬ essing the benefit increases effective in 1959. During the year the Bureau was surveyed by a group of business leaders (under the chairmanship of Mr. Beinhard A. Hohaus, Vice President and Chief Actuary of the Metropolitan Life Insurance Com¬ pany) selected by the Secretary to review the broad aspects of the manner in which the Bureau discharges its responsibilities in adminis¬ tering the old-age, survivors, and disability insurance program. The report of the Committee, submitted to the Secretary on June 20, 1958, summed up its broad findings by stating that . . the Bureau is carrying out its mission in a sound and vigorous manner. It should be a source of satisfaction to the Secretary to know that the Bureau has been a pioneer in the very difficult matter of introducing auto¬ matic machinery into the paper- work area with substantial savings to the Trust Funds. . . It further stated that the consultants “. . . were impressed with the effective and competent manner in which the staff of the Bureau appeared to be managing their responsibilities,” and that they were . . well impressed with the way the Bureau per¬ sonnel met and dealt with the public and with the impression of both efficiency and friendliness created by the typical OASI district office.” The Committee made several recommendations for procedural changes dealing with internal Bureau methods and operations and primarily concerned with the application of integrated data process¬ ing techniques and automation. Social Security Administration 31 Two recommendations involve Bureau relations with other agencies. The first, adoption of the Combined Annual Reporting Plan, which involves the Internal Revenue Service, would require legislative au¬ thorization before it could be effected. The second was a recommenda¬ tion that the check writing function associated with benefit payments be transferred from the Treasury Department to the Bureau. Since July 1, 1955, the Birmingham Payment Center has been is¬ suing benefit checks under a Treasury Department delegation. The Treasury Department will resume issuance of these checks early in fiscal year 1959. During the fiscal year, design of the new Bureau building in Balti¬ more was completed. On October 31, 1957, contracts were signed with the general contractors and construction was started in November. Under the contract, the building is to be completed in February 1960. Total administrative costs for the program in fiscal year 1958 amounted to approximately 2.1 percent of contributions to the trust funds. An assessment of operations in the perspective of recent years experience shows that the workload of the Bureau increased approxi¬ mately 203 percent from 1950 to 1958, while average staff increased by only about 109 percent during the same period. Legislative Developments During the Year The most important measure affecting old-age, survivors, and dis¬ ability insurance was the enactment, soon after the end of the fiscal year, of P. L. 85-840, the Social Security Amendments of 1958. This legislation, originating in the Committee on Ways and Means as H. R. 13549, was passed by the House of Representatives on July 31 and by the Senate on August 16 ; it was signed by the President on August 28. Ten other public laws enacted by the Eighty-fifth Con¬ gress make minor changes in the program. PROVISIONS OF THE 1958 AMENDMENTS Increase in benefit amounts. — Monthly benefit amounts were in¬ creased by about 7 percent over the levels provided by the 1954 amend¬ ments, effective with benefits for January 1959. The minimum in¬ crease in benefits for workers who retired at or after age 65 was $3 ; the average increase for workers already retired was $4.75. Under the new provisions, benefits for workers already retired (except for women who draw actuarially reduced benefits before age 65) will range from $33 to $116, as compared with $30 to $108.50 under previous law. F or those coming on the benefit rolls in the future, taking into account the increase in the earnings base from $4,200 to $4,800, benefits can be as high as $127, although it will be many years before the maxi¬ mum amount will be generally available in retirement cases. 32 Department of Health , Education , and Welfare , 1958 Payments to dependents and survivors of insured workers were also increased by the amendments. The minimum amount payable to a sole survivor was raised from $30 to $33; the maximum family benefit payable (within the limitation of 80 percent of the insured worker’s average monthly wage) was raised from $200 to $254, effective with benefits for January 1959. Increase in the earnings base. — The maximum amount of annual earnings taxable and creditable toward benefits was increased from $4,200 to $4,800, effective January 1, 1959. The $4,800 maximum re¬ stores the relationship between workers’ taxable and total earnings that existed in 1954, when the $4,200 earnings base was adopted. The $4,200 base covered all the earnings of about 56 percent of regularly employed men in 1954. In 1957 only 43 percent of such workers had all their earnings credited ; about 56 percent will have all their earn¬ ings credited under a $4,800 base. Increase in contribution rate. — The scheduled contribution rates on earnings paid by employers and employees were each increased by *4 of 1 percent, with an increase of % of 1 percent for the self-employed, effective in 1959. Scheduled future increases in the tax rates, begin¬ ning in 1960, are to take place at 3-year rather than at 5-year intervals. Benefits for dependents of disability insurance beneficiaries. — Bene¬ fits for dependents of disability insurance beneficiaries are payable for the first time for the month of September 1958, and are provided for the same categories of dependents as in the case of dependents of old-age beneficiaries, that is, for wives and dependent husbands who have reached retirement age, for unmarried dependent children (in¬ cluding sons or daughters disabled in childhood), and for wives who have an entitled child in their care. These monthly benefits are sub¬ ject to the same conditions as are applicable in the case of dependents of old-age beneficiaries and, in addition, are suspended if the disabled worker refuses, without good cause, to accept vocational rehabilitation services. The provision for benefits for dependents of disability in¬ surance beneficiaries closes a gap in the protection which the program affords to families whose income is cut off or reduced because the breadwinner is no longer able to work. Repeal of disability benefits offset provision. — Another significant change made by the amendments was the repeal of the disability bene¬ fits offset provision, effective with disability benefits payable for the month of August 1958. Under the offset provision, included in the disability provisions in 1956 to prevent duplication or pyramiding of benefits, disability benefits (and benefits payable to persons disabled in childhood) were reduced by the amount of any periodic benefits payable to an individual on account of disability under certain other Federal programs or under State workmen’s compensation programs. Social Security Administration 33 As of June 30, 1958, about 36,000 disability insurance benefits (and less than 1,000 childhood disability benefits) were either reduced or withheld under the offset provision. Disability work requirements. — The 1958 amendments eliminated the currently insured requirement for both disability benefits and the freeze and added as a requirement for the freeze that the worker must be fully insured. The currently insured requirement had operated to deny disability protection in many cases in which there was no doubt that an individual had stopped working because of disability. Many persons who had worked for substantial periods failed to meet the requirement because of interruptions in their work due to progressive illness which did not become severe enough to meet the definition of disability until after they had lost their currently insured status. Under prior law, it would have been possible, after June 1961, for a person to qualify for a freeze, and yet fail to qualify for disability benefits at age 50 or for old-age retirement benefits. There could also have been instances where dependents’ or survivors’ benefits would not be payable even though the worker had been allowed a disability freeze. It is estimated that the changed work requirements resulted in making about 35,000 persons, who could not have previously quali¬ fied, immediately eligible for disability benefits and the disability freeze and, in addition, about 15,000 persons eligible for the freeze. Retroactive disability insurance benefits. — The amendments provide retroactive payment of disability benefits for as many as 12 months before the month in which application is filed for such benefits. Applications for disability benefits are thus now accorded the same retroactive effect as applications for other types of monthly benefits under the program. Postponement of deadline for filing fully retroactive freeze appli¬ cations. — The amendments postpone for 3 years the June 30, 1958, deadline for filing applications for the disability freeze which permit a period of disability to be established as early as the actual onset of the disability; with respect to applications for the freeze filed after J une 30, 1961, the beginning of a period of disability may predate the filing of an application by as many as 18 months. Under prior law, a period of disability could begin no earlier than 1 year before appli¬ cation if filing occurred after the deadline for fully retroactive appli¬ cations. The postponement of the deadline makes it possible for about 30,000 additional disabled workers to become immediately eligi¬ ble for disability benefits ; an additional estimated 10,000 can become immediately eligible for the freeze. The retirement test. — The amendments increased from $80 to $100 the amount of wages an employed beneficiary who has total annual earnings in excess of $1,200 may have in a month without losing bene¬ fits, and made changes to improve administration of the test. 34 Department of Health , Education , and Welfare, 1958 Dependency provisions. — Changes in the provisions for dependents’ benefits increased protection for children and for dependent parents, and provided protection for certain beneficiaries who marry or re¬ marry. Employees of nonprofit organizations. — The amendments provide for a limited period of retroactive coverage for employees of non¬ profit organizations which elect coverage after 1959. Nonprofit organ¬ izations which elect, or have elected, coverage after 1955 and prior to 1960 may cover employees retroactively to January 1, 1956. Under another provision, a nonprofit organization employing persons in positions covered by a State or local retirement system who are mem¬ bers, or eligible to become members of such a system, is required to treat these employees as a completely separate group for purposes of social security coverage. P. L. 85-785 makes technical changes which broaden slightly the provisions of existing law under which tax returns filed by a nonprofit organization before it filed its waiver certificate may establish social security credit for wages reported on these returns if the wages were paid for services performed before the enactment of the 1956 amend¬ ments. Employees of State and local governments. — The 1958 amendments make various improvements in the provisions of the law permitting States to provide coverage for employees in positions covered under State or local retirement systems, particularly in the provisions which permit certain specified States to provide coverage for only those members of a State or local retirement system who desire such coverage. State and local sick-leave payments. — P. L. 85-786 provides that sick-leave payments received by an employee of a State and local government after he reaches retirement age shall be counted as wages if such payments are counted as wages for employees under retirement age. Under previous law, most State and local sick-leave payments were wages before retirement age but not after retirement age if the employee did no work during the pay period. Partnership earnings in the year of death. — The amendments pro¬ vide that a partner shall be credited, for social security purposes, with his distributive share of partnership earnings in the year of death. This change will affect relatively few people but will correct an in¬ equity which sometimes resulted from inability to credit a partner with income in the year of death. Turpentine workers. — Beginning with 1959, services performed by workers engaged in the production of turpentine and gum naval stores will be covered under the conditions applicable to other agricultural workers. While many of the estimated 15,000 workers in this new coverage group are only seasonally or temporarily employed, this new Social Security Administration 35 source of coverage will in many instances supplement the protection they acquire in other covered employment and self-employment. Americans who served in the armed forces of allied countries. — The amendments broaden the provisions of prior law for gratuitous wage credits of $160 for months of military service for the United States to include military service during World War II for certain allied countries. Such credits may be granted for the World War II mili¬ tary service of certain American citizens and former citizens, who, before December 9, 1941, entered the military service of a foreign country which was, on September 16, 1940, at war with a country that became an enemy of the United States during World War II. This amendment assures that these individuals will have no gap in their social security coverage because of such service. Administrative changes. — The definition of fraud under the pro¬ gram was expanded and clarified. The Department was also author¬ ized to charge for services provided the public for non-program pur¬ poses to reimburse the Trust Funds. Other changes were made to improve administration. Advisory Council on Social Security Financing The first Advisory Council on Social Security Financing, appointed in October 1957 to review the status of the Federal Old-Age and Sur¬ vivors Insurance Trust Fund and the Federal Disability Insurance Trust F und in relation to their long-term commitments, held a num¬ ber of meetings during the year. It was to submit its formal report by January 1, 1959. To assure that the system will continue to operate on a sound finan¬ cial basis, these Councils, authorized by the Social Security Amend¬ ments of 1956, will be appointed in advance of each scheduled increase after 1960 in tax rate and will report their findings and recommenda¬ tions not later than the first of J anuary before the year in which the scheduled increase takes effect. The Councils are composed of the Commissioner of Social Security, as chairman, and twelve representa¬ tives of employers, employees, the self-employed and the public. Special Studies Requested by the Congress The Committee on Ways and Means of the House of Kepresentatives, in connection with its consideration of proposed changes in the Social Security Act, has asked the Department to make three special studies and to report to the Committee on the results. The first of these stud¬ ies is to be concerned with proposals for covering tips as wages, and, more specifically, with methods of determining the amount of tips to be counted as wages under the program and the method of securing reports of these amounts. Second, the Department is to study, with a 36 Department of Health, Education, and Welfare, 1958 view to possible change, the provision of the retirement test which makes it possible for a beneficiary to receive benefits for some months in a year even though he may have had high earnings during the year. The third study is of alternative ways of providing insurance against the cost of hospital and nursing home care for old-age, survivors, and disability insurance beneficiaries. The Committee’s purpose in re¬ questing this study was to obtain more information on the practi¬ cability and the costs of legislative action which might be recommended to make such protection available. Survey of Resources of Old-Age Insurance Beneficiaries The Bureau conducted a national survey in the fall of 1957 in order to obtain current information about what resources beneficiaries had in addition to their old-age insurance benefits. According to preliminary findings from the survey, the median independent retirement income of old-age beneficiary couples (both entitled) was $1,700 in 1957. Single retired workers had about half as much income as the couples; aged widows, a little less than the single retired workers. Forty-four percent of the beneficiary couples and 60 percent of the single retired workers and widows had no inde¬ pendent retirement income in addition to their old-age and survivors insurance benefits, or had less than $75 for the entire year. The others had additional income from assets, and from miscellaneous permanent sources such as pensions or annuities. Many beneficiaries (35 percent of the retired workers, 15 percent of the aged widows) supplemented their retirement income with earnings from employment; one in ten of the family units (single persons, married couples, and widowed mothers with entitled children) received public assistance. Median income from all sources was $2,190 for beneficiary couples, $1,140 for single retired workers, and $880 for aged widows. Median net worth of the beneficiaries was $4,920; a fourth had zero or minus net worth ; a fourth had more than $13,700. Beneficiary couples (both entitled) had a median net worth of $9,620 ; single men, $800; single retired women, $2,080; and aged widows had a median net worth of $4,380. Equity in their homes accounted, on the whole, for the greater part of the net worth. Half of the family units owned their homes — 72 percent of the beneficiary couples, 32 percent of the single retired workers, and 46 percent of the aged widows. The median amount of liquid assets held was $1,580 for beneficiary couples, $220 for single retired workers, and $460 for aged widows. A fourth of the beneficiary couples, about 40 percent of the single retired work¬ ers, and about 40 percent of the aged widows had no liquid assets. Some life insurance, usually only small amounts, was carried by 70 percent of the beneficiary couples and half of the single retired workers. Social Security Administration 37 Program Simplification Project Considerable progress was made during the year under the Bureau’s program simplification project. As a result of the studies conducted of the retirement test and the computation and recomputation of bene¬ fits, a number of proposals for simplifying these two complex program areas were developed. Enacted into law as a part of the Social Security Amendments of 1958 were the following simplification pro¬ posals : (1) a table for computing benefit amounts replaced the benefit computation formulas, (2) a different order was established for al¬ locating excess earnings to the months of the year for deduction pur¬ poses, (3) the amount of wages that could be earned in a month before a deduction could be imposed was raised (from $80 to $100) to the monthly rate that is used in computing the annual exempt amount of earnings ($100), and (4) the requirement for a report of earnings where the benefits payable to the individual were suspended for the entire year was eliminated. Study was begun on two new program areas in 1958 — the coverage provisions for State and local employees and the benefit category of lump-sum death payments. Financing the Program P. L. 85-840 modified the schedule of contribution rates so as to continue to reflect the intent of Congress that the system be self- supporting from the contributions of covered workers and employers. A revision of the contribution schedule was arrived at after careful review of long-range actuarial cost estimates prepared for use by the Congressional committees in their legislative considerations. The program, as amended, continues to be financed on an actuarially sound basis. 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, retirement, disability, or earnings had been used, different results would have been obtained. Accordingly, no one set of estimates should be looked upon as final. It is the Department’s policy con¬ tinually to reexamine the long-range cost estimates of the program in the light of the latest information available. Old-age and survivors insurance benefits. — Three important changes made by the 1958 amendments will result in higher income to the system. First, as mentioned previously, there is a uniform % of 1 percent increase in the combined employer-employee rate and an in¬ crease of % of 1 percent for the self-employed for all future years beginning with 1959. Second, the increases in the contribution rates which, were scheduled at 5 -year intervals in the old law are now ad- 38 Department of Health, Education, and Welfare, 1958 vanced to 3-year intervals. Third, the maximum taxable and cred¬ itable earnings base is raised from $4,200 to $4,800 a year. Expressed as a level premium percent of payroll, the additional income thus realized will be significantly more than is needed to meet the larger outlays for benefits resulting from the amendments. As a result, the long-range financial basis of the program has been very substantially strengthened. In addition, the relationship between trust fund income and outgo over the next few years will be significantly improved. Income will be somewhat less than outgo during calendar years 1958 and 1959. Beginning in 1960, income will again exceed outgo — under the old law, outgo was expected to exceed income during most, if not all, years until 1965 — and the assets of the trust fund are expected, under the intermediate cost estimates, to increase each year throughout this century and for many years thereafter. The level premium cost of old-age and survivors benefits on an inter¬ mediate basis, with interest at 3 percent, figured into perpetuity is 8.27 percent of payroll. Contribution income is equivalent to 8.02 percent of payroll on a level basis. This leaves an actuarial insufficiency of 0.25 percent of payroll. In view of the very long range over which these projections are made, and the many variable factors included, the insufficiency is so small that the system may be considered in close actuarial balance. Disability insurance benefits. — The Social Security Amendments of 1956 established a system for financing disability benefits through a separate trust fund which is entirely apart from the financing of old- age and survivors insurance benefits. The level premium cost of the disability benefits, as amended in 1958, on an intermediate basis, with interest at 3 percent, is 0.49 percent of payroll. Contribution income has been specifically allocated to finance these benefits ; this income is equivalent to 0.50 percent of payroll, thereby producing an actuarial surplus of 0.01 percent of payroll. Public Assistance During 1958 the Bureau of Public Assistance worked closely with State public assistance agencies in further implementing the 1956 amendments to the public assistance titles of the Social Security Act, especially those concerned with helping to increase the capacity of needy persons for more independent living and strengthened family life. Attention also continued to be directed toward efficient adminis¬ tration as an integral factor in maintaining effective and constructive operation of State and local public assistance programs. In addition, increased efforts were made to learn more about the causes of dependency and other characteristics of persons receiving Social Security Administration 39 public assistance and to evaluate the adequacy of assistance and serv¬ ices available to them. These efforts both sharpened the outline of areas of need and made more clearly visible significant factors con¬ tributing to dependency of a relatively small, but important, segment of the Nation’s people. Consideration of some of these and many other related factors similarly claimed the attention of many individuals, organizations, and congressional committees during the year and culminated in re¬ visions of the public assistance titles of the Social Security Act which make possible further strengthening of the assistance and services available to needy persons. 1958 Amendments Affecting Public Assistance Amendments to the Social Security Act in August 1958 revised the basis of Federal financial participation in State expenditures for pub¬ lic assistance in three significant ways : (1) For the first time, the fiscal ability of each State is considered in part in determining the Federal share of a State’s expenditures for public assistance. (2) The Federal share is related to a single average expenditure per recipient for both money payments to recipients and vendor payments for medical care. (3) The amount of State expenditures for public assistance, including medical care, in which the Federal Government will participate is limited to an amount equal to $65 a month times the number of aged, blind, and disabled recipients in the State and $30 times the number of recipients of aid to dependent children.1 Effective October 1, 1958, the formula used in determining the Fed¬ eral share of State expenditures (except for Puerto Rico, the Virgin Islands, and Guam) is as follows : For the aged, blind, and disabled the Federal Government pays % of payments up to $30 per recipient, and for aid to dependent children, of payments up to $17 per recipient. The Federal share of the remainder of a payment ranges from 50 to 65 percent (depending on each State’s fiscal capacity based on per capita in¬ come data supplied by the Department of Commerce, except that 50 percent is specified for Alaska and Hawaii) up to an average limitation of $65, including medical care, per recipient in old-age assistance, aid to the blind, and aid to the permanently and totally disabled and $30 per recipient in aid to dependent children.2 1 Provisions of (1) and (3) above do not apply to Puerto Rico, the Virgin Islands, and Guam. 2 Previously, the Federal maximum share was determined in relation to payments to each individual recipient and to an average expenditure per recipient for payments to suppliers of medical care. Maximums for individual payments in which the Federal Gov¬ ernment shared were $60 a month for the aged, blind, and disabled ; $32 a month each for the first child and the person caring for him, and $23 for each additional child in the family receiving aid to dependent children ; and an average of $6 a month per adult recipi¬ ent and $3 a month per child recipient for vendor payments for medical care expenditures in their behalf. 40 Department of Health , Education , and Welfare , 1958 These changes (1) increase the amount of Federal funds available to all States for public assistance (2) make possible greater flexibility in meeting individual needs of people and (3) simplify State fiscal procedures for claiming Federal funds. The additional Federal funds are expected to enable States, espe¬ cially those with limited fiscal resources, to make more adequate as¬ sistance payments and to help achieve greater equity in the level of assistance available to needy persons in different parts of the country. However, responsibility for determining how the additional Federal money is to be used is a matter for individual State determination. Federal participation in public assistance expenditures is continued on a 50-50 matching basis in Puerto Rico and the Virgin Islands. Limitations on total expenditures in which the Federal Government will participate were revised to relate to average expenditures per. re¬ cipient as in other jurisdictions but at lesser amounts ($35 a month per recipient for old-age assistance, aid to the blind, and aid to the permanently and totally disabled, and $18 a month per recipient for aid to dependent children). The annual limitation on the authoriza¬ tion of Federal funds for Puerto Rico was raised to $8,500,000 (from $5,312,500) ; and for the Virgin Islands, to $300,000 (from $200,000). The public assistance provisions of the Social Security Act now apply to Guam on the same basis as to Puerto Rico and the Virgin Islands. The dollar limitation for Guam is $400,000 a year. In addition, special provisions relating to aid to the blind programs in Pennsylvania and Missouri were extended from June 30, 1959 to June 30, 1961; and Federal sharing was provided in payments to persons judicially appointed under State law as legal representatives of assistance recipients whether or not they are the legal representa¬ tives of such persons for other purposes. Provision was also made for establishing an Advisory Council on Public Assistance to review the status of public assistance programs. The Council is to report its findings and recommendations to the Sec¬ retary and the Congress by J anuary 1, 1960. Trends in Caseloads and Expenditures 3 In June 1958, 6.7 million persons (3.8 percent of the total civilian population) received either federally aided categorical public assist¬ ance — old-age assistance, aid to the blind, aid to dependent children, aid to the permanently and totally disabled — or general assistance, which is financed only by State and/or local funds. Aid was received by 800,000 more persons than a year earlier, an increase of 13.6 percent. 8 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 41 The largest increases occurred in the number of persons receiving either general assistance or aid to dependent children, the two types of assistance most sensitive to economic change. There was a smaller increase in the number receiving aid to the permanently and totally disabled. The number of blind recipients was virtually the same at the end of the fiscal year as at the beginning. The number receiving old-age assistance, however, continued to decline. Total expenditures for public assistance from Federal, State, and local funds, including payments for medical care, were $3,249.7 mil¬ lion during fiscal 1958, an increase of $280.5 million (9.4 percent over 1957). (See table 6, page 76.) The largest increases occurred in aid to dependent children ($114.9 million) and in old-age assist¬ ance ($75.0 million) . A fifth of the total increase in aid to dependent children and nearly a third of the increase in old-age assistance occurred in one State alone, reflecting both State policy liberaliza¬ tions and vendor payments under its new medical care provisions. National expenditures rose by $23.4 million in aid to the permanently and totally disabled, $4.8 million in aid to the blind, and $62.4 million in general assistance. The Federal share of total expenditures, ex¬ cluding general assistance, was 56.4 percent. Assistance payments for the past year represented about %0 °f a cent Per dollar of total per¬ sonal income in the Nation during 1957. Old-age assistance. — Almost 2,500,000 persons, about 1 in 6 per¬ sons (16.2 percent) in the country 65 years of age or over received old-age assistance in June 1958. This number was 1.7 percent (43,000) less than the number aided in June 1957. The national average monthly payment per recipient for old-age assistance was $61.39 in June 1958, an increase of $2.73 over the previous June. Average payments ranged from a low of $29.85 in Mississippi to a high of $106.40 in Connecticut (except for $8.12 in Puerto Eico and $18.66 in the Virgin Islands). Aid to dependent children. — The number of persons receiving aid to dependent children in June 1958 was nearly 2,733,000, the largest number in any month since the beginning of the program, and 334,000 more than in June 1957. This number includes 3.3 percent of all children in the Nation under 18 years of age. The national average payment per recipient in June 1958 was $27.29, an increase of $1.25 over the previous June. Average payments ranged from a low of $8.44 in Alabama to a high of $45.23 in California (except for $3.72 in Puerto Eico) . Aid to the permanently and totally disabled. — About 313,000 per¬ sons received aid to the permanently and totally disabled in June 1958, or 10 percent more than in June 1957. New programs in California and Texas brought to 48 the number of jurisdictions now 487270—59 - 4 42 Department of Health , Education , and Welfare , 1958 administering federally aided programs for the disabled, and ex¬ pansion of programs in Illinois and Pennsylvania contributed to the increase of 29,000 persons receiving such aid. The national average assistance payment per recipient in June 1958 was $60.71, an increase of $1.61 from the previous June. Average payments ranged from a low of $29.58 in Mississippi to a high of $122.57 in Connecticut (except for $8.73 in Puerto Eico and $20.39 in the Virgin Islands). Aid to the blind. — Approximately 108,000 persons received aid to the blind in June 1958, virtually the same as in the previous June. The national average payment in June 1958 was $66.72, an increase of $2.85 over June 1957. Average payments ranged from a low of $36.16 in Alabama to a high of $113.39 in Massachusetts (except for $8.03 in Puerto Eico). General assistance. — The 1,164,000 persons in 418,000 cases receiv¬ ing State and/or locally financed general assistance in June 1958 represented a 71 percent increase in persons and a 42 percent increase in cases over J une 1957. Most of the increase occurred in the winter and spring. Additions to the general assistance rolls in the spring included a number of unemployed persons who had exhausted their rights to unemployment insurance benefits. In April the increase in the general assistance caseload was relatively slight, and in May and June the number of cases dropped 5.1 percent and 2.9 percent respectively. The national average payment in June 1958 was $61.55 per case, an increase of $6.66 over June 1957. Average payments ranged from a low of $11.84 a month per case in Arkansas to a high of $93.11 in New Jersey (except for $6.64 in Puerto Eico). Public assistance supplementing insurance benefits. — Public as¬ sistance is used to supplement social insurance benefits in instances where low wages or the length of time worked in covered employment have entitled the beneficiary to receive benefits in an amount which does not meet his basic needs. It is also used to meet special needs, such as medical care, for those whose insurance benefits plus other personal resources are insufficient to meet this additional expense. The number of persons receiving both insurance benefits and old- age assistance continued to increase during the past year. About 596,500 or 24.2 percent of those receiving old-age assistance in Feb¬ ruary 1958 received both insurance benefits and assistance payments, compared with 22.2 percent a year earlier — an increase of 116 percent from September 1950. About 20 percent of all old-age assistance payments (approximately $29.3 million) was made to aged benefi¬ ciaries in February 1958 to supplement benefits. The average as¬ sistance payment supplementing benefits, however, was a fourth lower than payments to other aged persons, $49.09 compared with $64.73. The average insurance benefit received by these aged assistance re- Social Security Administration 43 cipients was $40.68, or about 70 percent of the average amount paid to all aged beneficiaries. The 37,200 families receiving both insurance benefits and aid to dependent children represented 5.4 percent of all families receiving aid to dependent children in February 1958 compared with 5.1 per¬ cent in February 1957. They received 4 percent (about $2.9 million) of the total payments to aid to dependent children families. The average assistance payment to families receiving both types of pay¬ ments was $78.27, compared with $102.71 for families not receiving insurance benefits. The average benefit received by these families was $66.19 or less than half the average benefit paid to all beneficiary families consisting of widows and children. The extension of benefits under the 1956 amendments to the Social Security Act to totally disabled workers aged 50-64 and to an insured worker’s dependent child 18 years of age or older who was disabled before he became 18 had little measurable effect on public assistance programs. Only about 3 percent of those receiving aid to the dis¬ abled and 1 percent receiving aid to the blind became eligible to re¬ ceive such benefits. Significant Trends and Their Implications Trends revealed in the above data have several important program implications. These trends are: (1) a steady decline in the number of persons receiving old-age assistance and a rising proportion re¬ ceiving assistance to supplement social insurance benefits ; (2) a sharp increase in the number of cases receiving general assistance, especially during the winter months; (3) a steady rise in the number receiving aid to dependent children, with this program now aiding the largest number of assistance recipients; (4) a lower total expenditure for aid to dependent children than for old-age assistance, even though the number of persons receiving aid to dependent children is greater than the number receiving old-age assistance; and (5) a relatively larger increase in the average payment per recipient for the aged, in comparison with the rise in average payment per recipient for needy children. Trends in old-age assistance and aid to dependent children are highlighted in the charts below which depict contrasting trends in the number receiving old-age assistance and aid to dependent chil¬ dren and portray the wide margin between the amount of expendi¬ tures for these two programs. The declining number of aged receiving assistance. — The number of aged persons receiving assistance declined about 2 percent during the past year, and 12 percent since 1950 even though the total number of persons 65 or more years of age increased 22 percent during this 44 Department of Health , Education , and Welfare , 1958 CHART 1.— TRENDS IN RECIPIENTS AND ASSISTANCE PAYMENTS IN OAA AND ADC, OCT. 1 950— JUNE 1958 THOUSANDS OF RECIPIENTS period. As a result, only 16.2 percent of the total aged population received assistance in June 1958 compared with 22.6 percent in 1950. With nine-tenths of all persons in paid employment now covered by the old-age, survivors, and disability insurance program, it can be expected that fewer and fewer older persons will be dependent primarily on old-age assistance. However, if the past trend con¬ tinues, an increasing proportion of old-age assistance recipients will probably need to receive assistance to supplement insurance benefits to meet basic or special needs such as medical care. The trend in the number of recipients of other assistance programs has been upward since 1953, due in large part to population increases, rising costs of living, direct and indirect effects of the recent recession, and to the relatively smaller influence so far of the insurance program on the blind, disabled, and children dependent for reasons other than the father’s death. General assistance on the rise. — The number of persons receiving help under State and/or locally financed general assistance programs increased 71 percent from June 1957 to June 1958. Although the number aided declined in May and June, the 45 percent increase from December 1957 to April 1958 is a significant indicator of the need of unemployed workers who were either not covered by unemployment insurance or who exhausted their benefits and for whom no provision is made under federally aided assistance programs. General assistance, although available in some parts of all States, is frequently limited to temporarily or permanently unemployable persons. Some States provide no assistance to employable persons Social Security Administration 45 and their families even in emergencies. For example, in February 1958, general assistance was available to employable persons in 26 States on a statewide basis ; in 16 it was available in some but not all parts of the State, not even in areas hardest hit by unemployment in 10 of these States ; and in 5 the granting of assistance was a matter for local determination. General assistance is financed by State funds alone in 11 States; by State and local funds in 26 States; and by local funds alone in 16 States. Most general assistance payments were lower than federally aided public assistance payments. Although most States met additional requests for assistance under their current standards for general assist¬ ance, many of these standards were extremely low. In some States funds were inadequate to meet need as determined even within these standards. Perhaps the most profound effect of the recent period of unemploy¬ ment has been to highlight the inadequacy of many State and/or locally financed general assistance programs to meet need even after Federal legislation extended unemployment compensation benefits. Voluntary welfare agencies and other community groups helping to meet economic need during the winter of 1957-58 have brought into sharper focus the relationship of voluntary and public agencies in the relief area. Many of these groups have also expressed concern about the hard¬ ship of the unemployed in those instances where residence require¬ ments restrict eligibility of such persons for public aid. All but 5 States have residence requirements for old-age assistance; all but 7 for aid to the blind and aid to the disabled ; and all but 8 for aid to dependent children. Most have State residence and some also have local settlement requirements for general assistance. An important argument in favor of residence requirements is made by some States which fear the expense of caring for nonresidents, migratory laborers, for example, for whom they traditionally have assumed no responsibility. Several other States have tried to mini¬ mize the restrictive effect of residence requirements through uniform State laws, reciprocal agreements, or interstate compacts. The increasing role of aid to dependent children. — National eco¬ nomic and social problems are reflected in the gradual upward trend in the number of recipients of aid to dependent children. The number of persons presently aided under this program is nearly 30 percent larger than 4 years ago. As indicated in Chart 1, above, the number receiving aid under this program in December 1957 exceeded the num¬ ber receiving old-age assistance. In June 1958 aid to dependent chil¬ dren recipients totaled 2,732,800 compared with 2,460,300 old-age assistance recipients. 46 Department of Health , Education , and Welfare , 1958 Other significant long-term factors, in addition to the recent reces¬ sion, have contributed to this increase. For example, the number of children in the Nation has increased until children under 18 years of age now constitute 35 percent of the total civilian population. There has also been a substantial increase in the number of families and an even greater relative increase in the number of broken families headed by women. Since these families usually have much less in¬ come than families headed by men, an increasing number of children in broken families are liable to need financial help. Death of the father as a cause of dependency accounts for only about 12 percent of the families currently receiving aid to dependent chil¬ dren ; in about 22 percent need is due to the incapacity of the father, but in about 60 percent need is related to the absence of a father be¬ cause of divorce, separation, desertion, unmarried parenthood, or other reasons. However, dependency on public assistance of about a fifth of the Nation’s families broken by separation or unmarried parenthood is only a part of the increasing evidence of social prob¬ lems in all elements of society. For example, the number of broken families with children under 18 increased from 1.5 million in 1950 to 2.8 million in 1956. Also, the number of children in the total population reported as born out of wedlock more than doubled between 1938 and 1956, rising from 87,900 to 193,500. The Bureau estimates the relative increase between 1938 and 1954 in nonwhite illegitimate births to be 143 percent compared with white illegitimate births of 52 percent. About 70 percent of white children born out of wedlock are adopted, but fewer than 5 percent of non white children. Few adopted children need aid. The non white illegitimate child, who usually remains with his mother, is more liable to be in financial need. In March 1957 about 1.3 million mothers in the labor force were widowed, divorced, or married but not living with their husbands. F amilies with a female head have shared to a relatively smaller extent than families with a male head in the general increase in money in¬ come in recent years. For example, their median total money income in 1956 of $2,754 represents a 24.1-percent rise from 1951 compared with a 29.7-percent rise to $4,965 for families with a male head. The concentration within the aid to dependent children program of families whose need is often associated with socially disapproved behavior has made this program a ready target for criticism. Although these social problems affect people at all income levels, they are more clearly visible in the causes of dependency of those receiving assistance under the aid to dependent children program. Experience has shown that dependency of children due to family instability has not been remedied by legislation, administrative reg¬ ulation, or financial aid alone. However, wider recognition of the Social Security Administration 47 value of increasing efforts by the States to help bring about more desirable adjustments within the family group resulted in 1956 in a Social Security Amendment emphasizing the provision of social serv¬ ices in all the federally aided public assistance programs. Passage of the “services” amendment, in turn, stimulated State agencies to in¬ crease their activities in providing social services in their aid to de¬ pendent children program to help maintain and strengthen family life and thus give children a better opportunity for health and emotional stability. The aid to dependent children program thus is playing an important part in helping to deal with the problems of children, harassed not only by poverty, but also by illness, incapacity, death or estrangement of parents, or unmarried parenthood. Program Developments In addition to providing technical assistance to Congress during their consideration of legislative changes, Bureau effort continued during the year, as in 1957, to further advance implementation of the 1956 amendments. These activities included interpretation of the amendments, issuance of basic policies for use by States, and wTork on major problems requiring resolution. Fiscal and administrative procedures were developed to effect necessary changes in grants to States, and technical assistance was provided to State agencies for implementing the new legislation. In addition, the Bureau issued information explaining the amendments to interested individuals and groups, and prepared a booklet interpreting social services in public assistance and pointing up the values of cooperative community efforts in providing social services for needy people. Considerable progress was made also by the Bureau and the States in providing social services to help public assistance recipients increase their capacity for self-care and/or self-support. STRENGTHENING SERVICES FOR NEEDY PEOPLE The nature and extent of social services provided by public welfare agencies vary greatly between States, within a State, within a locality, and even between workers in the same agency depending on their awareness, skills, and the acceptance of such practice as an essential part of the effective administration of public assistance. Efforts dur¬ ing the past year, therefore, were increasingly directed toward helping the States to strengthen the services aspects of their programs. By July 1, 1957 (as required by the 1956 “services” amendment) States had developed descriptions of the services available in their public assistance programs, and of the steps taken to assure maximum utilization of services furnished by other agencies. This process led 48 Department of Health , Education , and Welfare , 1958 the States to a critical evaluation of existing services and planning for their extension and increasing effectiveness on a statewide basis. These services plans indicate progress in clarifying the services made available by the State welfare agency and increasingly effective utili¬ zation of other community resources. Although there is variation between States, certain common problems are recognized in the plans of most States, namely, the effects of financial need, illness, family breakdown, and lack of education and training for employment. These plans also indicate areas needing further nationwide emphasis, such as increasing utilization of such resources as child welfare services within the agency and in the community, and more active participation of the public assistance agency in planning for the development and utilization of new and needed resources in the community. Certain proposals for expanding social services developed by individual States utilizing new and dynamic concepts have identified policy areas re¬ quiring further consideration. The Bureau also continued its efforts in planning for the increasing provision of appropriate social services for needy people. For ex¬ ample, a staff committee of the Children’s Bureau and the Bureau of Public Assistance is considering services to families and children under public assistance and child welfare programs as a basis for making recommendations regarding program relationships in areas of service common to both. The Bureau is also represented on an intradepartmental committee to consider the problems of working mothers in relation to programs within the Social Security Adminis¬ tration. In addition, the Bureau maintains liaison with the Child Welfare League of America in developing standards on protective services for children and is represented on the American Public Welfare Association’s Committee on Services to Children. Work is continuing to strengthen cooperative relationships between State pub¬ lic assistance and vocational rehabilitation agencies in providing serv¬ ices to needy individuals. The Bureau is also helping to plan the second National Conference on Homemaker Service to be held in February 1959 under the joint sponsorship of 8 constituent units in the Department and 26 national voluntary social and health agencies. Preconference activities in¬ cluded Bureau participation in planning a Public Health Service survey of existing homemaker services and the development and issu¬ ance of a descriptive directory of agencies providing homemaker and related services in 1958. State and local public welfare personnel are also serving on most of the study groups organized in various parts of the country to develop basic work materials for the Con¬ ference. Bureau staff also worked closely with the Public Health Service in efforts to improve nursing homes and institutional care for the Social Security Administration 49 aged. For example, it participated in the National Conference on Nursing Homes and Homes for the Aged called by the Public Health Service in February 1958. It is also planning for implementing the recommendations made at this conference, including regional meet¬ ings that will assist both the personnel of licensing agencies in im¬ proving their educational and consultative services to nursing homes and homes for the aged, and personnel of welfare agencies in improv¬ ing their services to individuals requiring care in these homes. The Bureau’s interest in the aging is also reflected in many other activities, including membership on the Social Security Administra¬ tion’s Committee on Aging ; participation in the Social Security Ad¬ ministration’s representation on the Department’s Committee on Aging; and collaboration with American Public Welfare Association committees in developing statements on social service needs of older people, community planning responsibilities of public welfare agen¬ cies, and the educational needs of staff working with aged persons. Similarly, it participated in the various activities of the National Social Welfare Assembly’s Committee on Aging. The Bureau is cur¬ rently developing a statement of its program responsibilities in the field of aging and is planning to participate in the Department’s preparation for the White Plouse Conference on the Aging authorized by Congress under Public Law 85-908. Improvement in medical care for public assistance recipients. — Separate Federal matching in vendor payments for medical care pro¬ vided under a 1956 amendment effective July 1, 1957, required exten¬ sive planning and preparation on the part of both Federal and State agencies during the year. At the Federal level discussions were held with representatives of various groups to interpret the amendments and to get the benefit of their specialized knowledge and suggestions for implementation. By J une 30, 1958, 41 State agencies in 37 different States were pro¬ viding medical care with Federal participation through vendor pay¬ ments for one or more categories of federally aided public assistance, including 17 agencies which previously made no vendor medical pay¬ ments, and 4 States that had made such payments in 1 or more programs but now extended them to other categories. Nursing-con¬ valescent home care was the item included most frequently for adult categories as of January 1958; and drugs, the item most frequently included in the aid to dependent children program. Nursing services provided by registered or practical nurses other than those made available in hospitals and nursing-convalescent homes was the item supplied least often. States used the vendor payment method more often for hospitalization than for other items of medical care. 50 Department of Health , Education , and Welfare , 1958 Vendor payments for medical care made in behalf of recipients of federally aided public assistance programs totaled $21.6 million in June 1958 and $236.1 million for the fiscal year 1958. RELATED SOCIAL WELFARE ACTIVITIES In addition to administering the public assistance provisions of the Social Security Act, the Bureau carries other broad public welfare responsibilities on a nationwide basis. These include, for example, planning for defense emergency welfare services and services to re¬ patriated American nationals and to refugees from other parts of the world. In addition, Bureau staff take an active role in international social welfare developments. Defense welfare services. — Although activities were suspended on Federal Civil Defense Administration delegations with the termina¬ tion of supporting appropriation on June 30, 1957, the Bureau partici¬ pated in Operation Alert 1958 and continued limited activity in plan¬ ning for emergency organization and operations during a disaster. These included preparation of materials for protecting essential rec¬ ords, delegations to the field, lines of succession, and self-triggering regulations and guidelines for implementation of field delegations. With possible additional delegation of functions from the new Office of Civil and Defense Mobilization under Reorganization Plan Ho. 1 of 1958, and an allocation of limited funds, consideration is being given to possible resumption of a broader range of defense planning activities. Services for repatriated Americans. — The Bureau continued its cooperative activities with the Department of State in arranging for assistance and services needed by repatriated American nationals. Although Federal funds are not available for this purpose, the Bureau, through its regional staff, enlists various community resources in pro¬ viding essential reception services at ports of entry, contacting rela¬ tives and friends, arranging for needed hospital or medical care, or providing temporary financial aid or help with family relationship problems. During the year such help was requested for 40 persons repatriated from 20 countries. The Bureau also continued its work with the Department of State and Department of Defense in developing a legislative proposal for a program to cover both repatriation of American nationals from abroad during a national emergency and peacetime repatriation needs. An Interdepartmental Ad Hoc Committee on Repatriation of American Nationals, inactive since 1954, was reconvened at the request of the Department of the Army to assess the status of these plans and to determine needed next steps. Services to refugees. — Following active participation in the tem¬ porary program of the President’s Committee on Hungarian Refugees, the Bureau evaluated the most effective ways, in relation to our na- Social Security Administration 51 tional interests and safety, of making income maintenance programs applicable to the specific needs of refugee and immigrant families. From this experience the Bureau also contributed to the Departmental Task Force report on refugees and immigrants in outlining the De¬ partment’s potential role in this area. International activities. — The Bureau participates in the training, reporting, and policy development activities of the International Service of the Social Security Administration. The Bureau Director continued to serve as chairman of the Inter¬ departmental Committee on International Social Welfare Policy and Bureau staff participated in the preparation and review of technical materials for use at the United Nations and other international meet¬ ings. The Bureau Director served as one of two vice chairmen of the United States Committee of the International Conference of Social Work, which held its biennial meeting in Tokyo in November 1958. Bureau staff also assisted in developing the United States exhibit for this conference. Bureau staff in regional offices provided consultation and planned or arranged observation programs in cooperation with State and local public and voluntary welfare agencies for visitors from 66 different countries during the past year. In the central office staff specialists provided consultation to foreign visitors and to international groups referred by various U. S. Departments, such as the labor leader teams referred by the Department of Labor ; and also assisted in orientation sessions for foreign visitors at the American Council on Education’s International Center in the District of Columbia. Bureau staff also make a substantial contribution to the preparation of United States material for the United Nations biennial surveys of programs of social development. This year, in addition to sections on public assistance and related services, sections were prepared on organization and administration of public social services, training of social welfare personnel, public administration and social develop¬ ment, and social welfare measures relating to urbanization. Administrative Developments During the year special attention continued to be directed toward a more effective and efficient administration of public assistance pro¬ grams as well as improving Bureau administration and management. The study, “Federal Participation in Administrative Costs of State and Local Administration of the Public Assistance Programs,” which explored numerous factors relating to questions raised by Congress, gave assurance that the Federal Government participates only in those costs that are essential for proper and efficient administration of State public assistance programs. 52 Department of Health , Education, and Welfare, 1958 The findings of the study also pointed up the importance of the relation between administrative costs and the social service functions of a public welfare agency and clarified areas in which further guide materials and technical assistance are needed by the States. This gave new impetus to work already initiated in such areas as case recording, organization and staffing patterns of local agencies, and workload management; and provided the basis for planning several regional conferences to be held during the coming year for joint ex¬ ploration of these areas with the States. The Bureau also has been keeping in touch with experimental projects undertaken by some States to evaluate the effect of selected staff carrying limited case¬ loads, especially in the aid to dependent children program. The evaluation of staff needs and long-range planning for staff development initiated by the States in anticipation of Federal funds under the 1956 “training” amendment, plus the pressing need of States for skilled staff, has motivated a series of significant developments. Some States made funds available for staff-development personnel, educational leave, or other training needs. F or example, 44 States had staff development personnel in December 1957 compared with 14 States in 1950. Many States made progress in strengthening line staff, identifying knowledges and skills needed for staff services, and clarifying the staff- development function. Many States also devel¬ oped orientation or induction training plans and held short-term courses to increase supervisory and administrative staff skills. Similarly, most States made efforts to improve the educational level of staff, since only about 1 of 5 public assistance workers have some professional social- work training. About 475 staff were granted educational leave in 1958 in comparison with 325 in the previous school year. Also, study of education and experience of current staff resulted in some States raising educational requirements for be¬ ginning positions; others intensified staff recruitment; and some are considering readjustment of salary scales in order to retain personnel with professional training. Several States reported greater success in recruitment campaigns because of higher salary scales, improved benefits, and more frequent merit system examinations. To meet the need of rising caseloads or new or expanded medical care programs, or to reduce the number of cases per worker, 46 of the 59 State agencies administering one or more public assistance programs had larger State or local staffs in June 1957 than a year earlier (an increase of 1,400 to a total of 66,500). However, while 35 agencies reduced caseloads, the 15 agen¬ cies which increased cases per visitor indicated they were unable to add more staff because low salaries limited their ability to compete in the labor market. Social Security Administration 53 Although progress made in staff training has been significant, progress to the extent needed to develop enough competent staff is seriously hampered by lack of funds to implement the training pro¬ gram passed by Congress in 1956, and undoubtedly will retard the provision of services directed toward self-support, self-care, and strengthened family life — prime objectives of public assistance pro¬ grams in 1958. In general, public assistance activities in 1958 have made significant strides in providing essentials of living and other needed services for many needy individuals and families in the country. However, the realization of the fullest potentials of the public assistance pro¬ grams, even within existing legal and administrative framework, provides a challenge in the years ahead in order to utilize their in¬ herent strengths in helping to build strong family life in America. Children’s Bureau For the 47th year, the Children’s Bureau continued to reflect in the Federal Government the Nation’s special concern for its most cherished human resources. It operated, first, under its original mandate from Congress in 1912 “to investigate and report upon all matters pertain¬ ing to the welfare of children and child life.” Secondly, in its respon¬ sibility under Title V of the Social Security Act of 1935, the Bureau administered grants to the States totalling $41,500,000 to assist them in extending and improving health and welfare services to children. To implement its overall concern for improving the conditions under which children are born and grow, the Bureau made studies and reports, worked cooperatively with a wide range of public and voluntary agencies, helped create guides and standards for services, and administered the grants voted by Congress for maternal and child health, crippled children and child welfare services. A major step forward, following the close of fiscal 1958, was the enactment of new amendments to the Social Security Act. These amendments authorize an increase of $5 million in future appropria¬ tions for each of the three grant programs administered by the Children’s Bureau : Maternal and Child Health Services : from $16,500,000 to $21,500,000. Crippled Children’s Services: from $15,000,000 to $20,000,000. Child Welfare Services: from $12,000,000 to $17,000,000. Other changes, all relating to child welfare services, include : 1. For the first time, child welfare services are authorized for children in urban areas on the same basis as services for rural children. 2. A revision of the formula for allotment of Federal funds so that grants will be in direct proportion to total child population and in 54 Department of Health , Education , and Welfare , 1958 inverse proportion to State per capita income. However, no State will receive less than the amounts it would have received prior to the amendments, with an appropriation of $12,000,000. 3. A new requirement by which State and local funds must match Federal child welfare funds, beginning with fiscal year 1960. 4. Broadening of provisions on runaway children, to increase the age limit from 16 to 18 and to permit using Federal funds for mainte¬ nance up to 15 days pending their return. 5. Authorization to reallot Federal funds when a State certifies it will not need them to carry out its child welfare program. 6. A new section establishing an Advisory Council on Child Welfare Services. The Council will report findings and recommendations to the Secretary and to the Congress on or before January 1, 1960. The Council membership, appointed by the Secretary, will consist of 12 persons, representing public, voluntary, civic, religious, and profes¬ sional welfare organizations and groups, and the public. Effective July 1, 1959, Guam will be included in all of the grant programs. Some Facts and Figures About Parents and Children Live births in the Nation continue to be above 4 million annually. Since 1950, crude birth rates have remained about 25 per 1,000 popu¬ lation and fertility rates in relation to women of child-bearing age have continued to increase. Women in this age group in 1957 had borne 22 percent more children, on the average, than women of the same age range in 1950. Increases in fertility have been greater in urban than in rural areas, among non white than white population, and among the low or middle income than the high income groups. The number of children under 18 rose from 47 million in 1950 to an estimated 59 million in 1957, an increase of 27 percent, while adults in the age group 18 to 64, to whom children look for support, increased by only 5 percent. Children now constitute 35 percent of the total population. The death rate for infants under 1 year per 1,000 live births moved up slightly in 1957 for the first time in 22 years. The rate was 26.4 compared with the 1956 figure of 26.0, the lowest rate ever recorded. Maternal mortality continued its steady decline, with only 3.9 maternal deaths per 10,000 live births in 1957. For children above 1 year, accidents, cancer, congenital malforma¬ tions, influenza, and pneumonia are still the most frequent causes of death. Births out-of-wedlock rose again in 1956 to 193,500. The ratio per 1,000 live births increased to 46.5, and the rate per 1,000 unmarried women, aged 15 to 44 years, was 20.2. About 77,000 unmarried moth¬ ers were under 20 years of age. Social Security Administration 55 In March 1957, about 7 million mothers with children under 18 were in the labor force. They were about 28 percent of all mothers with children of this age. Nearly 2.6 million of them had children under 6. About 1.3 million were widowed, divorced, or married but not living with their husbands. In 1957, more than 58 million children under 18 were living in family homes — their own or relatives’ homes. About 390,000 were living in foster family homes, in institutions, in boarding houses, or in other unrelated households. The number of broken families with children under 18 has increased from 1.5 million in 1950 to 2.8 million in 1956. Juvenile court delinquency cases more than doubled between 1948 and 1956. In that year an estimated 450,000 different children, or 2.2 percent of all children aged 10 through 17, were referred to courts in the United States for delinquency. Preliminary data for 1957 indicate further increase to about 520,000 children. The recent increases, both in juvenile court delinquency cases and in police arrests of children, are much greater than can be accounted for by population increases or better reporting procedures. Preparation for the 1960 White House Conference on Children and Youth In May 1958, the President announced March 1960 as the date for the Sixth White House Conference on Children and Youth, and asked the Secretary of the Department of Health, Education, and Welfare to invite State and Territorial Governors to appoint special committees to begin a State-by-State stocktaking on problems of the young. Such a conference has been held every 10 years since President Theodore Roosevelt convened the first in 1909. The President asked the Children’s Bureau to serve again as the focal point in the Federal Government for the conference planning and Congress appropriated $150,000 for development of a Conference staff in the year ahead. The actual theme and scope of the Conference will be determined by a national committee named by the President. In advance of such steps, the Children’s Bureau, during the year, sought to lay groundwork for the 1960 Conference by consulting with various professional groups — physicians, educators, and social work¬ ers, to learn of their interests in the Conference planning and program. In September 1957, advance suggestions had been sought in a meeting of representatives of three national groups — the Council of National Organizations, the National Council of State Committees on Children and Youth, and the Interdepartmental Committee on Children and Youth. 56 Department of Health , Education , and Welfare , 1958 Federal Interdepartmental Committee on Children and Youth In the decade since this Committee was formed, the Federal agencies participating in it to coordinate their interests and activities for children have increased from 11 to 34. Subjects of special interest during the past year included : need of rural youth ; radiation, as it affects children; urban renewal programs; and a special report on Soviet children by a member of the United States Mission to that country. A Special Committee was formed to provide for Federal agency participation in the 1960 White House Conference on Children and Youth. Continuing its close working relationship with the National Council of State Committees for Children and Youth, the Interdepartmental Committee again cosponsored the Joint Conference on Children and Youth in Chicago in March. Attending were representatives from 25 State Committees and 100 national organizations. In June, 22 Federal agencies joined in a seminar, sponsored by the Interdepartmental Committee, on the reasons why many adolescents fail to get along in school and the ways in which Federal agencies can assist local efforts to help them. Programs of thefBureau RESEARCH IN CHILD LIFE The Bureau’s research staff has a major responsibility for carrying out the mandate “to investigate and report upon all matters pertaining to the welfare of children.” In addition to conducting its own studies and cooperating in joint studies, the Bureau stimulates other agencies to undertake research in child life by formulating the questions re¬ quiring study, developing research methods, and providing technical advice and assistance. A prime emphasis in the Bureau’s technical research has been the development of methods of measuring the effectiveness of programs designed to deal with some of the current pressing problems in child life. A study on evaluation of casework and other social services has been completed. Various approaches to gauging the effectiveness of official programs for juvenile delinquents have been examined to determine the most promising line of research in this field. The Bureau has reached the final stage of a joint study, with the Florida State Department of Public Welfare and the Russell Sage Foundation, to assess the outcome of independent adoptions and, as a byproduct, to discover the factors associated with successful and unsuccessful placement of children for adoption. Social Security Administration 57 During the year the Bureau, with the cooperation of the State departments of public welfare, the Child Welfare League of America, the Family Service Association of America, and their constituent agencies, has been studying the reasons for the large number of staff losses in operating agencies, in an effort to improve administration. To get some of the basic facts concerning maternal and child health, particularly the handicapping conditions of childhood, plans were made for several studies to be conducted in conjunction with the Na¬ tional Health Survey. Factfinding studies were planned also on the nature and extent of public child welfare services for mentally re¬ tarded children, the effects of maternal employment on children, and, in cooperation with the National Probation and Parole Association, on court probation services for children. The Bureau compiles and publishes statistical data received from State agencies administering the maternal and child health, crippled children’s, and child welfare grant-in-aid programs. It also pub¬ lishes certain statistical data on voluntary child welfare services, the work of juvenile courts and public training schools for juvenile de¬ linquents, and on child adoption. These reports are occasionally sup¬ plemented by special statistical analyses, such as Crippled Children's Program , A Statistical Revieiv , and Financing Public Child Welfare Services , both published during the year. As part of its research interpretation activities, the Bureau has been exploring channels through which the findings of research in child and family development, parent-child relationships, and mental health in family life can be more effectively shared with the public and has encouraged interdisciplinary discussion of problems in parent educa¬ tion requiring further study. A revision of Prenatal Care , one of the series of publications for parents on child growth and development, has been started. Two issues of Research Relating to Children , an inventory of current research in child life to keep investigators mu¬ tually informed, were published during the year. MATERNAL AND CHILD HEALTH SERVICES All of the States, the District of Columbia, Hawaii, Puerto Rico, and the Virgin Islands receive Federal funds to extend and improve services for promoting health of mothers and children. For the fiscal year 1957-58, Congress increased the appropriation for maternal and child health to $16,500,000 and earmarked $1,000,000 to be used only for special projects for mentally retarded children. Ongoing programs of the State maternal and child health agencies continue to make a major contribution to the health of the Nation. State maternal and child health reports show that about 241,000 moth- 487270— 59 - 5 58 Department of Health , Education , and Welfare , 1958 ers received services at maternity medical clinics in 1957. In addition, health nurses served over 447,000 mothers before or after delivery. About 558,000 infants and 768,000 other children received health supervision through well-child clinics. In addition, health depart¬ ment programs provided nursing service for over 2,878,000 infants and other children. Almost 1,715,000 children were vaccinated for smallpox, and nearly 3 million were immunized for diphtheria by State and local health departments through grants provided by the maternal and child health programs. Polio immunization through these programs reached 11,809,000 children. Continued emphasis on services for mentally retarded children re¬ sulted in the development of 44 State programs with a total allocation of about 2 million dollars. Each of these is operated as part of the State health department’s mental and child health program, 30 are financed by Federal funds for special projects, and 14 are supported by the States’ regular MCH funds. Progress was made in extending geographically and in improving services for mentally retarded children by continued recruitment and training of professional staff, by better integration of services for the mentally retarded into overall MCH programs and into other com¬ munity facilities. Clinic teams were enlarged and better administra¬ tive practices adopted in order to reduce the backlog of cases awaiting diagnostic evaluation. Several States inaugurated plans for early detection and treatment of specific causes of mental retardation, such as phenylketonuria, in which prevention is possible. Two national conferences with significance for future program de¬ velopment were held. One conference of MCH directors and di¬ rectors of clinical services for mentally retarded children representing 50 States and Territories recommended that a committee be established to advise the Children’s Bureau on how the experiences of the various State programs could be exchanged for the benefit of all. The second was an institute of professional workers on nutrition and diet in re¬ lation to mental retardation, probably the first of its kind. A third important conference for public health nurses working in special projects for mentally retarded children discussed home train¬ ing programs. In addition, a number of statewide conferences and workshops for nurses, physicians, and other health personnel were held. Material for a manual on “Home Training” of mentally retarded children was completed; also “Newer Concepts of Mental Retardation in Medical Care Programs for Children,” the report of the 1957 in¬ stitute of the Tulane School of Social Work was issued. Social Security Administration 59 Maternal and neonatal mortality rates in scattered areas and among certain groups sparked fresh interest and activity in maternity care in a number of State programs. In July 1957, the 7th American Congress on Maternal Care, spon¬ sored by the American Committee on Maternal Welfare was held, with participation by many Children’s Bureau staff members and State MCH directors. The keynote, “Complete Maternity Care,” expressed a broadened concept of maternity care. The year ended with a work conference on the nurse-midwife, her role and training, sponsored by the Maryland State Health Department in cooperation with the American College of Nurse Midwifery and the Children’s Bureau, and financed by a Children’s Bureau grant. Concurrent with increasing numbers of hospital deliveries, over¬ crowded and inadequately staffed nurseries and increased use of anti¬ biotics, has been the emergence of antibiotic-resistant staphylococcal infections. The epidemics in hospital nurseries were of particular concern to maternal and child health programs. One beneficial ef¬ fect of these has been a closer working relationship between hospitals and health departments and an increase in hospital consultation to maternity and newborn services by maternal and child health person¬ nel. The number of States starting perinatal mortality studies, usu¬ ally in cooperation with medical societies and hospitals is increasing. The community obstetrical study which began in the hospitals of Hartford, Connecticut, has expanded to include hospitals of Hart¬ ford County. Some significant statistical information on medical care given to maternity and newborn patients is being collected. Increasingly, health agencies are recognizing the potentialities of parent group education. In-service training programs for the prepa¬ ration of staff in leadership skills were held in New York State, Massachusetts, and Texas. Adaptation of services to the health needs of migrants was evident in the special migrant project in Florida. There, family clinics are held during evening hours after the field work is finished. Mothers and fathers are seen by a general practitioner, while a pediatrician examines the children. Preclinic planning sessions and post-clinic conferences are features of the service. A project worker, acceptable to both professional staff and migrants, acts as a liaison. “Colorado Cares,” a color film on community organization for migrant workers, was developed by the Colorado migrant project. Because accidents are the chief cause of death in children from 1 to 18 (up to 25) years, and because the pain and disability from accidents affects a much larger number of children, MCH and Crip¬ pled Children activities in accident prevention and poison control are increasing. Not only are MCH funds going into these programs, 60 Department of Health, Education, and Welfare, 1958 but CC agencies are cooperating in preventive programs as well. In a number of States, health educators have been assigned to MCH divisions to assist with this activity. In at least two regions, con¬ ferences on accident prevention, sponsored by Public Health Service, in cooperation with Children’s Bureau, were held. Interest in developing health services for adolescents is growing. A clinic for children 12 to 18 years of age at Colorado General Hospi¬ tal, conducted by the University of Colorado Department of Pedi¬ atrics, was approved as a special project. Clinic services (pediatric, nursing, medical social, nutrition, psychiatric, and remedial reading) are being coordinated with the school health program; objectives will be service, training and research. The Children’s Bureau, Office of Education and Public Health Service are represented on the Department Committee on Health of the School-age Child. Each agency has responsibilities and inter¬ ests in the development and promotion of school-community health programs. Ever since the inauguration of health services for children under the Social Security Act, the Division of Health Services has stressed the importance of early casefinding among children. This position has been reinforced during the last year by the National Congress for Parents and Teachers, which in the future will emphasize the importance of health supervision and medical care from infancy throughout the school years. CRIPPLED CHILDREN’S SERVICES All of the 53 States and Territories, with the exception of Arizona, are participating in the Crippled Children’s program. Though the State agency auspices vary, the objective is uniform, namely : to lo¬ cate children who require care, and to provide restoration through diagnosis, medical and surgical treatment, and alleviation of un¬ favorable social and psychological influences which adversely affect the degree and duration of the disability. The appropriation for Crippled Children’s Services is $15,000,000, the amount authorized. A new peak was reached in 1957 in the number of handicapped children served under federally aided programs, preliminary figures from State reports indicate. Of the 313,000 children cared for dur¬ ing the year, 246,000 were seen in clinics; about 66,000 received physician’s services through home or office visits. About 52,000 chil¬ dren were hospitalized. Convalescent home care was given to the smallest group, around 3,700. As States attempt to more adequately meet the needs of handi¬ capped children, they are moving toward the concept of child- centered, rather than disease-centered programs, and are giving more comprehensive service to each child and his family. Examples of Social Security Administration 61 coordination of services to children with many types of handicaps are the children’s diagnostic and rehabilitation center programs at the Universities of Kansas and Buffalo, New York. Two centers in Maryland, at Johns Hopkins University and the University of Maryland, have been developed to serve children with multiple handi¬ caps. Neurological aspects of handicapping conditions are receiving increased attention at each of these centers as elsewhere in this country. The trend of States to accept children with chronic illnesses which require long continued medical management rather than surgery or appliances is continuing. Begun in 1940 with the rheumatic heart disease program, it has been further extended by the inclusion of cystic fibrosis, nephrosis and similar chronic diseases by a number of States. Progress in research in prostheses for child amputees continues through special projects at the University of California at Los Ange¬ les, and the Child Amputee Center at Grand Rapids, Michigan, where children with more and more difficult amputations are being fitted and trained. In addition, a special project to be conducted by New York University for Field Studies in Prosthetic Rehabilitation of Children was approved this year. At present, 30 States are voluntarily reporting services to child amputees under the crippled children’s program to the Children’s Bureau. An increasing number of States are able to care for their own cases as amputee teams are trained at the California, Michigan, or New York University Amputee Centers and special clinics for child amputees are opened. In Pennsylvania, an important study of hearing impairment in school-age children was begun with Crippled Children’s B funds, as a joint undertaking of the University of Pittsburgh and the American Academy of Ophthalmology and Otolaryngology. Crippled Chil¬ dren’s B funds also support studies of profoundly deaf preschool children at the John Tracy Clinic. Services to children with speech and hearing defects continue to expand. Surveys in local areas indicate that the number of children with congenital heart disease is much larger than formerly estimated. Among State crippled children’s program, the congenital heart pro¬ gram is one of the most rapidly growing. An increasing number of States are now able to provide heart surgery within their own State. For patients needing more advanced heart surgery and those in States without facilities, regional heart centers have been established in five States: California, Illinois, Maryland, Minnesota, and Texas. More than 10,000 children suffering from congenital malformations of the circulatory system were served by crippled children’s programs 62 Department of Health , Education, and Welfare, 1958 in 1957. This is about five times the comparable number for 1950. The number of States accepting children with congenital heart disease has steadily increased. Factors which have contributed to this growth, include : (1) the brilliant and rapid advances in heart surgery within the past decade, making repair possible in many types of con¬ genital heart defects ; (2) the widespread development of heart centers as diagnostic and surgical teams are trained ; (3) the return of children with previous anastomotic operations for closure of shunts and cor¬ rection of the original defect; (4) increasing public and professional awareness that many types of congenital heart disease are now ame¬ nable to treatment; and (5) high cost of care. Because progress has been so rapid, the regional heart program has had difficulty keeping step. Since the bulk of patients apply to the regional center performing the most advanced heart surgery, the fa¬ cilities for that center have become overcrowded. CHILD WELFARE SERVICES Child welfare services are experiencing the effects of broad and sig¬ nificant technological and sociological changes, of new developments in social work, and of new interest and demands on the part of the public. The child welfare staff of the Children’s Bureau strives con¬ tinuously to provide help and leadership as major changes in our cul¬ ture and society have effect on children. Some of the immediate areas of expanded public concern are the care of children while mothers work; the problems of mentally re¬ tarded and emotionally disturbed children; increase in neglect and abuse of children; expansion and changing practices in the field of adoption; care and protection of children in disadvantaged groups such as migratory families, Indian children and low income families ; and the pressing need of adolescent boys and girls to find guidance and security essential to their maturing in these times when the only sure thing is change. During 1957, the overriding emphasis in child welfare has been on deeper understanding of what a child’s own home means to his well¬ being and growth. Staff development programs are being focused on early recognition of problems of children and on work with parents. Several States report more “reaching-out” services by agencies to serve multiproblem families. Studies of children in foster care are being made to determine whether more adequate diagnosis, plus serv¬ ices to families, might have averted placement and whether return to their own homes may now be indicated for some children. A forward step in strengthening families is the progress being made in providing protective services to neglected or abused children. The Children’s Bureau has given consultation to both public and private Social Security Administration 63 agencies engaged in protective services and is currently cooperating with such national voluntary agencies as the Child Welfare League of America, and the American Humane Association, Inc., in developing definitions, standards and guides to improve practice. With an increasing number of women in the labor market, there is new emphasis on day care as a service to enable children to continue living at home, even though they need several hours of care away from families each day. In some States, agencies having child welfare responsibility are operating day care facilities. In other States, such agencies have been given authority to license day care facilities, with emphasis on consultation and stimulation rather than on enforcement. The Children’s Bureau is taking steps to find out more about the effects of employment of mothers on children. At the Bureau’s re¬ quest, the Census Bureau’s current population survey for one month included a series of questions for enumerating the children whose mothers work and the kinds of care arranged during the mother’s absence. The Bureau is also working with the Department of Labor in evaluation of day care needs. Within the Department of Health, Education, and Welfare, the Bureau of Public Assistance, the Bureau of Old-Age and Survivors Insurance, and the Children’s Bureau are in active cooperation on a Committee on Working Mothers. Homemaker Service is receiving increasing recognition as a basic part of the community program for health and welfare, for strengthen¬ ing family life, and for assisting parents in caring for children in their own homes. Significantly, this service is now being used in a wide variety of situations in contrast to its single original purpose of fur¬ nishing temporary care of children during the absence of the mother. Agencies may now use it to relieve mothers from constant care of a handicapped child, for continuing care of a motherless family while the father works, or to teach parents ways of giving better care to their children. In 1942, Homemaker Service was found to be available in only 41 agencies in 28 cities. The 1958 Directory of Homemaker and Related Services shows the service available in 145 agencies in 104 cities and 32 States and the District of Columbia. Consultation from the Chil¬ dren’s Bureau has been used by both types of program. The Children’s Bureau has initiated plans for a National Confer¬ ence on Homemaker Service to be held February 10-11, 1959. Because of their shared interest, seven other constituent units of the Depart¬ ment of Health, Education, and Welfare were asked to join in spon¬ sorship of the Conference. Twenty-six national voluntary agencies, whose member agencies either administer, support, or have promoted homemaker service programs, also agreed to sponsor the Conference. Along with increasing effort toward strengthening families to better 64 Department of Health, Education, and Welfare, 1958 care for their children, there is recognition that there will always be some children for whom alternate care must be planned. The estimated number of children in foster care reached an all-time high of 268,000 in 1957. While this represents an increase of 8,000 children over the estimate for 1956, the proportion of children in foster care out of the total child population remained the same. In contrast, the proportion of children in foster care declined from 496 per 100,000 children in the 1933 population to 414 per 100,000 in 1956. More and more emphasis in foster care is toward better diagnosis at intake so as to permit more adequate planning and avoid placement of children if services can strengthen their own homes. When a child must be placed away from home, sound diagnosis would help to determine care according to each child’s specific need. In institutional care, the primary question seems to be whether the right children are coming for care or whether children are coming for care because community and foster family services are not avail¬ able. In general, institutions are slowly moving their infants and preschool age children out into foster family care. Many institutions are carefully “retooling” to give skilled care to emotionally disturbed children. Much interest is being shown by agencies, institutions and licensing staff in the development of agency operated “group homes.” These are being used for adolescents, certain emotionally disturbed children, unmarried mothers, and others. Entering this new field, agencies are interested in developing criteria for intake, examining special uses and limitations, and weighing costs. From consultation and work with State and local child care agencies, came much of the mate¬ rial for “Child Caring Institutions — Their New Eole in Community Development of Social Services,” a recent Bureau publication. In the field of adoptions, the Children’s Bureau has continued the project undertaken in 1957 to bring together representative profes¬ sional groups to work toward clarification of their various roles in adoption. A report of a meeting of social workers, held in 1957, with a statement of the social worker’s role, is now being published. A meeting of physicians was held in November 1957, and another with lawyers in May 1958. The statements of the roles of these two pro¬ fessions are almost completed. Amendments to the Immigration and Nationality Act in 1957 pro¬ vided for the issuance of special non-quota immigrant visas to eligible orphans under age 14, adopted or to be adopted by United States citizens. Immigration and Naturalization Service of the Department of Justice was made responsible for determining that satisfactory assurances have been given to the Attorney General that the new parents will accept care for the child properly and that preadoption requirements of the State where the child will live have been met. Social Security Administration 65 Since the amendments, the Children’s Bureau has worked closely with Immigration and Naturalization Service and with national voluntary agencies such as International Social Service, United Hebrew Immi¬ grant Aid Society, and Catholic Committee for Refugees, to imple¬ ment services to children brought into this country for adoption. With proxy adoptions of foreign children believed to be on the in¬ crease, there are continuing reports of the breakdowns of many of these adoptions and tragedies for the children, adoptive parents and natural parents. Growing public understanding of both the capacities and special needs of mentally retarded children and the expansion of community resources to meet these needs are major factors contributing to the emphasis on rehabilitation services for this group. As more retarded children are enabled to remain in their own homes or foster homes, professional casework help is being widely recognized as a vital need in building the social and emotional well-being of the total family. With a trend away from long-time custodial care, institutions are coming to be regarded as training resources. These changing con¬ cepts point up the importance of individual evaluation and planning for each mentally retarded child and the responsibility of the child welfare field for strengthening casework services and community planning. Activities of national and State welfare organizations are demon¬ strating that social services are an essential part of a multidisciplinary approach to the needs of retarded children. Some professional schools of social work are making student field work placements in services for the mentally retarded and sponsoring summer institutes in their area. The Bureau’s Social Services Specialist for Mentally Retarded Children has conducted workshops and institutes in Utah, Colorado, Missouri and Kansas for social workers, for professional personnel in health, education, recreation, and related fields ; and for parents and interested citizens. Continuing attention is being given to the needs of the children of migratory farm workers in a number of States. These needs are inten¬ sified by such factors as a family’s remoteness from friends, relatives, and resources ; low, irregular, and unpredictible income ; denial of aid because of residence requirements, etc. During the long working hours of the parents, the service most widely needed by migrant children is day care; however, whenever social workers have worked on day care facilities for migrant children, they have found that multiple child welfare services were needed. These include foster family care for young infants ; counseling and aid to unmarried mothers and their children; adoptive placement; pro¬ tective services for children who are neglected, abused, abandoned or 66 Department of Health , Education, and Welfare, 1958 exploited; and services to unattached teenage children traveling un¬ supervised in the work group. In Pennsylvania and Ohio, combined State, local and Federal child welfare funds have been used to develop and operate day care centers for migrant children. Because of the establishment and strengthening of all child welfare services in each State, the Children’s Bureau has added a specialist on child welfare legislation to lead and assist in developing guides to standards for State child welfare legislation. The shortage of professionally trained personnel has stimulated activity in breaking down some of the barriers to staffing in State agencies. In addition to increased educational leave, a number of States have been working on a variety of recruiting plans. The per¬ centage increase in the amount budgeted for professional education in 1958 reflects a significant move by the States to step up their efforts to obtain better qualified staff and thereby improve services. The Bureau has issued a revised guide for educational leave policies in State public welfare agencies. JUVENILE DELINQUENCY SERVICE With reports showing an increase in youthful offenses, juvenile delinquency continues to be one of the major social problems in the country. Public interest in the problem of juvenile delinquency remains high. Many local welfare planning councils are including study of juvenile delinquency in the range of social problems with which they are concerned. At the same time, they are giving support to State and metropolitan youth commissions by identifying gaps in de¬ linquency-related services and encouraging improved coordination and cooperation between them. In many cases they are helping to finance demonstration projects sponsored by some of their members, especially those involving services to organized groups of hostile, de¬ linquent youth. Many State, county, and city governments have assumed greater responsibility for stimulating and integrating State and community efforts to combat delinquency. They are, for example, establishing or extending official planning bodies and offering consultant services to communities to help them study and develop solutions to youth problems. As a result of recent court decisions and law journal articles, the legal rights of children and parents appearing in juvenile courts are receiving increased attention. Such questions as the right to coun¬ sel and a fair hearing, parental liability, and publicity have been re¬ ceiving increased attention from court personnel, attorneys, and professional workers in related fields. Social Security Administration 67 The trend towards specialization within police departments appears to be slowing up. National police organizations and a number of police adminstrators have begun to question some of the involvement of specialized juvenile units in a number of character-building activ¬ ities aimed at the prevention of delinquency. Greater stress is being placed on the police role, in general, in dealing with juveniles and the improvement of standards of the entire department. Evidence of a greater recognition of the police role is found in the fact that four States now have State consultants in this area and three other States are contemplating such action. In the institutional field, a number of States are reviewing or have already changed the State administrative structure relating to train¬ ing schools. The older aggressive delinquent has also been the object of increased concern, particularly with respect to court procedures and institutional care. Interest in training in the institutional, probational, and police field remains high. A number of workshops and institutes were con¬ ducted by Children’s Bureau staff, including a second one at Rutgers University on Staff Development for Administrators of Institutions for Juvenile Delinquents. Development of a much closer interaction between the field of cor¬ rections and social work education is now discernible. Inclusion of the findings of the Committee on Corrections in the Council on Social Work Education curriculum study reflects this, as does the growing participation by schools of social work in inservice training and spe¬ cialized training courses. Bureau staff worked with a variety of agencies in a variety of areas during the year. Cooperative effort has continued with the National Council of Juvenile Court Judges and the National Pro¬ bation and Parole Association to develop Standard Juvenile Court and Family Court Acts. Similarly, the Bureau has been working cooperatively with the National Probation and Parole Association on the publication Standards and Guides for the Detention of Chil¬ dren and Youth. At the Association’s request, the Bureau partic¬ ipated in five statewide studies. Other joint activities included work with the National Social Welfare Assembly and Council of State Governments on the development of an interstate compact related to residence and settlement laws ; with the Interstate Compact Admin¬ istrators Association on the operation of the Interstate Compact on Juveniles, and with the Family Service Association of America on a project to promote understanding and cooperation between attorneys and social agencies. Close working relationships were maintained with the Council on Social Work Education, the National Association of Training Schools and Juvenile Agencies, and the organization of training school superintendents. 68 Department of Health, Education, and Welfare, 1958 Among the important publications completed during the year were : Staff Training for Personnel in Institutions for Juvenile Delinquents (CB Pub. 364) , a report on the first Rutgers Workshop ; Youth Groups in Conflict (CB Pub. 365), a report of a national conference of people involved in working with groups of hostile, delinquent youth, was also published. INTERNATIONAL COOPERATION The new Chief of the Children’s Bureau was appointed by the President to serve as United States Representative on the Executive Board of the United Nations Children’s Fund (UNICEF). At her first session in this capacity, in the spring of 1958, she introduced a resolution for the United States suggesting the possibility of expan¬ sion of UNICEF aid in the area of child welfare, with a beginning step in concern for children in institutions and day care centers. As a means to determine UNICEF’s possible role in this area, she sug¬ gested a study by the United Nations Bureau of Social Affairs and UNICEF with consultation from WHO, with a report to be made in the Spring of 1959. This proposal was warmly received by many representatives on the Board, was approved, and the study is now in progress. Under the continuing, cooperative program with the International Cooperation Administration, the Bureau’s international staff recruits Americans for maternal and child health and child welfare positions abroad, provides technical materials and information as requested, and plans and arranges training programs for persons from other countries. The trend in requests, both for recruiting and for training in the health field, is toward the clinical specialities of pediatrics and obstetrics rather than the general areas of maternal and child health. In the child welfare field, there has been a similar trend and away from general child welfare, particularly toward juvenile de¬ linquency specialists in the training program. The maternal and child health specialists recruited and back-stopped by the Bureau contributed to programs in six countries. During the year a pediatric nurse-educator arrived in India. There were ma¬ ternal and child health physicians in Iraq and in Paraguay, a nurse- midwife in Bolivia, a pediatric nurse-educator in Brazil, a maternity nurse-educator and a pediatric nurse-educator in Guatemala. During the year, the Bureau’s international staff planned and ar¬ ranged programs of study in this country for 75 long-term trainees and observers and 182 short-term visitors. The trainees were in pro¬ grams 12 months or more, the observers 2 to 6 months, and the short¬ term visitors a few hours to 2 months. They came from 35 countries under the auspicies of the International Cooperation Administration, Social Security Administration 69 the United Nations, the World Health Organization, and the Inter¬ national Exchange Service of the Department of State. Of the 75 long-term trainees and observers, 49 were in the health field, and 26 in the welfare field. In the health field, there were 36 physicians, of whom 19 took courses in public health with a specialty in maternal and child health, and 17 took graduate work in pediatrics or other clinical specialties as applied to children. Of 12 nurses, 11 studied children’s dentistry. Here to study in the area of juvenile delinquency, were two police officers, an institutional director, a psy¬ chologist, and several group workers interested in work with “problem children.” An additional ten people came for study in the general field of child and youth welfare. Three social workers received training in medical social work. Appointments were arranged also for 182 short-term visitors from 59 countries. Of this number, 114 were interested in child and youth welfare, 52 in maternal and child health, and 16 in a combination of maternal and child health, crippled children’s programs, and child and youth welfare. INFORMATION FOR PARENTS AND THOSE WORKING WITH CHILDREN In March 1958, the Government Printing Office reported that four of the five best-selling Government publications were those of the Children’s Bureau, including Infant Care , Prenodal Care , Your Child From One to Six, and Your Child From Six to Twelve. The fact reflected both a heavy demand from the public for information about children, and a long history in the Bureau of reporting information which could contribute to the well-being of children and advancement of services in their behalf. The Division of Reports is the Bureau’s central channel for imple¬ menting its reporting function. Working with administrative and technical staff in developing written and visual materials, it released during 1958, 26 new and revised publications, while 13 more were in press at the end of the year. Five of the 39 were directed to parents and 34 of a technical or professional nature. In addition, information on children’s problems and services was supplied to press and other media, or given in response to queries from parents themselves. Nearly 150 direct requests came from news¬ papers, magazines, professional journals, broadcasters, and other com¬ munication channels. Federal Credit Unions Substantial growth again characterized the Federal credit union program in fiscal year 1958. Charters were issued to 617 new groups, 70 Department of Health , Education, and Welfare, 1958 and 310 credit unions entered liquidation during the year, bringing the number of active charters to 8,992 on June 30, 1958. As member¬ ship, savings, and lending activities continued to increase, asset ac¬ cumulation moved up to a new high level. By the middle of the fiscal year, median assets exceeded $70,000, and 340 Federal credit unions, or 4 percent of the total number in operation, had assets in excess of $1 million. Total assets moved up to about $1,860 million on June 30, 1958, an increase of 14 percent during the current fiscal year in contrast to a 19-percent rise in the preceding twelve months and a 22-percent gain during fiscal year 1956. Members’ shareholdings increased at about the same rate — 14 percent — during fiscal year 1958. Active member¬ ship in Federal credit miions exceeded 50 percent of the potential num¬ ber eligible for membership for the first time during the fiscal year. By the end of June 1958, more than 5 million individuals held mem¬ bership in a Federal credit union while another 5 million who were included in the field of membership had not yet joined by the end of the fiscal year. Individual credit unions made significant progress during the fiscal year in strengthening their financial position in the face of rising de¬ linquency rates. In order to combat the trend toward slower repay¬ ment of loans, many credit unions set up special reserves or increased their regular reserve by setting aside out of undivided earnings an amount in excess of the required 20 percent of their net income for the year. The fiscal year for Federal credit unions is the 12-month period ending December 31. At the end of 1957, reserves in all Fed¬ eral credit unions exceeded loans classified as delinquent by 20 percent. Regular and special reserves set aside to protect members’ sharehold¬ ings increased 27 percent in 1957 in contrast to a rise of only 16 percent in shares. After intensive study by the Washington and Regional Office staff of the Bureau, a new examination procedure was developed and put into effect early in 1958. The new procedure was designed to achieve more nearly uniform examinations throughout the country by the institution of examining techniques culled from the experiences of examiners in all areas. Standardization of numerous work papers, and development of printed sets of report forms are expected to enable the examiners to complete a thorough examination in less time, and thus reduce the expense to the credit unions for these examinations. Emphasis has been placed under the new examination procedure on activities of the Supervisory Committee. The work of this committee is of major importance to the credit union, and may very well represent the difference between success and failure, particularly among newly organized units. The Supervisory Committee is responsible for periodic internal audits of the credit Social Security Administration 71 union in order to ascertain that all actions of the directors and officers conform with established procedures and are in the best interests of the members. Under the new examination procedure, the Bureau will determine whether or not the Supervisory Committee is carrying out its responsibilities, and will be in a better position to render effective assistance to the credit unions. The heaviest workload of the Bureau is in the examination activity. For many years, the Bureau has been faced with the problem of recruiting and training a sufficient number of examiners to keep up with the increasing workload as the program continues to grow. Dur¬ ing fiscal year 1958, the Bureau was able to recruit a full staff of examiners for the first time. Henceforth, a regular examination of all Federal credit unions will be scheduled annually. In the current fiscal year, the Bureau completed 8,693 examinations of Federal credit unions, or 22 percent more than the number completed during fiscal year 1957. There were no amendments to the Federal Credit Union Act during fiscal year 1958. Table 1. — Social Security Administration : Funds available and obligations incurred , fiscal years 1958 and 1957 1 [In thousands; data as of June 30, 1958] Item Funds available 2 Obligations incurred 1958 1957 1958 1957 Total . . . . . . $1, 960, 587 $1, 741, 948 $1, 937, 598 $1, 751,997 Grants to States: Public assistance.. 8 1, 767, 177 « 1,575,000 1,745,173 1, 052, 708 44, 192 525, 318 122, 955 40, 722 16, 336 14, 847 9,539 504 144, 449 1,974 2, 045 2,731 1, 586, 361 993, 284 41, 361 443,210 108, 506 38, 253 15, 498 14, 835 7,920 361 121,413 1,730 1,811 2,068 Old-age assistance _ _ Aid to the blind . . . . . Aid to dependent children _ _ _ _ 3 1, 767, 177 4 1, 575, 000 Aid to the permanently and totally disabled... Maternal and child health and welfare services _ Maternal and child health services - Services for crippled children _ _ _ 41,500 16, 500 15.000 10, 000 C41 144, 692 1,982 2. 048 2,647 39. 361 16,000 15, 000 8, 361 121,500 1, 748 1, 822 2,145 Child welfare services . . . . Administrative expenses: * Office of the Commissioner 8 . . .. _ Bureau of Old-Age and Survivors Insurance 7 . . Bureau of Public Assistance _ Children’s Bureau 8 . . . . . Bureau of Federal Credit Unions _ _ • Funds available and obligations reported by administrative agencies. 2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. 3 Excludes $3.4 million transferred to other DHEW appropriation accounts pursuant to P. L. 85-472 for meeting portion of increased pay in 1958. 4 Excludes $11.4 million spent from 1958 appropriation for 1957 requirements. 5 Funds made available and obligations incurred for salaries, printing and binding, communications, traveling expenses, and all other objects of expenditure. 6 Appropriations by Congress from general revenues accounted for approximately 56 percent of the ad¬ ministrative expenses of the Office of the Commissioner in 1957 and 1958; balance from old-age and survivors insurance trust fund. 7 Administrative costs of the old-age, survivors, and disability insurance program which involved ben¬ efit payments of $6,515,000,000 in 1957 and $8,043,000,000 in 1958. Does not include construction eosts of new building as follows: Funds available; 1958, $30,140,163; 1957, $24,491,787. Obligations incurred: 1958, $22,370,702; 1957, $61,624. 8 Includes expenses for investigating and reporting on matters pertaining to the welfare of children au¬ thorized by the act of 1912, as well as expenses for administration of grants to States. 72 Department of Health , Education , and Welfare , 1958 Table 2. — Financing social insurance under the Social Security Act: Contribu¬ tions collected and trust fund operations , fiscal years 1956—58 [In millions] Item 1958 1957 1956 Contributions collected under— Federal Insurance Contributions Act: 1 Retirement and survivor . . . . . $7, 269 $6,540 $6,442 Disability 2 _ _ 925 337 Federal Unemployment Tax Act 3 _ _ _ _ 336 330 325 State unemployment insurance laws 43 _ _ 1, 500 1, 537 1, 329 Old-age and survivors insurance trust fund: Receipts, total - - - 7,826 7, 100 6,937 Transfers, appropriations, and deposits 4 * 6 7 . . . 7, 269 6,540 6,442 Interest and profit on investment ®.— . .. 7 557 561 495 Expenditures, total _ _ 8,041 6,665 5, 485 Monthly benefits and lump-sum payments 8 _ 7,875 6, 515 5,361 Administration 9 _ _ 166 150 124 Assets, end of year . . . . 22, 814 23, 029 22, 593 Disability insurance trust fund : 2 Receipts, total _ 941 339 Appropriations and deposits. _ 925 337 Interest and profit on investment _ 7 16 1 Expenditures, total _ 180 1 Monthly benefits 8 _ 168 Administration 9 _ 12 1 Assets, end of year. _ _ _ _ 1, 097 337 State accounts in unemployment trust fund: Receipts, total - - - - 1, 721 1, 790 1,520 Deposits 3 _ _ _ _ _ 1, 501 1, 578 1, 333 Interest _ _ - . . . . 220 212 187 Withdrawals for benefit payments _ _ _ _ 2,926 1, 513 1, 287 Assets, end of year _ _ _ _ _ 7,360 8,492 8,216 1 Contributions on earnings up to and including $4,200 a year beginning Jan. 1, 1955. Contribution rate paid by employers and employees: 2 percent each through Dec. 1956 and 2 34 percent each beginning Jan. 1, 1957, the additional J4 percent each being for disability insurance. Contribution rate paid by self-employed: 3 percent through Dec. 1956 and 3% percent beginning Jan. 1, 1957 (the additional 3A percent for disability insurance). Includes deposits by States under voluntary agreements for coverage of State and local em¬ ployees. Includes deductions to adjust for reimbursement to the general Treasury of the estimated amount of taxes subject to refund on wages in excess of wage base. 2 Under the 1956 Amendments to the Social Security Act, Federal disability insurance contributions began Jan. 1, 1957, and benefit payments began Aug. 1957 (for July 1957 eligibility). 3 Tax paid by employers of 8 or more through 1956, beginning Jan. 1957 by employers of 4 or more. Em¬ ployers offset against this tax— up to 90 percent of the amount assessed— contributions which they have paid under State unemployment insurance laws or full amount they would have paid if they had not been allowed reduced contribution rates under State experience-rating provisions. Rate is 3 percent of first $3,000 a year of wages paid to each employee by subject employer; because of credit offset, effective rate is 0.3 percent of such wages. 4 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 6 Contributions and deposits by States usually differ slightly, primarily because of time lag in making deposits. 6 Includes interest transferred from the railroad retirement account under the financial interchange provision of the Railroad Retirement Act, as amended in 1951. 7 Reflects transfer of interest from disability insurance trust fund to old-age and survivors insurance trust fund on account of adjusted administrative expenses for prior fiscal year. See footnote 9. 8 Represents checks issued. 9 Beginning Jan. 1, 1957, subject to subsequent adjustment between the old-age and survivors insurance and disability insurance trust funds. First such adjustment in June 1958 for fiscal year 1957 resulted in transfer of $9 million from the disability insurance to the old-age and survivors insurance trust fund. Social Security Administration 73 Table 3. — Old-age, survivors, and disability insurance: Estimated number of families and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group , end of June 1958 and 1957 [In thousands, except for average benefit; data corrected to November 1958] June 30, 1958 June 30, 1957 Family classification of beneficiaries Total . . Retired worker families... . Worker only _ _ _ _ _ Male . . . . Female _ _ _ Worker and aged wife . . . . Worker and young wife 1 _ Worker and aged dependent husband _ Worker and 1 or more children _ Worker, wife aged 65 or over, and 1 or more children _ _ Worker, young wife, and 1 or more children _ _ Worker, husband, and 1 or more children.. Survivor families _ Aged widow . . . . . Aged dependent widower _ Widowed mother only > _ _ Widowed mother and 1 child, . . . Widowed mother and 2 children _ Widowed mother and 3 or more children.. Divorced wife and 1 or more children . 1 child only. . . . . . . 2 children . . . . 3 children . . 4 children . . . . . . 1 aged dependent parent _ 2 aged dependent parents _ _ Disabled worker families 2, _ , _ _ Male _ _ _ Female _ _ _ _ _ _ Number of families Number of bene¬ ficiaries Average monthly amount per family Number of families Number of bene¬ ficiaries Average monthly amount per family 8, 794. 4 11, 905.3 7, 580. 8 10, 342. 1 6, 638. 5 8, 785. 1 5, 832. 3 7, 710. 1 4,661.2 4, 661. 2 $61. 80 4,092.2 4, 092. 2 $60. 30 2, 498. 9 2, 498. 9 69.50 2, 273. 0 2, 273. 0 67. 10 2, 162. 3 2, 162. 3 53.00 1,819.2 1, 819. 2 51.70 1, 835. 4 3, 670. 8 109.90 1, 628. 4 3, 256. 8 107. 70 1.0 2.0 107. 00 .7 1.4 100. 00 13.7 27.4 94.00 12.8 25.6 91.80 29.9 70.8 104. 00 21. 1 52.9 101.00 7.8 23.8 138.00 3.0 9.2 135. 50 89.4 328.8 128.00 74.1 272.0 125.30 . 1 .3 132.00 0 0 0 1, 955. 5 2, 919. 8 1, 748. 5 2, 632. 0 1, 165. 5 1, 165. 5 51.60 1, 017. 7 1,017.7 50.70 1.5 1.5 48. 50 1.3 1.3 47.30 1.0 1.0 49.00 1.5 1.5 49. 00 149.6 299.2 116.60 134.6 269.2 111.70 102.6 307.8 148. 70 92.6 277.7 143. 70 97.2 461.4 147. 90 87.4 414.6 141. 70 .3 .7 133.00 .3 .7 135.00 254.9 254.9 51. 20 237.6 237.6 49.80 98.9 197.8 87.90 94.3 188.6 85.80 34.7 104.1 113.80 33.8 101.4 109.20 21.6 96.5 125. 10 21.0 93.6 117.30 26.0 26.0 52. 70 24.7 24.7 51.60 1.7 3.4 99.60 1.7 3.4 98.60 200.4 200.4 74. 40 158.8 158.8 75. 50 41.6 41.6 70. 10 • Benefits to children were being withheld. 2 Benefits to disabled workers aged 50-64 began July 1957f 487270-59- 6 74 Department of Health , Education , and Welfare, 1958 Table 4. — Old-age, survivors, and disability insurance : Selected data on bene¬ fits, employers, tcorkers, and taxable earnings, by State, for specified periods, 1955, 1957 , and 1958 [In thousands, except for average taxable earnings; data corrected to Oct. 24, 1958] State Monthly bene¬ fits in current- payment status, end of fiscal year 1958 1 Benefit payments fiscal year 1958 1 Em¬ ployers report¬ ing tax¬ able wages, •1 uly- Sep- tember 1957 2 Calendar year 1955 Work¬ ers with taxable earn¬ ings 3 Amount of taxable earnings 4 Num¬ ber Amount Total Monthly benefits Lump¬ sum pay¬ ments Total Average per worker Total _ 11, 905. 3 $659, 684 $8,043, 353 $7, 900, 639 $142, 714 4, 150 66, 000 $157, 700, 000 $2, 390 Alabama _ 180.4 8, 075 98,690 96, 713 1,977 59 990 1, 734. 000 1,750 Alaska _ _ 5.3 269 3, 263 3, 187 76 4 70 135, 000 2, 040 Arizona _ _ . 59.6 3, 206 39, 227 38, 420 807 23 390 705, 000 1, 830 Arkansas _ 121.6 5. 340 65, 091 64, 009 1,082 35 560 875, 000 1,580 Calif omia _ 928.6 53, 436 651,513 640, 243 11, 270 351 5, 610 13, 870, 000 2, 470 Colorado- . 98.1 5, 316 64. 815 63, 718 1,097 41 640 1, 256, 000 1,970 Connecticut.. . 188.7 11,850 144, 335 141, 861 2, 474 66 1,100 2, 942, 000 2, 070 Delaware _ 26.9 1, 548 18, 870 18, 533 337 13 180 427, 000 2, 320 Dist. of Col _ 41.5 2, 280 27, 917 27, 312 605 31 500 1,038, 000 2,040 Florida _ .. 357. 1 20, 282 246, 364 243, 016 3, 348 116 1,530 2, 591, 000 1,700 Georgia . . 186.9 8, 457 103, 496 101, 289 2, 207 80 1,330 2, 330, 000 1,750 Hawaii . . 24.8 1,259 15, 361 15, 128 233 12 170 387, 000 2, 220 Idaho - - 43.5 2, 287 27, 874 27, 431 443 15 250 482, 000 1, 910 Illinois . . 695.9 41,314 504, 104 494, 716 9, 388 240 4,430 11, 312, 000 2, 550 Indiana . 348 2 19, 583 238, 584 234, 584 4, 000 96 1, 960 4, 463, 000 2,280 Iowa _ _ 211.6 11,398 138, 742 136, 629 2,113 69 1, 100 2, 344, 000 2, 130 Kansas _ 155.6 8, 149 99, 157 97, 684 1, 473 51 860 1, 670, 000 1,940 Kentucky _ 210.7 9, 932 121, 071 119,017 2, 054 58 980 1, 853, 000 1,890 Louisiana - - 137.2 6, 451 79, 124 77, 269 1,855 64 920 1, 856, 000 2, 010 Maine . . 88.4 4, 654 56, 690 55, 756 934 25 400 735, 000 1,820 Maryland. . 159. 3 8, 784 107, 625 105, 182 2, 443 71 1,040 2, 294, 000 2, 200 Massachusetts _ 441.9 26, 501 322, 859 317, 291 5, 568 127 2, 170 5, 120, 000 2, 360 Michigan _ 509.3 30, 806 375, 387 368, 898 6, 489 160 3, 370 8, 742, 000 2.600 Minnesota . . 234.7 12, 874 156, 832 154, 327 2, 505 75 1, 230 2, 657, 000 2, 160 Mississippi _ 114.1 4,635 56, 645 55, 593 1,052 35 570 902, 000 1, 570 Missouri . . 325.6 17,605 214, 698 210, 912 3,786 103 1, 780 3, 861,000 2, 170 Montana . . 46.2 2, 565 31, 265 30, 764 501 16 280 559,000 1, 990 Nebraska _ 102.1 5, 408 65, 943 64,840 1,103 35 590 1, 083, 000 1, 840 Nevada _ ... 12.1 694 8, 552 8, 319 233 7 140 235, 000 1, 690 New Hampshire _ 54.5 3, 051 37, 202 36, 558 644 17 280 542. 000 1, 940 New Jersev. . . 437.3 27, 005 329, 625 323, 297 6,328 154 2, 550 6, 050; 000 2, 370 New Mexico _ 34.2 1,563 19, 077 18, 753 324 17 230 381, 000 1,670 New York - 1, 245. 7 74, 512 909, 295 892, 332 16, 963 512 7, 790 19, 524, 000 2, 510 North Carolina _ 227.0 10, 219 125, 145 122,414 2,731 90 1,620 2, 677, 000 1, 650 North Dakota .. .. 35.3 1, 823 22. 241 21. 875 366 13 210 367, 000 1,750 Ohio _ _ 661.5 38,901 474, 274 465, 816 8. 458 207 4,290 11,290, 000 2, 630 Oklahoma _ 140.7 7, 005 85, 377 83, 953 1,424 52 870 1, 624, 000 1, 870 Oregon _ _ _ 144.9 8, 237 100, 204 98, 747 1,457 44 770 1. 731, 000 2,240 Pennsylvania _ 881.8 51, 726 630, 191 619, 090 11, 101 257 4, 680 11, 558, 000 2, 470 Puerto Rico _ 67.3 2, 011 23, 568 23, 270 298 16 430 382. 000 890 Rhode Island.. 76.0 4,485 54, 580 53, 689 891 22 410 865, 000 2, 120 South Carolina _ 111. 7 4, 926 60,377 58, 991 1, 386 45 720 1, 220, 000 1,690 South Dakota _ 46.5 2, 417 29, 429 29, 002 427 16 220 414, 000 1, 840 Tennessee _ 199.9 9, 025 110, 125 108, 142 1, 983 73 1, 140 2,054, 000 1, 810 Texas . . 445.7 21, 749 265, 962 260, 624 5, 338 223 3, 380 6, 781, 000 2. 010 Utah _ 45.1 2, 462 30, 018 29, 520 498 16 350 672, 000 1.920 Vermont _ _ 32.9 1, 750 21, 352 20, 960 392 11 160 331, 000 2,070 Virgin Islands _ . 7 26 303 302 1 1 10 6, 000 470 Virginia _ _ 211. 6 10, 221 124, 927 122, 425 2,502 84 1, 340 2, 553, 000 1,910 W ashington _ _ 208.0 11,995 145, 991 143, 713 2, 278 65 1,020 2, 330. 000 2, 290 West Virginia _ 150.4 7, 669 93, 295 91, 812 1,483 37 600 1, 265, 000 2, 120 Wisconsin _ - 300.6 16, 948 206, 522 203, 039 3,483 91 1,550 3, 817, 000 2, 470 Wyoming . .. 17.4 946 11, 539 11, 348 191 9 150 266, 000 1,800 Foreign •_ _ 72.9 4, 055 48, 640 48. 326 314 50 149, 000 2,760 Maritime® _ 150 C94, 000 2, 690 1 1 Distribution by beneficiary’s 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 State data represent workers employed in the State at some time during the year. Workers employed in more than 1 State are counted once in each of the States in which employed. 4 State data represent taxable earnings distributed according to the State in which earned. Averages, based on unrounded estimates of workers and earnings, are rounded to nearest $10. 3 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. a Relatse to employment of officers and crews of American vessels. Social Security Administration 75 Table 5. — Old-age, survivors, and disability insurance: Selected data on benefits, employers, workers , and taxable earnings for specified periods, 1956—58 [In thousands, except for average monthly benefit and average taxable earnings; corrected to Oct. 24, 1958] Item 1958 1957 1956 Fiscal year Benefits in current-payment status (end of period) : 11, 905. 3 10, 342. 1 8, 374. 5 4, 731. 9 1, 255. 0 1,316.7 747.8 6, 638. 5 1, 947. 4 1, 571. 9 1, 172. 8 5, 832. 3 1, 719. 0 Child’s 1 * _ 1, 427. 4 1, 020. 5 Widow’s or widower’s _ _ -- - _ 344.9 314.9 297.3 Parent’s _ 29.4 28. 1 25.7 Disability* _ _ _ _ _ 200.4 Total monthly amount _ _ _ _ _ _ $659, 684 $436, 244 $554, 637 $439, 424 $373, 230 $296, 976 $41, 968 $48, 662 $36, 648 $13, 876 $1, 293 Wife’s or husband’s _ _ _ _ - - $67, 821 $58, 749 Child's 1 _ _ _ _ $61,471 $54, 283 $51, 707 $15, 224 $1, 445 Widow’s or widower’s _ $60, 457 Mother’s _ _ _ $17, 241 $1, 538 Parent’s _ Disability * _ _ _ _ $14,911 Average monthly amount: Old-age _ _ _ _ $65. 71 $63.99 $62. 76 Wife’s or husband’s _ $34.83 $34. 18 $33. 44 Child’s i _ _ _ _ _ $39. 11 $38. 03 $36. 96 Widow’s or widower’s _ _ $51. 55 $50. 67 $49.01 Mother’s _ _ _ _ $49. 99 $48. 35 $46. 67 Parent’s _ _ $52. 34 $51. 38 $50. 31 Disability * . $74.42 Benefit payments during period: Monthly benefits _ _ - _ _ $7, 900, 639 $6. 391, 690 $5, 245, 476 $3. 531, 824 $531, 831 $1, 181,821 Old-age _ _ _ _ $5. 245, 778 $4, 340, 271 Supplementary _ _ $860, 488 $679, 289 $1, 372, 130 Survivor _ . _ _ $1,625. 953 Disability*.. _ - _ _ - -- - _ - $168, 420 Lump-sum payments - _ _ _ - $142, 714 74, 000 $122, 891 72,500 $115, 337 70,900 Insured workers (midpoint of period — Jan. I)3 4 _ _ Fullv insured 73,000 72, 200 70, 100 800 Currently but not fully insured.. - _ 1,000 4 4, 150 300 Estimated number of employers reporting taxable wages, 1st quarter of fiscal year. _ _ _ - _ 4 4, 050 4 3, 950 Calendar year Estimated number of workers with taxable earnings _ (*) (5) (») 74,000 68,000 Estimated amount of taxable earnings _ _ _ $183, 000, 000 $2, 470 $170, 000, 000 $2,500 Average taxable earnings ® _ _ _ _ _ 1 Data for 1957 and 1958 include benefits payable to disabled persons aged 18 or over — dependent children of deceased or retired insured workers— whose disability began before age 18. * Monthly benefits to disabled workers aged 50-64. 3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from: (1) provisions that coordinate the old-age, survivors, and disability 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. 4 Excludes agricultural employers. s Not available. • Rounded to nearest $10. 76 Department of Health, Education, and Welfare, 1958 Table 6. — Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average payment, June 1958, and total payment to recipients , by program and State, fiscal year 1958 [Includes vendor payments for medical care and cases receiving only such payments; data corrected to Oct. 16, 1958] Aid to the permanently and totally disabled Payments to recipients Total, fiscal year (in thous¬ ands) $165, 183 188, 844 212, 209 5, 156 2, 801 1,023 3, 828 3.155 233 2, 175 4. 156 8,030 874 715 13, 747 3, 885 2, 862 8, 897 906 3,624 13, 083 3,177 1,279 Average payment, I June $56. 72 59. 10 60. 71 CO 1 iNMONh-^O O0 CO OO CO 1 1 to CO CO CO OO rH OO o ^ 1 i CO to to 05 CO to CO to CO i 1 to ^ CO 00 cm cm CO » 1 to CD 6 (N CO N N cd CO to 1-4 i 1 00 OO O CO © co i » co co cm co co »o ^ co co oo i i co to co cohooo Num¬ ber of recip¬ ients, June 258, 279 283, 910 312, 594 CO i IOOOWOHHOO OO 05 tO 1 HOOOON 050CMC O to i i CM © OO CO 05 CM rH CM O CO OO 1 1 to OO CO 05 CO CO rH t'- 1 I 00 CM ^ O CM ■*« CO to rH 05 CO 1 1 CM Tt< 05 ^ o ^ to 05 cm" ! loco to cm" cm"co to r-T t*T ! tdoTcoi-T Aid to the blind Payments to recipients Total, fiscal year (in thous¬ ands) $73, 064 80, 610 85, 397 CO rH CO CO rH CO to ^4 05 CO O O CO tO N ^ CO 00 H050rt< CO CM CO co 00 CO CM 05 CO 05 CO ^ 05 05 CO CO to CO CM GO 1>- to co CM CO CM CO CM rH 05 HOOrfTftOOHCO CO CO to CM rH CO rH rH CMrHrH r-T CM* CMrHi-T Average payment, June $60. 42 63. 87 66. 72 36.16 67. 40 64.00 53. 23 104. 68 76. 03 98. 76 72. 29 64. 50 58. 37 48.11 65. 10 64. 90 77.62 69. 03 82.79 78. 51 39. 93 74. 12 61.26 59. 56 113. 39 75. 84 89. 62 Num¬ ber of recip¬ ients, June 105, 796 108, 441 108, 332 05 to 00 05 05 CO co CO HOOCOCMCOH05COO O 00 CO 05 OOOCHCOCMONCOCl 05 00 00 CO ^ cO CM to CO O 05 CM CO 00 O 00 CO CO CM CM to rH CM 00 ^ CO CM ^ ^ r-T CM~CO CM" CO COrHrH CO"CM" CM f-TrH Aid to dependent children Payments to recipients Total, fiscal year (in thous¬ ands) $639, 476 700, 269 815, 196 CO rH co CM 00 CO CO CO CM h$4 CM CO CM rH 05 CO CO O CO CM 00 CO O CO O 00 05 to O 05 ^ o CO 05 CO CM CO CO CM 00 05 CO N CO ^ ^ 00 to 00 1-H CM CO CM CO CO 00 05 00 00 CO to 05 CO CO O 05 oT i-T co to" to 05" cT H' ^4" co H^scd'cM"oo rH'o"t^‘cd'co"td‘ ooco"to"co" O rH rH rH rH CM CM CO rH Average payment per recipient, June $24. 35 26. 04 27. 29 8. 44 28. 66 26. 90 15. 48 45. 23 31.96 45. 03 23. 63 28. 28 16. 29 22. 19 29. 39 38. 48 37. 28 28. 19 34. 92 33. 42 19. 63 20.91 26. 61 26. 64 43. 54 37.52 40. 93 Average payment per family, June $89. 27 96. 52 102. 40 CM CM rJ4 CM to CO O CO 05 ONNN^CMOOOCO 00 rH tO 00 CM CO 05 CM O to H 05 to CO 05 00 1-4 00 CO CM CO CM cd 05 to* 05 05* cd cm 05 cm ^ © o cm cd rH cm © ^ o co 05 0 to to ^ 00 to oo jfj o 2 2 ^ 00 05 0 ^ co ^ Number of recipients, June Children 1,707,629 1,831,860 2, 091, 823 T^COCONCDOOOrHCOtO CMNC0c0O(M00t005^ r-4 05 05 to CCNOOOCMOOOHCOC5 N(NMOhhC^OO 0*0 00^ O co CO O Tt< to to to CMtOOH^OStON^tO CM HJ4 co o'cd'r^'to ccTo"to h^o'oT H^^05"o5"co"o5"oo o" co" co" © 05 CM CO CM CM CM rH 05 ton CM CO CM rH t'- 05 rH COh^OOCO CM r-i Fam¬ ilies 613, 720 647, 185 728, 303 OtON^OOOOOCONCO 1-H CM to CM to 05 CO 05 -^4 05NO^ t005N05NN05 05rH05 CM *^4 00 O to O 00 O O CO 05 05 rH 05 H 00 T|4 CO CO M to rH N ^NOON-^OWCOCOCM CO CO O 00 CM"r-Tto"oo" co" co" rH^ cd' td" cm" r-T cTo"oo" to o"^" to t^cd^oo CM CO CM rH CO rH CM CM T-H CM Old-age assistance Payments to recipients Total, fiscal year (in thousands) $1, 633, 533 1, 724, 289 1, 798, 374 CO 05 b- 05 Tt< CM 00 CO ^ 05 ^ O CO to CO ^4 CM CM rf 05 to t*4 CM CO t'- CM to O CM CO CO 00 CO to to o ^ CM 05 O to O COCMCO-^4 CM rH CO CM 05 CM tO 05 CO 05 CO 05 00 to CO CO 00 CO CM rH CM P'- to o" 1-h" oT o' oT co" 05" cm" cd" o" to P^»" r-T o" P-" co" rf4~ oo" co" co" co" to CO tO to H ^ to CO CM CO CM CM 05 05 tO ^ CM Average payment, June $54. 29 58. 66 61.39 CO CO to CO 00 05 O CO 00 CO "^4 CM O CO CO -^4 CO -^4 CM CO Tt4 CO Tf4 00 05 to rH CO 00 rt4 05 CO 00 CO O to t*4 O to CO CO CO 00 ^OH05 oorHtdoocdrHco'occdcd cdcMOcdoot^cdoocdoo to cd co* o CO CO to Htt 00 05 O tJ4 to to HJ4 to CO CO to CO CO CO to tOO5CO00 Number of recip¬ ients, June 2, 523, 716 2, 503, 790 2, 460, 308 102, 863 1,527 14, 085 55, 649 265,986 52, 152 15, 142 1,531 3,118 69, 425 98, 097 1,531 7, 961 81, 844 30, 613 37, 087 30, 737 57, 362 124, 116 12, 241 9, 716 84, 729 66, 998 48, 395 State Fiscal year: 1956. . 1957 . 1958 . . Alabama _ Alaska . Arizona . . . Arkansas _ California . Colorado _ Connecticut . Delaware. . . District of Columbia. Florida _ _ Georgia . Hawaii . . . Idaho . . Illinois . . Indiana . . Iowa . . . Kansas. . . . . Kentucky. . . . Louisiana. . . Maine. . . . Maryland . . Massachusetts . . Michigan . Minnesota . Social Security Administration 77 sis§ 339 182 300 945 742 086 342 381 188 077 175 875 176 579 401 741 542 409 26 726 822 400 651 433 _ro-.vr wr^Mt-r-H«5tCT*rd'(N i-Teo *~r Vofeoo o«%h o>%h o'00" 111111 8SBSS3SS13 sailllssSI 33S «s-«fgciV 2«g^-og2-o,- »S»='gg»™ » ii ii i< ii Amount $185,237 211,171 238, 037 CO ! ' 05 05 CO CO N N N OHrHC5 1 0 00005 hOOONtJI to - 1 lO ^ Cl TH x CO lO CM © 05 CO 1 i05 05 h05 T}' (M X lO n to . iOC5CO^ (NCON 1 1 m CO CO 05 05 CO CO rf ^H to i i co" r-f cd cfrjf co to . . co cT cd cd *-f cd Aid to the blind Percent from Federal funds 47.8 47.6 47.8 C5H005HOIO^'OX N005 0«rf<00c0»0« (NMOOO CM CO 00 CO 05 t-h 00 CM id t-h N O CO 05 >h iO 05 rH rH CO 05 id t-h CO CM N lO lO CO CO lO co O lO CO COtOiOTtnO^^NiOcO iCCOO^N Amount $79, 110 87, 293 92, 549 (NONONkOWiOOO^ CO CO CO Tt< 05 00 CO ^ 00 00 00 iO 03 NXiOOOri-HHiOOCO HNi010O»0N(NQ0C0 CO Tt< CO *0 Tf ©cmt-hco^cmcmoo t-h hinmococonco cooococoo r-T 00 r-f Cm" Whh hN (NHHN Aid to dependent children Percent from Federal funds 56.0 58.0 58.7 t}.* cb cd cm* 05 id id o 05 oo i^-cocor^-TTHio^coiop^ t^-iQ’^iocoiQioi>-t'-co cd to ^ p- Amount $708, 289 776, 479 902, 651 NMINCOOOONOOION Tt< © CM 05 00 CO CM CM 00 CICOCOCOCI rf O CM iO 05 CO h iO iO O (MCO^'ONC10X05h 0 0 0 0510 COOhOOOhhNXcO COCOCNNOiOdOCOX 00 CM CO CM 00 o i-T t>f to of ©" r-f r-f - oo to rd co" cm" co" r-f ob ob cd to of cd p-" id tC r— 1 (NHH rH H »OHH i-H CM CM CO T-H Old-age assistance Percent from Federal funds 54.0 55.1 55.4 00 IO O CO CO 00 IO IO O «05H10NN05^C0H IO 05 IO rf oidcbo5t^^Hid^io‘T^ 05 © pf cm* id cb r-i cm’ oo* O5o^*t^o6 t>- to co CO ^ ^ co co IO co COCOIOOIOOIONIOCO lOr^iO^N Amount $1, 735, 436 1, 832, 190 1,911,217 COCO^C^OOCOCOOION CO iO ^ 05 Cl h IO rH Tji CO CONIONO CO N 05 iO 05 O CO CM CO CO CO »-h CM CO Cl iH CO CO CO 0d^05^ CO CM IO CM CM © 00 O to h COOh«^hh05^CO CD iO O 05 h nh of r-T ob id © rd cm" co cdT-fcdcbcbcM"ofrdofob cocdodocTcf IO CO iO CM ^ IO 1^ CM CO CM CM 05 o IO TJH CO CM 1-i Federal grants to States 1 Aid to the permanently and totally disabled $90, 669 108, 506 122, 955 o 1 COrHT^OOONCO NOOON 1 ! CD t-h CO 05 OOHOCOW CM i i 00 P— t-h CO 05 CO CM CO CO i 0 05^05 hCOt^NN CM i . CM CM rH t-h H CM 05 00 iO CD i CM 00 iO 00 CD ^f 1 1 CM r-f CM" r-f »— T of to CO 1 cm" cm" co" cm" T»f r-f rH II II II II II II II II Aid to the blind $37, 618 41, 361 44, 192 CM iH CO CO fcO to rH rH CM HH HH Old-age assist¬ ance $922, 539 993, 284 1,052,708 H05tOCO»dNHNHH O5CMCM’rH©CM^00©P- iO CM H CM N CM i—4 CD t-h ^ 00 CD CD CO 05 Tf CO t-h CO CD CO 05 00 to OO CO iO CO Tt< NNONTHrHCMCOTtf r-f of p-T cd pf cm" cd id cf of id cd r-f r-f cm" co" CO CM CO CM CM CO CO H H H CM to ^ CO CM CM Total $1,446,116 1, 586, 361 1, 745, 173 ^ 00 CO 00 05 00 CO 00 to CM Tt* CO 00 05 05 P~ CM CO 05 T-H CD r-H CD to ^NCDON05CMODO ^XrHNOND^^N CD h O CO CM 00 CO ^ T-H CO CD CM CD CO CM CD iO Is- 05 CO O CD CM CO P^-P>-CD00t>- cfrH"r-foftC*-fcdcM"to"od cd co" tcf cd r-f co" cm" r^f cd" cf cm" oo cm" i-f cd to 1-H CM 05 CO rH to P— CM CM CM CO 00 t-h rH to to CO CO State Fiscal year: 1956 . . . . 1957 _ _ - 1958 _ _ Alabama _ _ Alaska . _ _ _ Arizona . . _ . Arkansas _ _ _ _ California _ ........ . Colorado . ... ._ Connecticut _ _ _ Delaware _ . ... _ District of Columbia _ Florida.. ... _ _ _ _ Georgia.. . . . . . Hawaii. _ _ _ _ Idaho _ _ _ Illinois _ _ _ Indiana . _ _ ...... Iowa _ _ _ Kansas.. . _ _ ... ... _. Kentucky... . . . Louisiana . . ... _ Maine... ... .. __ .. . _ Maryland _ _ . _ Massachusetts. . . .. Michigan _ ... . _ Minnesota . . .... . . Mississippi. _ _ Social Security Administration 79 3co»~So o3woSo3?SoS?5oc3oS FJo5s3~33£f:;S^ SS'fe sg sssgssssss; ssssssssss s’sss; sss o^-r-r I ISllSSlell i8Sg3S9”3S |gs *0 t-h" CT 00 r-T tC tC t}7 r-T csf csfco CsTr-TrH CO co«-T C5C5CO O>05»0 S8SSS SSSSS3S3SSS SSSRSSSSKB KSS ISrIr isaiiSlsSa 1I11I112SI IIS ujeoeo rH* ^^xToge^ood^oo ooo ajV-T OOOOOOrH 03 ,-H 1C Tt< ^ >0 to 05 M HNOHOiOOlU;^^ >-H t»- 00 SS111 SiiSS§!SsS 3§18§§lS3g 111 is rC 2,501 955 19, 024 5, 776 477 4,396 4, 090 2, 065 6,177 884 939 2, 597 420 1,810 749 874 271 15 2, 072 2, 841 2,650 642 254 2,174 208 485 74 113 471 193 2,291 2, 048 54 1,894 976 153 3, 641 69 60 658 82 1,115 2, 700 108 62 3 477 399 375 506 33 253 859 449 616 940 Slugging 707 074 343 985 790 626 890 80 588 315 888 OOr-7' l-“ o co co o' t»“ CO V o' 80 Department of Health , Education , and Welfare , 1958 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 1958 1 [In thousands] State Maternal and child health services Crippled children’s services Child welfare services United States _ $16, 336. 4 $14, 846. 7 $9, 539. 5 536.6 504.0 297.5 120.8 193.2 47.6 151.2 90.4 276.8 266. 5 210.4 833.6 731.2 342.6 Colorado _ 313.4 166.4 113.9 Connecticut _ 257.9 214.5 90.1 Delaware _ 111.9 94.6 51.3 District of Columbia.... _ 201.9 169.1 33.3 Florida _ _ _ 379.3 247.9 184.2 Georgia _ 449.8 460.4 331.8 Hawaii _ 206.0 136.5 56.4 Idaho _ 165.4 106.4 32.7 Illinois. . . . 468.3 448.6 295.0 Indiana _ 309.7 242.3 119.0 Iowa _ 168.6 288.9 214.6 Kansas _ _ _ .. _ _ 178. 1 199. 1 151.8 Kentucky _ 368.7 427.5 307.2 Louisiana _ 371.9 356.2 240.0 Maine _ 133.8 114.8 90.2 Maryland _ _ _ 396.1 284.5 141.8 Massachusetts _ 417.7 311.5 98.4 Michigan _ 515.7 502.1 325.0 Minnesota _ 335.0 400.8 233.8 Mississippi _ 400.9 297.7 274.4 Missouri _ 317.6 307.3 237.9 Montana _ _ 123.3 144.2 81.8 Nebraska _ 115.1 131.2 77.5 Nevada _ 150.6 67.6 21.0 New Hampshire _ 97.6 105. 2 61.3 New Jersey _ 205.7 205.4 109.0 New Mexico _ 203.9 140.2 95.3 New York _ 742.5 560.4 283.3 North Carolina _ 647.3 613. 1 450.3 North Dakota _ 113.6 105.5 99.9 Ohio _ _ _ _ 563.4 497. 1 375.4 Oklahoma _ 240.8 257.0 179.0 Oregon _ 148.0 176.1 111.3 Pennsylvania _ 713.4 657.6 441.8 Puerto Rico _ 382.7 413.5 277.5 Rhode Island _ 127.6 93.8 48.0 South Carolina _ 373.2 368.8 261.8 South Dakota _ 73.3 79.0 94.6 Tennessee. _ 521.9 474.6 303.1 Texas . . . . 699.5 706.0 476.8 Utah _ _ _ _ _ _ 147.5 175.6 77.5 Vermont _ 105.6 91.9 64.1 Virgin Islands _ _ _ 93.3 87.5 34.9 Virginia _ _ _ _ _ : _ 522. 1 398.5 263.1 W ashington . . . . . . 259.4 170.6 140.5 West Virginia _ _ _ _ _ _ 233.4 247.5 224.6 Wisconsin . . . . . 237.0 322.4 241.3 Wyoming _ 108.0 84.4 33.5 Based on checks issued less refunds. Social Security Administration 81 Table 9. — Federal credit unions: Number of members , amount of assets, amount of shares , and amount of loans outstanding, Dec. 31, 1935—57 1 Year Number of operating Federal credit unions Number of members Assets Shares Loans out¬ standing 1935 _ _ 772 119, 420 $2, 372, 100 $2, 228, 400 $1, 834, 200 1936 _ _ 1,751 309, 700 9, 158, 100 8, 510, 900 7, 343, 800 1937.. - - 2, 313 483, 920 19,264,700 17, 649, 700 15, 695, 300 1938. _ _ _ 2, 760 632, 050 29, 629. 000 26, 876, 100 23. 830, 100 1939 _ _ _ 3, 182 850,770 47, 810. 600 43, 326, 900 37, 673, 000 1940 _ 3, 756 1, 127, 940 72, 530, 200 65, 805. 800 55, 818, 300 1941 _ _ _ 4, 228 1, 408, 880 106, 052, 400 97, 208, 900 69, 484, 700 1942 _ _ _ - 4, 145 1, 356, 940 119, 591, 400 109, 822, 200 43, 052, 500 1943 _ _ _ 3, 938 1,311,620 127, 329, 200 117, 339, 100 35, 376, 200 1944 _ 3, 815 1, 306, 000 144, 365. 400 133. 677, 400 34, 438, 400 1945 _ _ _ _ 3, 757 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 1946.. _ _ _ _ 3, 761 1, 302, 132 173. 166, 459 159, 718, 040 56, 800, 937 1947 . — - - 3, 845 1,445,915 210, 375, 571 192, 410, 043 91,372,197 1948 _ _ _ _ 4, 058 1, 628, 339 258,411,736 235, 008, 368 137, 642, 327 1949 . . . . . . 4, 495 1,819,606 316, 362, 504 285, 000, 934 186, 218, 022 1950 - - - - - 4,984 2, 126, 823 405, 834, 976 361, 924, 778 263, 735, 838 1951 _ _ 5, 398 2, 463, 898 504, 714, 580 457, 402, 124 299, 755, 775 1952 _ _ _ _ 5,925 2, 853, 241 662, 408, 869 597, 374,117 415, 062, 315 1953.. _ _ 6, 578 3, 255, 422 854, 232, 007 767, 571,092 573, 973, 529 1954 _ _ _ 7, 227 3, 598, 790 1, 033, 179, 042 931,407, 456 681,970, 336 1955 . . 7,806 4, 032, 220 1, 267, 427, 045 1, 135, 164, 876 863, 042, 049 1956 _ 8, 350 4, 502, 210 1, 529, 201, 927 1, 366. 258, 073 1, 049, 188, 549 1957... _ _ 8,735 4, 897. 689 1, 788, 768, 332 1, 589, 190, 585 1,257,319, 328 1 Data for 1935-44 on membership, assets, shares, and loans outstanding are partly estimated. Table 10. — Federal credit unions: Assets and liabilities, Dec. 31, 1957, and Dec. 31, 1956 Assets and liabilities Amount Percentage dis¬ tribution Dec. 31, 1957 Dec. 31, 1956 Change during year Dec. 31, 1957 Dec. 31, 1956 Number of operating Federal credit unions . . . . 8, 735 8,350 385 Total assets . . . $1, 788, 768, 332 $1, 529, 201, 927 $259, 566, 405 100.0 100.0 Loans to members . . . 1, 257, 319, 328 1, 049, 188, 549 208, 130, 779 70.3 68.6 Cash . . . 135, 115, 485 118, 900, 595 16, 214, 890 7.5 7.8 United States bonds _ 90, 921, 596 88, 009, 631 2,911,965 5.1 5.8 Savings and loan shares . . 251, 614, 676 228, 565, 099 23, 049, 577 14.0 14.9 Loans to other credit unions _ ... . 38, 827, 893 31,647,416 7, 180, 477 2.2 2. 1 Land and buildings . . . . . 4, 587, 837 3, 449, 730 1, 138, 107 .3 .2 Other assets . . . . . .. . . 10, 381, 517 9,440,907 940, 610 .6 .6 Total liabilities _ _ _ 1, 788, 768, 332 1, 529, 201, 927 259, 566, 405 100.0 100.0 Notes payable _ _ . 41, 281, 715 34, 572, 441 6, 709, 274 2.3 2.3 Accounts payable and other liabilities- 5, 273, 781 4, 344, 517 929, 264 .3 .3 Shares . . . . . . 1, 589, 190, 585 1, 366, 258, 073 222, 932, 512 88.9 89.3 Regular reserve _ 62, 344, 129 49, 668, 568 12, 675, 561 3.5 3.2 Special reserve for delinquent loans _ 3, 674, 115 3, 469, 216 204, 899 .2 .2 Other reserves 1 . . . . . . .. 2, 536, 571 692, 884 1, 843, 687 .1 .1 Undivided earnings . . . . . 84, 467, 436 70, 196, 228 14, 271, 208 4.7 4.6 Reserve for contingencies and special reserve for losses. ■ ' Public Health Service Health of the Nation The American people continued their march toward better health during the past year. The Nation’s health status remained high, despite the impact of a worldwide influenza epidemic in the fall and winter of 1957. Public interest in health activities continued to grow and expenditures for health purposes again rose. This interest and support resulted in significant progress in such major areas as re¬ search, health manpower and facilities, and public health practice. Medical research probed deeper into the basic processes affecting life and health. At the same time, there was widespread study of specific techniques to add to the skill, equipment, and resources of the Nation’s health workers. The growth of training programs, particularly those aided by the Federal Government, helped to expand the national reservoir of health manpower and to increase its professional competence. The Nation’s health facilities, especially those geared to the needs of long-term care and chronic disease, continued to expand. Wider use of new scientific knowledge helped save lives, prevent disability, and restore some measure of independence to thousands of ill and handicapped people. Health leaders agreed, however, that an unfinished task of utmost importance is to reduce the lag between the discovery and application of knowledge. The responsibilities of the Public Health Service continued to grow in response to these and other current challenges to health. Al¬ though there were few new legislative measures in fiscal year 1958, increased appropriations and administrative actions resulted in the expansion of several programs. These developments and other sig¬ nificant activities of the year are covered in the pages that follow. 83 84 Department of Health, Education, and Welfare, 1958 HEALTH RECORD The vital rates that measure the Nation’s health have shown a very different picture for the two extremes of life during recent years. Great gains in life expectancy for the young have been accompanied by increases in death rates for conditions characteristic of the latter part of life. The death rates for infants under 1 year and for mothers in child¬ birth, for example, have declined in the last decade. The infant death rate dropped 18 percent, from 32.2 deaths per 1,000 live births in 1947 to 26.3 in 1957.1 The maternal mortality rate for 1957 was 3.9 per 10,000 live births, compared with 13.5 in 1947 — a 71-percent drop. Deaths from childhood disease also declined sharply. Scarlet fever and streptococcal sore throat, diphtheria, whooping cough, and measles caused about 8 deaths for every 100,000 youngsters under 15 years of age in 1947. In 1957, however, these diseases were responsi¬ ble for only about 1 death per 100,000. The death rates for a number of infectious diseases which affect the young and the old alike have also dropped since 1947. Thus, the death rate for tuberculosis was 7.8 per 100,000 population in 1957, compared with 8.4 in 1956 and 33.5 in 1947. There have also been proportionately fewer deaths from syphilis, particularly among in¬ fants. The epidemic of Asian influenza last year produced an in¬ crease in the influenza and pneumonia death rate (except for pneu¬ monia of the newborn) from 28.2 per 100,000 in 1956 to 35.8 in 1957. It also caused a much larger increase in the number of deaths in older people with cardiovascular disease. Death rates for suicide, homicide, and accidents have decreased since 1947. While suicides increase with age, homicide is more likely to occur in the middle years. Most fatal accidents, except for motor- vehicle accidents, tend to occur at the two ends of life. No definite trend has been apparent for motor-vehicle accidents, but the death rate has remained at a high level. It was 22.7 per 100,000 in 1957 and 22.8 in 1947. For all other accidents, however, the death rate dropped from 46.4 in 1947 to 33.2 in 1957. In contrast to the generally favorable picture in the infectious dis¬ eases, the chronic diseases characteristic of the latter part of life con¬ tinued to take heavy toll of lives. Together, diseases of the heart and blood vessels and cancer accounted for 70 percent of all deaths in 1957. The death rate for the major cardiovascular- renal diseases was 523.7 per 100,000 in 1957, compared with 491.0 in 1947. The 1957 cancer death rate was 148.7, substantially higher than the 132.3 rate of 10 years ago. All the trends in the Nation’s health are summed up in the general death rate and in life expectancy figures. Over the last few years, 1 All vital statistics are given for the calendar year. Public Health Service 85 these indicators have remained virtually unchanged, showing a stand¬ off between the forces working for longer life and the forces working for death. Since 1946 the general death rate has not risen above 10.1 per 1,000 population nor fallen below 9.2 ; it has varied only between 9.2 and 9.6 since 1952. The rate stood at 9.6 in 1957, slightly higher than the 9.4 rate in 1956. The average length of life for the entire population increased from 66.8 years in 1947 to 69.6 years in 1954, but the figure has remained practically unchanged since then. It was 69.5 years in 1955 and 69.6 years in 1956 (the last year for which the life span has been calculated) . The average life expectancy in 1956 was 67.3 years for white males, 73.7 for white females, 61.1 for nonwhite males, and 65.9 for nonwhite females. The life span for women has been increasing more rapidly than for men, and the gap between the white and the nonwhite popu¬ lation has continued to decrease. BIRTHS, MARRIAGES, AND DIVORCES The Nation’s birth rate has remained at a high level since the end of World War II, while the death rate has declined slightly. About 4,301,000 live births occurred in 1957, for a birth rate of 25.3 per 1,000 population. There were 4,218,000 births in 1956, and a rate of 25.2 per 1,000. Since there were 9.6 deaths per 1,000 people in 1957, or a total of 1,633,128 deaths, the rate of natural increase came to 15.7 persons per 1,000 — slightly lower than last year’s rate of 15.9. The highest rate of increase in a single year — 16.5 — during the past 25 years for which national data are available occurred in 1947. The estimate of marriages performed in 1957 was 1,518,000, or 4.2 percent less than the figure for 1956. The marriage rate was 8.9 per 1,000 population, compared with 9.5 in 1956. The estimated number of divorces granted in 1957 was 381,000, less than 1 percent below the figure for 1956. INFLUENZA In the fall and winter of 1957, the United States experienced its most widespread influenza epidemic in 40 years, caused by a new Asian strain of the influenza virus. The Service’s National Health Survey estimated that about 80 million people spent one or more days in bed between July 1 and the end of the year from acute upper respira¬ tory illnesses, a substantial amount of which was Asian influenza. Localized outbreaks were reported in this country during the sum¬ mer, and the first community- wide outbreak occurred in a Louisiana parish in early August. For the Nation as a whole, the peak of the epidemic was reached in mid- October when National Health Survey estimates indicated that some 12 million people were in bed during the week with respiratory illness, chiefly influenza. 86 Department of Health , Education , and Welfare , 1958 The Nation had been alerted to the danger of an epidemic in the spring when the disease first appeared in the Far East. A number of steps were taken by the Nation’s health leaders to minimize the impact of the epidemic which was expected in this country. A new vaccine was developed against Asian influenza and rushed into production by the pharmaceutical industry. Vaccine began to be available by Sep¬ tember and about 60 million doses were produced by the end of the year. In the fall of 1957, when the vaccine was in short supply, the produc¬ ers agreed to a voluntary allocation system. This was administered by the Public Health Service and enabled each State to receive supplies of vaccine which were proportionate to the size of its population. Rec¬ ommended priorities were also established to give first preference to those people who were essential in maintaining health and other basic community services and to people who constituted special medical risks. Cooperative plans were also made for other measures to meet the anticipated epidemic. Beginning early in the spring, the Public Health Service held a series of meetings with representatives of the medical profession, State health officials, voluntary health agencies, hospital administrators, and the producers of influenza vaccine. Plans were developed for the use of the vaccine, the control of outbreaks, and for emergency medical care needs in local communities. An in¬ formation program was carried on to keep the public informed about the nature of the disease and the precautions, including vaccination, which could be taken. A reporting system was established so that the extent and virulence of the epidemic could be checked. And State and other viral laboratories were equipped with diagnostic re¬ agents to assist in rapid detection of outbreaks. As a result of these activities, a comprehensive program was devel¬ oped before Asian influenza made its appearance in the United States. Even though the epidemic struck earlier than had been expected, the Nation was well prepared to deal with it. Partly because of the preparations, and also because the virus strain was generally mild, no serious disruption of community life occurred, and medical and hospital facilities were not overtaxed. The most serious consequences occurred after the epidemic phase of the disease had ended. During January and February of 1958 the death rates from influenza and pneumonia rose markedly. Although the reason for this rise could not be definitely ascertained, epidemiologists believed that the virus was reaching elderly people who had been protected from earlier exposure. A post-epidemic evaluation of what the Nation had gained from dealing with this epidemic included the following : 1. Knowledge and experience which will enable health leaders to predict with greater confidence the course of future epidemics. Public Health Service 87 2. A stronger research program and improved laboratory facilities for the study, diagnosis, and surveillance of virus diseases. 3. A tested pattern of organization which mobilizes public health, medical, hospital, voluntary health agency and drug industry resources into a coordinated action program. 4. Evidence that American industry is capable of producing 60 million doses of influenza vaccine in 6 months and probably could produce even more in an extreme emergency. POLIOMYELITIS The incidence of paralytic poliomyelitis continued to decline during 1957 as more and more people took advantage of the protection af¬ forded by the poliomyelitis vaccine. The total number of paralytic cases reported in 1957 was 2,499 ; this was a 68-percent reduction from the 7,911 cases reported in 1956 and an 82-percent reduction from the 13,850 cases reported in 1955, the year the vaccine first became available. By the end of 1957, at least 45 million people under 40 years of age had had one or more injections of the vaccine ; most of them had had the full initial course of three injections and a few had had a fourth in¬ jection. However, there remained some 66 million people under 40 who had had no vaccine at all. Consequently, the Advertising Coun¬ cil’s vaccination promotion campaign, which was initiated in the fall of 1957 under the sponsorship of the Public Health Service, the Ameri¬ can Medical Association, and the National Foundation for Infantile Paralysis, was continued through the spring of 1958. Following a brief period of shortage in the spring of 1957, vaccine remained in plentiful supply throughout the year. By early 1958, all manufacturers were reporting inventories of unshipped vaccine. Funds and Personnel A total of $718.4 million was available to the Public Health Service in 1958. (See table 1, p. 145.) About $565.9 million of this amount was in appropriations and authorizations. The balance was made up of reimbursements for services rendered to other agencies and in un¬ obligated balances from previous years. About two-thirds of the total amount available was allocated to agencies and institutions outside the Federal Government in the form of grants for research and training, for State and community public health programs, and for the construction of hospital and medical facilities and of sewage treatment plants. The remainder supported the direct activities of the Service, including the operation of PHS hospitals, foreign and interstate quarantine, and Indian health services. 88 Department of Health , Education , and Welfare , 1958 At the close of fiscal year 1958 there were 24,483 full-time employees in the Public Health Service. (See table 2, p. 147.) This number included 1,478 members of the regular Commissioned Corps of the Service, 1,883 members of the Reserve Corps on active duty, 142 mem¬ bers of the Commissioned Reserve on temporary training duty, and 20,980 full-time Civil Service employees. National Library of Medicine A major change in the National Library of Medicine operations occurred in September 1957, when interlibrary loans and photodu¬ plication service were unified into a single system. Integration of the two services provided a more efficient instrument for making the Li¬ brary’s extraordinarily complete resources of medical literature avail¬ able throughout the country. Implementation of the new service was expedited by conversion of photoduplication processes to Xerography and by accompanying procedural changes designed to speed the processing of requests for interlibrary loans. IMPROVEMENT OF INDEXING OPERATIONS With financial assistance in the form of a grant of $73,800 from the Council on Library Resources, Incorporated, the Library began a 2-year program for improving its indexing publication mechanisms. Aims of the project are to experiment with and develop mechanical systems for the filing and layout operations involved in preparing printer’s copy for the Current List of Medical Literature • to achieve maximum convenience of consultation through improved format; to improve methods for preparing cumulative indexes ; and to seek meth¬ ods for rapid retrieval and publication of material relating to specialties within the medical field. FOREIGN LANGUAGE MATERIALS The Library continued to increase its procurement of Soviet medical literature by resumption of an exchange relationship with the State Central Medical Library in Moscow, and by enlarging existing agree¬ ments with Eastern European countries. Of the foreign language journal articles indexed last year in the Current List of Medical Lit¬ erature, 11,000 were from 156 Russian and other East European publications. NEW BUILDING PROGRAM Construction funds for the new library building were included in appropriations for fiscal year 1959. Final working drawings for the new building are expected to be completed by December 1958, and it is anticipated that the structure will be completed by the summer of 1961. Estimated cost has been set at $7,300,000 for a building of approximately 232,000 square feet consisting of five levels, two above Public Health Service 89 and three below ground, to be located on the grounds of the National Institutes of Health. PROGRAM STATISTICS During fiscal year 1958 the National Library of Medicine acquired 13,447 books, 75,028 serial pieces, and 1,157 new serial titles; it pur¬ chased 469 old and rare items for its History of Medicine Division, cataloged 23,595 titles, and added 1,492 pictures and portraits to the art collection. The number of volumes circulated to users of the Library was 111,594; 8,205 reference questions were answered and 334 bibliographies were compiled. There were 12,199 major entries pre¬ pared for the annual volume of the National Library of Medicine Catalog , and 110,708 items were published in the Current List of Med¬ ical Literature from 1,594 journal titles. Over 1.3 million pages of medical literature were microfilmed in response to 64,421 requests. Public Health Methods The Division of Public Health Methods has principal staff responsi¬ bility for program planning in the Office of the Surgeon General. In discharging this responsibility, the Division conducts selected studies on public health needs and problems, analyzes economic, so¬ cial, and public policy trends which affect Public Health Service programs, and cooperates in public health planning activities. NATIONAL HEALTH SURVEY In June 1958, the U. S. National Plealth Survey, located in this Division, completed its initial year of operation on an annual basis. During the year, preliminary reports were published on the prevalence and incidence of acute upper respiratory diseases, on physician visits, dental care, persons injured, and the extent of disability in the popu¬ lation. Preliminary studies indicated that persons visit physicians at a rate equivalent to slightly under five visits a year, and visit dentists at a rate equivalent to 1.6 visits per person per year. About 25 million persons were injured during the last 6 months of 1957, according to National Health Survey data. Moreover, during the period July-September 1957, an estimated total of 662.8 million per¬ son-days of restricted activity due to illness or injury occurred. In other parts of the Survey, field work had been completed, by the end of the fiscal year, on a number of contract studies relating to methodo¬ logical problems of a projected health examination survey, alternate methods of collecting morbidity data, and household interviewing. HEALTH RESOURCE STUDIES In a study of health resources, the future supply of physicians in the continental United States was predicted under four series of esti- 487270—59 - 7 90 Department of Health , Education , and Welfare , 1958 mates of graduates of medical schools. Under the assumption of graduation rates currently predicted for existing and planned schools, the number of physicians in 1975 will be 290,409 — a rate of 127 per 100,000 population, in contrast to the 1955 rate of 132 per 100,000. If the number of graduates were to be increased sufficiently to regain and maintain the 1955 ratio of physicians to population, the equivalent of 20 new medical schools would have to be added to the 87 scheduled for existence in 1965. As part of its study of health services, the Division provided an executive secretary for a National Conference on Homemaker Serv¬ ices, organized under the aegis of the Children’s Bureau with the joint sponsorship of 7 other units of the Department, and 26 national voluntary agencies. In preparation for the Conference, the Division collected data from the 143 agencies which provided this service in the spring of 1958. A total of 110 programs — 3 out of 4 — are under pri¬ vate auspices. During the study week, a total of 1,715 homemakers was employed and served 2,188 families. In preparation for a monograph that will show methods for col¬ lecting information on community needs of and resources for long¬ term patients, questionnaires designed in the Division were tested by three local communities, which conducted their own surveys. The information includes data on institutions serving long-term patients, outpatient facilities, public health nursing agencies, vocational re¬ habilitation agencies, and other resources. Several activities of the Division during the past year were con¬ cerned with the health problems of older adults in the population. Data were compiled on the health status of the aged and the inter¬ relationship of health and socioeconomic factors. Among the geron¬ tological health problems, economic status continues to be prominent due to the composite effect of the increase of expenditures for medical care as age advances, a consequence of higher rates of disabling and chronic illness among older persons; the comparative decline, with age, in income and in health insurance protection; the tendency of persons with lower income to experience proportionately more illness than those of better economic status. In collaboration wTith the Bureau of Labor Statistics, a study is being made of various indexes of medical care prices compiled by public and private agencies, their uses, design, and relation to med¬ ical care costs. Medical care expenditures of urban dwellers were also studied during 1958, including differential in medical spending by age, characteristics of large medical expense, dental spending of urban residents, and other aspects of medical expenditures. Public Health Service 91 National Institutes of Health The National Institutes of Health conducts medical research in its laboratories at Bethesda, Md., and supports research, training, and research construction in institutions throughout the Nation. Its grants are awarded after careful review by non-Federal groups — study sections composed of technical experts, and advisory councils composed of leaders in science and public affairs. In fiscal year 1958, changes were made in the advisory structure of NIH to facilitate the administration of research. Boards of scientific counselors were established to advise the Institutes on intramural studies, and two new study sections were created to review the in¬ creasing number of grant applications in the fields of genetics and cell biology. A new Division, General Medical Sciences, was created to strengthen support of the sciences basic to medicine; and the Di¬ vision of Research Grants, responsible for general administration of research grants and fellowships, was reorganized. In fiscal year 1958, Congress appropriated $211 million for the Institutes’ programs and an additional $30 million for grants to finance the construction of health research facilities. Research and training grants approved by the Institutes reached an unprecedented level. There were 7,028 research grants and 1,725 training grants, totaling $134 million. The first in a series of long-term, university-centered programs to coordinate studies in basic science with others on the social, economic, and behavioral problems affecting the country’s aging population was initiated at Duke University. In support of the worldwide program of malaria eradication, NIH has undertaken an accelerated 5 -year search for cheap, effective, nontoxic drugs. The cancer chemotherapy program, now in its third year of opera¬ tion, clarified procedures for protecting both the rights of industry and the public interest when chemical agents useful in the control of cancer are developed through Government contracts with industry. A program of grants for studies in physical biology stimulated the expansion of this increasingly important field. A modest extension of the postdoctoral research fellowships pro¬ gram has made the awards available to scientists of foreign coun¬ tries. Fellowships were awarded in 1958 to 13 outstanding medical scientists in Western Europe, permitting them to conduct research in this country. To increase the number of trained scientists in the United States, a general research training program in such areas as pathology, pharmacology, genetics, anesthesiology, epidemiology, and 92 Department of Health , Education , and Welfare , 1958 biometry was established at the graduate level by some American uni¬ versities with the support of training grants. A number of facilities for specialized treatment or study were opened during the year. Among these were a residence treatment center for disturbed children, a center for the evaluation of psycho- pharmacologic agents, and a small field laboratory — the Middle America Research Institute in Panama — for the study of tropical diseases, particularly of virus origin. The seven Institutes comprising NTH are named for the health problem areas on which they concentrate — allergy and infectious dis¬ eases, arthritis and metabolic diseases, heart, cancer, dental research, mental health, and neurological diseases and blindness. Recent de¬ velopments in these programs, in the supporting divisions, and in the Clinical Center are described in the following sections. Clinical Center The 516 research beds of the Clinical Center form a major national resource for medical research. Having attained this maximum- planned bed capacity late in 1957, a particular goal of NIH during 1958 was optimal utilization of the clinical research facility. A series of intensive studies of the many elements involved, together with ap¬ propriate action, resulted in the attainment of an average daily census of approximately 400 patients during the last months of the year. This is the patient load considered ideal in terms both of superior clinical study and of the high quality of care required for research patients. Each year the Clinical Center’s importance as an influence for interchange of scientific facts and viewpoints becomes increasingly evident. The number of visitors has increased from about 2,000 in 1953, when the Center was opened, to nearly 10,000 in 1958. Of this number, 31 percent were professionals and 33 percent students in fields related to medicine and medical research. Of particular interest is the fact that 500 of the professional visitors were from 71 foreign countries. Division of Biologies Standards The Division of Biologies Standards prescribes and maintains standards to ensure the safety, purity, and potency of commercial biological products. These include vaccines, serums, toxins, anti¬ toxins, and related products, as well as human blood and its deriva¬ tives. Close surveillance of production and quality is accomplished through the licensing of both the manufacturer’s establishment and his products. Standards for each product are developed by DBS, Public Health Service 93 and production processes are inspected periodically to ensure com¬ pliance with requirements. Within recent years, the nature of the programs needed to meet these responsibilities has changed considerably. Large-scale use of tissue-culture methods for quantitative assay, serologic diagnosis, and vaccine preparation has greatly expanded the potential range of biologies. Thus, the Division must maintain a research program of sufficient flexibility to provide information as the need arises. Production of the Asian-strain influenza vaccine in 1957 demon¬ strated both the research and control functions of DBS. Tests were developed, reference vaccines established, and data from investiga¬ tions correlated. Specifications for a vaccine containing a hitherto unknown strain of influenza virus were provided for the guidance of industry. The Division also contributed to the formulation of standards for a vaccine that protects young adults against respiratory illnesses caused by three types of adenovirus. The first license has been granted for its manufacture. Tissue culture methods have been studied in relation to the production and standardization of smallpox vaccine, and to the antigenicity of measles vaccine. Recent dis¬ coveries relating to the enteroviruses — the ECHO and Coxsackie groups — indicate that vaccines may also be developed for these agents. Division of Research Grants The recent expansion of NIH grants and training programs was reflected during the year in the largest volume of applications yet received. The review procedure wTas characterized by the same high standards that were established at the beginning of the program in 1946. This was achieved through the appointment of additional ad¬ visory groups. During the year, a General Research Training Program was initi¬ ated. It will help stimulate and expand research training in areas basic to the biological and medical sciences as well as in other spe¬ cialty areas where acute shortages of research-trained manpower exist. Moreover, the acceleration of basic research training will pay dividends in sustained productivity in applied medical and biological research. The health research facilities program had awarded $60 million by June 30 of this second fiscal year of operation. Since the grantees matched an average of $2 for every $1 received from the Govern¬ ment, the total outlay for federally supported research construction amounted to approximately $180 million. 94 Department of Health , Education , and Welfare, 1958 Central Services The Division of Business Operations furnishes NIH scientists with auxiliary management services. Emphasis during the year was on the programing of payroll, financial, personnel, and stock-control data for a giant electronic computer installed in March 1958. The Division of Research Services provides a wide range of tech¬ nical, scientific, and engineering skills in support of research at NIH. Major emphasis in 1958 was again given to new construction author¬ ized by Congress. A plant for chemical waste disposal, five animal wings, and special facilities for the production and care of germ-free animals were completed during the year, and construction was be¬ gun on a laboratory for biologies control. Planning and design work progressed on a surgical wing for the Clinical Center, a permanent office building, and laboratories for the National Institute of Dental Research. Other developments included the expansion of the Russian scientific translation program. Institute of Allergy and Infectious Diseases The microbiological approach is basic to most research by NIAID. Many of this Institute’s advances help to answer basic questions for more specialized institutions. The Institute is also exploring new specialties and frontiers. Virology, for example, is opening the way to a more comprehensive understanding of the role of microbial agents in degenerative as well as infectious diseases. Allergic and infectious diseases are tremendously costly in terms of dollars or human distress. The specter of outbreaks such as the influenza epidemic of 1918, which took millions of lives, gives impetus to influenza research during inter-epidemic periods. In geographic areas linked politically and economically with the United States, diseases such as malaria, schistosomiasis, and filariasis are paramount killers and cripplers. The Institute is a world center for research on such problems. Institute scientists, active on many fronts during the 1957 epidemic of Asian influenza, evaluated vaccine efficacy in infected volunteers. They also developed a more rapid laboratory method of influenza diagnosis. This led to uncovering previously unknown agents, the hemadsorption viruses, apparently prevalent in young children. The Institute’s Rocky Mountain Laboratory at Hamilton, Mont,, has developed a new method for purifying viruses, with a view to aiding research directed toward new or improved vaccines. The method employs a filtering column of adsorbent chemicals. Also at this Laboratory, a new vaccine against the virus of Colorado tick fever has been developed to the stage of clinical trials. Public Health Service 95 The causative agent of toxoplasmosis was demonstrated for the first time in pork muscle. Institute scientists also showed that latent toxoplasmosis organisms can be transmitted by chronically infected rats to their offspring, suggesting the possibility of similar mech¬ anisms in human infection. Clinicians of the Institute found that intravenous amphotericin brought cure or improvement to several patients with systemic fungal diseases such as histoplasmosis — a significant experimental finding in the absence of other chemotherapy for such infections. GRANT-SUPPORTED RESEARCH Allergic (anaphylactic) shock is a hazard to hypersensitive persons receiving drug injections or blood transfusions. Institute grantees at Columbia University have found that certain steroids and tran- quilizing drugs protect mice from shock. The investigators are seek¬ ing the pharmacologic basis of this protective action. In grant-supported studies at Louisiana State University, single or multiple infections by whipworm, threadworm, roundworm, and pinworm were effectively treated with a single drug, dithiazanine. This work is particularly promising for the care of patients in insti¬ tutions where conditions may favor the spread of these intestinal parasites. Scientists at Children’s Hospital in Detroit employed grant funds to develop a method for identifying causative agents in nursery epi¬ demics of infant diarrhea. Fluorescent antibodies in a preprepared solution “spotlight” their corresponding antigens, or disease agents, and rapidly give definitive information upon which treatment can be based. Heightening concern over staphylococcal infections that resist treatment underscores the importance of studies supported at Har¬ vard University and Boston City Hospital. Erythromycin is sug¬ gested as the antibiotic of choice in the clinical trials. Institute of Arthritis and Metabolic Diseases During the year, the Institute strengthened its basic research at¬ tack on arthritis and other rheumatic diseases, and on the metabolic diseases such as diabetes and gout. In addition, research and train¬ ing activity was expanded into two new research areas : gastroenter¬ ology — the medical specialty dealing with such disorders as peptic ulcer, ulcerative colitis, and regional ileitis — and the new science of physical biology. In the latter field, the techniques of modem phys¬ ics are helping to solve basic biological problems. Arthritis and the rheumatic diseases continue to afflict more than 10 million people in the United States. Although the basic cause of arthritis is still unknown, continuing research has led to better forms 96 Department of Health, Education, and Welfare, 1958 of treatment and a more complete understanding of the underlying disease process. Since cortisone’s antirheumatic properties were first discovered in 1949, other steroids — hydrocortisone, prednisone, prednisolone, methylprednisone, triamcinolone — have been developed for the treat¬ ment of rheumatoid arthritis. Clinical investigators at the Institute recently completed preliminary studies of still another new steroid, which appears to be even better than its predecessors. Known as dexamethasone, the drug is 25 times more potent than hydrocorti¬ sone and 6 times more potent than prednisone. It has been found ef¬ fective in relieving the characteristic pain and inflammation of rheu¬ matoid arthritis in patients who have received little or no benefit from the other steroids. Important basic knowledge about gout recently was uncovered by Institute scientists, who found that overproduction of uric acid in the body is the effective metabolic defect in this disease. This has been a controversial point ever since the high blood levels of uric acid were first detected in gout patients. Some scientists believed the excess uric acid was due to insufficient destruction of the acid in the body, and others thought it due to an inability to excrete proper quan¬ tities of the material. Institute clinicians have evaluated a new intravenous preparation of colchicine, an age-old drug for the relief of gout attacks. They found that, by injecting the drug, the attacks could be relieved more promptly and without the distressing gastrointestinal disturbances that often accompany colchicine when taken by mouth. A few highlights of basic research in the Institute were the de¬ termination of how thrombin, the body’s essential blood-clotting enzyme, does its work; the recognition of selenium as an important trace element in the diet to prevent dietary liver necrosis in experi¬ mental animals ; and the discovery that the bones of the human skele¬ ton wear out and are replaced by new bone growth to a much greater degree than previously supposed. GRANTS AND AWARDS Diabetes research is one of the primary areas of interest to the Insti¬ tute. The year’s most noteworthy development in this field was the widespread use of the new oral antidiabetic drug tolbutamide. After extensive clinical trials by Institute grantees and other physi¬ cians throughout the country, the drug went on the market in June 1957. Today it is used by over 300,000 Americans with diabetes. The new drug, though not chemically related to insulin, does have the ability to bring about one of insulin’s major effects in the body — that of lowering the high level of blood sugar found in diabetes. Public Health Service 97 Studies by Institute grantees indicate that the drug acts in part by stimulating the body’s own insulin-secreting cells in the pancreas. Other Institute-supported studies have shown that postoperative patients recover more rapidly if the long-accepted semi-starvation method of feeding is replaced by one supplying adequate nutrition. The nitrogen losses that were formerly thought to be the result of operative injury or stress were found to be almost entirely the result of poor nutritional intake. The investigators prevented these losses in their surgical patients by administering intravenous solutions with a high protein and calorie content. Cancer Institute Studies in virology, exfoliative cytology, and chemotherapy pro¬ duced some of the most encouraging advances in the field of cancer ever achieved in a single year. The relationship between viruses and cancer has become one of the more promising areas of investigation. In one study, laboratory animals developed multiple tumors affecting nearly every organ and tissue after receiving a single injection of an agent that has the proper¬ ties of a virus. This observation, together with similar ones in the recent past, has stimulated a search for additional viral agents with cancer-producing properties. Research during the year reaffirmed the importance of exfoliative cytology as a technique for the detection of uterine cervical cancer in its early, unsuspected, and most curable stages. Analysis of the data gathered in a cytologic study of more than 100,000 women showed that invasive uterine cervical cancer may produce no symptoms for 2 to 3 years, but that it can be detected during that time by cytologic examination. Studies are continuing in an effort to adapt the cytologic technique to the detection of cancer of other body sites, such as the lung, large intestine, bladder, and prostate gland. A quantitative method has been developed which permits the detection and estimation of the number of cancer cells in the circulating blood of cancer patients. This permits completely new approaches to the study of the biological characteristics of clinical cancers. Research in chemotherapy was directed principally at producing new and more effective anticancer agents and improving procedures for administering drugs to patients. In a laboratory study, adminis¬ tration of dichloroamethopterin produced a marked increase in the survival time of mice with advanced leukemia. This agent is closely related to methotrexate, which continued to produce encouraging re¬ sults in the treatment of choriocarcinoma, a rare type of uterine tumor that occurs in women during or after pregnancy. One choriocarci- 98 Department of Health , Education , and Welfare , 1958 noma patient treated with methotrexate has remained apparently free of cancer for more than 30 months. The adoption of a new Departmental patent policy encouraged a substantial increase in industry’s participation in chemotherapy re¬ search. The Cancer Chemotherapy National Service Center, at the National Cancer Institute in Bethesda, Md., is coordinating the re¬ sources of the Nation’s leading research institutions, colleges, and the pharmaceutical industry in an intensive effort to find more effective anticancer drugs. Chemicals, fermentation liquors, hormonal agents, and other materials are being studied at the rate of 40,000 per year in the Chemotherapy Service Center’s screening program. Important advances were also made in fundamental research into the nature of normal and malignant cells, the carcinogenic process, and intricate host-tumor relationships. INSTITUTE RESEARCH In collaboration with the Division of Biologies Standards, Institute scientists produced multiple tumors in mice and hamsters by in¬ jecting them with cell-free tissue culture preparations obtained from certain mouse tumors. The following observations suggest that the tumor-inducing agent used in these studies is a virus. It grows in tissue culture; is destroyed by heat, but not by storage at freezing temperatures; is in the virus size range, as indicated by the filter through which it passes; is not destroyed by antibiotics, which kill bacteria but not viruses; and produces neutralizing antibodies in rabbits. Within the year a group of Institute scientists reported the results of laboratory studies on the problem of tumor metastasis. Experi¬ ments with mice showed that a primary tumor may exert an inhibitory effect on the growth of distant metastases, and that removal of the tumor acts as a stimulus on the metastatic deposit. Another phase of the investigation showed that neither anesthesia nor cortisone admin¬ istration, nor operative procedure in which the primary tumor was not removed, had any effect on the number of lung metastases. The third study in the series demonstrated that the anticancer drug TSPA was effective in reducing the number of lung metastases when admin¬ istered several hours after removal of the primary tumor. Metastases were completely prevented in some mice. Biostatistical studies on nearly 200,000 United States veterans re¬ vealed that the death rate for smokers exceeded that for nonsmokers by 32 percent. Mortality was 58 percent higher among cigarette smokers than among nonsmokers, and the smokers showed a death rate from lung cancer 10 times higher than did the nonsmokers. NCI continued its comprehensive study in Washington County, Md., of the relationship between environmental factors and cancer. Public Health Service 99 GRANT-SUPPORTED RESEARCH A National Cancer Institute grantee reported that administration of large amounts of the compounds prednisone and prednisolone pro¬ duced complete or partial remissions in several patients with acute leukemia. The drugs are newly synthesized hormones closely related to cortisone, which is also useful in treating this disease. Promising results have been achieved in the treatment of tumor¬ bearing mice with a new anticancer drug, azauridine. The drug is chemically related to 6-azauracil, which has been used with encourag¬ ing results in the treatment of some cancer patients. The synthesis of azauridine was undertaken as part of a research plan to produce and study compounds that might interfere with the metabolism of tumor cells. The scientists reasoned that compounds that hinder the formation or utilization of uracil might prove useful as anticancer agents. This led to the synthesis and testing of 6-azauracil and later to the synthesis of azauridine. The results of studies in mice indicated that azauridine was significantly more effective than 6-azauracil in inhibiting the growth of transplanted mouse tumors. In another study the use of chemotherapeutic agents in tumor¬ bearing mice made X-ray therapy more effective. More tumors re¬ gressed completely in a group of mice receiving both drugs and radiation than in groups treated by either chemicals or X-rays alone. A study in animals showed that radioactive sulfur selectively damages cartilage cells. This indicates that radioactive sulfur may also be effective in the treatment of cartilaginous tumors in man. Institute of Dental Research The program of the National Institute of Dental Research is di¬ rected toward both the prevention and treatment of oral diseases. Thus, research is emphasized which increases basic knowledge of oral biological systems and their relationship to the whole body. The most important problem in studies of both calcified and soft tissues of the mouth is the magnitude and complexity of the oral microbial flora. Even under normal conditions, saliva contains no less than 500,000,000 microorganisms per cc. Upward of 50 species of organisms have been isolated in saliva to date. In recognition of the inestimable value of germ-free animals in oral bacteriologic studies, the National Institute of Dental Research under¬ took in 1958 to study the etiology and mechanism of caries, calculus formation, periodontal disease, and wound healing. Among pre¬ liminary findings is the confirmation that caries does not occur in germ-free animals. It may, however, be induced in rats infected orally with a single pure strain of certain streptococci organisms. The expansion of epidemiologic and biometric studies in 1958 to in¬ clude selected population groups in India and Alaska is contributing 100 Department of Health , Education , and Welfare, 1958 not only to a better understanding of oral disease patterns among these groups, but also to the further development of methods of assess¬ ing periodontal diseases. Parallelling this work is the continuing genetic study of a racially isolated group in Southern Maryland and a new survey of hereditary oral defects in some 5,000 offspring of first-cousin marriages in Hiroshima and Nagasaki, Japan. In the area of biochemistry, nutritional studies of oral disease are being continued. These suggest that certain proteins and mineral phosphates effect a marked reduction in dental caries. Other investi¬ gations in the biochemical field relate to a better understanding of the organic and inorganic composition of saliva, dentin, enamel, and other oral tissues. Pioneer work in the use of electron and X-ray microscopy in mor¬ phologic studies of heretofore unseen crystallites and the supporting organic framework of enamel and dentin is contributing new and significant knowledge. Other investigators are applying new histo- chemical methods in a study of protein and enzyme components of oral tissues. In the field of clinical research, more effective means are sought for minimizing the danger of bacteremias subsequent to oral surgery on heart patients. Still other areas of investigation include dental anesthesiology, oral and facial abnormalities, and periodontal disease. GRANTS AND AWARDS The Institute increased its support of dental research projects in institutions throughout the country. In the training area, the Na¬ tional Advisory Dental Kesearch Council granted approval for the establishment of a permanent Training Grant Committee to advise on needed expansion and programming to meet rapidly increasing needs for scientific manpower. Heart Institute Basic and clinical research was strengthened during 1958 both in the National Heart Institute’s laboratories and in those of institutions receiving grants. Training programs were enlarged to increase the supply of much-needed scientific manpower. Activities designed to assist in the application of rapidly developing knowledge from re¬ search progressed. Through these primary means, steady gains were made in the effort against diseases of the heart and blood vessels, which now claim more than 800,000 lives a year. Atherosclerosis, a disease in which fatty deposits on the walls of blood vessels can progressively restrict blood supply to vital centers, is a major cause of death in this country. When it affects the blood vessels supplying the heart, it leads to myocardial infarction, the common form of heart attack. The disease is associated with eleva- Public Health Service 101 tion of the concentrations of fats in the blood, a subject of intensive research at NHL Studies of the effects of adrenalin on fat metabolism have been undertaken, in view of the long-suspected relation between emotional factors and heart disease. Adrenalin, the hormone produced by the adrenal gland during emotional excitement or anger, has been shown to cause a marked increase in the cholesterol content of the blood. The mechanism by which this occurs is not yet clearly understood, but the implications with respect to heart disease may be important. An¬ other kind of adrenalin effect has been shown — namely, a stimulation of the release of fatty acids from depots of fat tissue. Taken to¬ gether, these findings indicate a central role for adrenalin in the con¬ trol of fat metabolism and blood-fat concentrations. It is now well established that the ingestion of large quantities of unsaturated fats can lower blood-fat concentrations quite signifi¬ cantly, but it is not yet known how this comes about. At the Clinical Center, patients with high blood-cholesterol levels are being treated with liquid formula diets containing large quantities of unsaturated fat, and their cholesterol metabolism is being studied with the aid of radioactive-tagged cholesterol molecules. It has been found, contrary to previous notions, that most of the cholesterol excreted is still in its original form and that only a small percentage has been converted to oxidized products (bile acids). In some patients, unsaturated fats increase the amount of cholesterol and of bile acids excreted. Further studies are in progress to clarify the mechanism involved in this prom¬ ising dietary approach to treatment of high blood-cholesterol levels. Another approach being explored is the use of inhibitory sub¬ stances that will decrease the rate at which the body manufactures cholesterol. A number of compounds have been shown effective in suppressing cholesterol production, and one of these, delta-4-choles- tenone, proved to have a very interesting side effect. Given in large doses, it suppressed the production of the adrenal hormones. It has been known for some time that cholesterol could be converted to adrenal steroid hormones. The present findings strongly suggest that cholesterol is necessary for their production. Fats in the diet are absorbed from the intestine and initially shunted to the blood stream in the form of large particles, the chylo¬ microns. Kecent studies demonstrate that the protein contained in chylomicrons is of three kinds, one of which appears to be identical with another protein associated with the fats that are always circu¬ lating in the blood. The finding may have significance in relation to the mechanisms by which the body clears the blood stream of newly absorbed fats. Further studies of the chylomicrons show that their removal is probably not piecemeal, but that the entire particle is 102 Department of Health , Education , and Welfare , 1958 removed as a unit and that the tissues responsible for the major uptake will vary with the nutritional state of the animal. The problem of high blood pressure is being approached in sev¬ eral ways. Substances that inhibit the enzyme monamine oxidase give promise of value in treatment of hypertension. A new diagnos¬ tic test of the efficacy of such compounds has been developed which can be safely used in patients. Availability of this test should permit effective screening of potential therapeutic agents. A protein present in human urine and possessing potent activity against high blood pressure has been considerably purified. This material has the capac¬ ity to break down other protein molecules. Since it is a naturally occuring compound, it may play a role in regulating blood pressure. When the heart fails, one of the major effects is an accumulation of water in the tissues. Evidence is strong that malfunction of the kidneys plays an important part in this process and that a number of hormones contribute to the over-all effects. In NHI studies of normal and abnormal kidney function pursued during the past year, an important new theory regarding the way in which the kidney controls its output of water has been developed. Also of importance was the finding that one of the classes of drugs used in the treatment of heart failure has, in addition to its direct effects on the heart, a direct effect on kidney function as well. The keystone to successful surgical repair of cardiac defects is accurate preoperative diagnosis. The past year has seen the develop¬ ment in the Heart Institute of several new procedures that give the surgeon an accurate indication of the location and size of cardiac defects prior to surgery. These include the application of a radio¬ active gas, krypton85, which the patient inhales for a brief period while blood samples are drawn from the circulation at several points. Nitrous oxide gas has been used in the same way. These procedures tell the surgeon how much blood is passing through an abnormal connection between the two sides of the heart so that the desirability of surgery can be evaluated. GRANT-SUPPORTED RESEARCH Efforts to unravel the interrelations of diet, hormones, and ather¬ osclerotic disease continued at many institutions. It is not yet estab¬ lished whether the tendency to atherosclerosis is attributable to an excess of total fat, too high a fat-protein ratio, an imbalance among chemicals in the body such as cholesterol-phospholipid-fatty- acid triglyceride, too much saturated fat, too little unsaturated fat, a lack of essential fatty acids, or some other dietary factor or deficiency. Use of the technique of gas-liquid chromatographic sep¬ aration of lipids to attack parts of the problem was extended and should lead to important new data. Public Health Service 103 Studies of the role of the endocrine system — particularly the thy¬ roid, the pituitary-adrenal axis, and the sex glands — in regulating lipid metabolism, were pursued. Trials of estrogens in patients with coronary artery disease gave promising results, and the search con¬ tinued for new estrogen-like substances that may be used without producing feminization in males or uterine bleeding in females. An important achievement in hypertension research was the syn¬ thesis of angiotensin, a natural blood-pressure raising substance. Availability of angiotensin has opened new approaches to the study of renal pressor mechanisms in high blood pressure. A new oral diuretic drug, chlorothiazide, has been found effective not only in edema but in high blood pressure. Combined use of this drug with other antihypertensive agents has reduced the blood pres¬ sure of some patients formerly refractory to treatment. Mental Health Institute Significant progress was made during the year in mental health research, training of needed personnel, and the development of mental health services. The ultimate goals of investigators in the mental health field are to discover and clarify the mechanisms of psychological development and to determine the origins of human behavior. Important work toward achieving these goals is being done by scientists and grantees of the National Institute of Mental Health. IVe have learned, for example, that there is no single inherited or environmental determi¬ nant of behavior or of psychological functioning, but that behavior results from the complex interplay of a great number of inherited, constitutional, and environmental forces. RESEARCH PROJECTS GRANTS The relations among all these forces may be clarified by an NIMH grantee who is studying “imprinting,” an extremely rapid form of learning that takes place for a brief period in the early life of many organisms. During this period, both the timing and effective¬ ness of the process can be altered by changing the environment of the animal — presenting physical or emotional obstacles, administering drugs, etc. Since human development may include stages analogous to the imprinting stage in lower animals, these studies may well clarify some of the effects of early childhood experience on learning and later social behavior. Another Institute-supported study is concerned with the effects on learning of pre- and postnatal X-irradiation. This study will permit better understanding of the physical and behavioral consequences of irradiation and more precise determination of the times of maximum vulnerability of the growing organism to X-rays. 104 Department of Health , Education, and Welfare, 1958 While behavior is profoundly affected by environmental condi¬ tions, it appears to have its physiological correlates as well. Pre¬ liminary results of one grant-supported study, for example, indicate that adaptive behavior in the rat can be correlated with the level of the enzyme cholinesterase in the animal’s nervous system. Other studies by NIMH investigators and grantees are concerned with the physiological and psychological roles of a variety of chemical agents in the body. It may well be that disturbances in the metabo¬ lism of epinephrine, serotonin, certain amino acids, carbohydrates, or other substances may be responsible for abnormalities in psychological functioning. Credence for this view is found in two recently analyzed forms of mental retardation rooted in abnormal biochemical activity in the body — phenylketonuria and galactosemia. DIRECT RESEARCH Recognition of abnormal functioning is dependent upon knowledge of the normal. A significant advance during the year was the dis¬ covery of an enzyme which is responsible for the normal metabolism of 70 percent of the epinephrine in the body of the rat. This discovery revealed a hitherto unknown pathway for the transformation of a variety of body metabolites, and will undoubtedly elucidate a number of still unknown biochemical processes. The study is part of a broad program of investigation of the biological aspects of schizophrenia, in which an effort is being made to distinguish between the physiologi¬ cal functioning of schizophrenic patients and normal controls and to contribute knowledge of the biochemical abnormalities, if any, which underlie the schizophrenic process. Differences in the reaction of the mentally ill and of normal people to various drugs are also being studied by Institute scientists. The re¬ sults may help clarify the mechanism of action of the tranquilizing and energizing drugs. The Institute’s Psychopharmacology Service Center is continuing to stimulate and support research concerned with the synthesis and evaluation of a wide range of psychoactive drugs. Other studies at the Addiction Research Center in Lexington, Ken¬ tucky, include evaluations of addicting drugs and attempts to find a nonaddicting analgesic. COMMUNITY SERVICES State activities in developing community mental health programs, stimulated by Federal grants-in-aid, have expanded considerably. A total of $54 million, an all-time high, was appropriated from all sources for these purposes during the past year. NIMH funds con¬ stituted only 7.4 percent of this sum. Four States — California, Min¬ nesota, New Jersey, and Vermont — enacted legislation providing for State grants-in-aid to localities for community mental health services. Public Health Service 105 In September 1957, funds became available, under the provisions of Title V of P. L. 911, for the support of demonstrations and studies designed to improve the care, treatment, and rehabilitation of the mentally ill. By the end of the fiscal year, 65 of these special projects had been approved and were under way. TRAINING AND BIOMETRICS A review and report of the Institute’s training program at the end of its first decade of operation, conducted at the request of Con¬ gress, revealed that mental health training has improved both in quantity and quality during this period and that the program is ac¬ complishing its objectives. One measure of this success is that more than 70 percent of former trainees and research fellows are now doing mental health work in public agencies or as researchers or teachers. In line with the Institute’s forecast that the immediate future need is for increased research training, two new types of doctoral-level training awards were developed for initiation as of July 1, 1958. One is for training research personnel in several areas of psychology. The other is to provide training of psychologists for research and service roles in mental health areas of acute personnel shortage, such as men¬ tal retardation, delinquency, geriatrics, and alcoholism. The collection and analysis of mental health data continue to broaden understanding of the epidemiology of mental diseases. Dur¬ ing the year the cooperative program undertaken with the States for collecting statistical data on mental hospital patients was strengthened. Two more States, Connecticut and Kentucky, joined the model report¬ ing area, bringing the total to 20 States. Institute of Neurological Diseases and Blindness Neurological and sensory disorders, as a group, are the main cause of permanent crippling in the United States. These disorders are the result of damage to the brain, spinal cord, and peripheral nerves, and thus affect the entire body. Collaborative efforts of many scientists have provided fresh leads to a number of these serious health problems. Although there is no known cure for multiple sclerosis, Institute scientists made a discovery this past year which may hasten its con¬ quest. Myelin is the fatty sheath insulating the nerve fiber tracts of the brain and spinal cord. In multiple sclerosis and related dis¬ orders, myelin deteriorates — demyelination — and fails to regenerate. An essential compound in the fats of myelin is sphingosine. Institute scientists have discovered the specific manner in which sphingosine is formed in the body, and have synthesized it in the laboratory. This new understanding of sphingosine may lead to additional knowledge 487270—59 - 8 106 Department of Health , Education , and Welfare , 1958 concerning the disappearance of myelin and the possible reversal of the process. Structural regeneration of central nervous tissue in animals is now known to be possible. The regeneration has been aided by cellulose acetate plastic shields, w'hich prevent the growth of scar tissue and permit a free exchange of nutrient materials. To date, however, there has been no significant functional restoration. Various recent basic research studies have developed new informa¬ tion concerning the cellular structure of the brain. It has been thought that the function of neuroglia, which make up 80 to 90 per¬ cent of the cells of the central nervous system, is primarily to support nerve cells and fibers and to repair damage following injury. Re¬ cent studies of neuroglia in tissue culture and under the electron microscope reveal that they play more than a supporting role. They may act as a filter or manufacturer of the fluids which nourish the nerve cells of the brain. Electrical activity of neuroglia has been recorded. They have been found to have synaptic relations with nerve cells and may respond to nerve impulses. Research also indi¬ cates that they play an important role in the formation and main¬ tenance of myelin. Among the most difficult blinding diseases to diagnose are those in the general category of retinal disorders. Through electroretino- graphic research techniques, Institute scientists developed new leads of diagnostic value which may help elucidate retinal mechanisms. Neuromuscular diseases, including muscular dystrophy and myas¬ thenia gravis, have presented many perplexing problems for medical research. Widely acclaimed both in this country and abroad is the Atlas of Muscle Pathology in Neuromuscular Diseases, prepared by Institute scientists. It is an aid to the diagnosis of these diseases and to basic investigation. GRANT-SUPPORTED RESEARCH Significant among the research accomplishments of grantees during 1958 is the collaborative investigation of brain damage during preg¬ nancy and early childhood, the completion of a classification of cere¬ brovascular diseases, and the coordination of international advances in the understanding of allergic encephalomyelitis and its possible relation to demyelinating disorders. Fifteen universities and hospitals are now collaborating with NINDB in an extensive investigation of adverse factors causing brain damage during pregnancy, at the time of birth, and in the early years of childhood. The groundwork has been laid for the study of 40,000 mothers and babies over a 5-year period, in order to increase the understanding of the nature and causes of cerebral palsy, mental retardation, epilepsy, and related neurological disorders. Public Health Service 107 For the first time, all known types of brain strokes have been de¬ fined and classified by a committee of leading neurologists and in¬ ternists, appointed by NINDB’s Advisory Committee. The comple¬ tion of this 2-year study provides a common language for the ex¬ change of information among researchers throughout the Nation and offers a useful tool to practicing physicians. A large mass of data on “allergic” encephalomyelitis has been de¬ veloped in recent years in the United States as well as in many other countries. In an attempt to assemble this material in a uniform manner and to evaluate new developments, a symposium of scientists from the United States, Canada, England, Germany, France, Italy, and Japan was sponsored by NINDB’s Advisory Council in the fall of 1957. Further work is necessary to determine the extent to which allergy is a factor in diseases of the nervous system. Among other efforts are studies to determine the sites of the earliest neurological damage in such conditions. Bureau of Medical Services The Bureau of Medical Services is responsible for the programs of the Public Health Service related to care and protection of the in¬ dividual. It operates hospitals and outpatient clinics; the foreign quarantine activities; the health program for American Indians and Alaska Natives; aids in construction of community hospitals and health facilities and in the development of the Nation’s dental and nursing resources. Research is carried on in hospital design and management, epidemi¬ ology and treatment of tuberculosis and other infectious diseases com¬ mon among American Indians and Alaska Natives, control of yellow fever and the mosquitoes that transmit it, measurement of dental malocclusion, and many phases of nursing practice. National, re¬ gional, and State studies are made of present and future supply and demand for dentists and nurses. The PHS hospitals conduct clinical investigations in the treatment of leprosy and of narcotic addiction, as well as in many aspects of modern medical practice. They are among the Nation’s primary resources for the training of physicians, nurses and other health personnel. Hospitals and Outpatient Facilities The Division of Hospitals operates the medical care program for legal beneficiaries of the Public Health Service. Besides American seamen, these patients include officers and enlisted men of the Coast Guard, officers and crew members of the Coast and Geodetic Survey, commissioned officers of the Public Health Service, civil service ern- 108 Department of Health, Education, and Welfare, 1958 ployees of the Federal Government injured in performing their work, active duty and retired members of the Uniformed Services and their dependents, and several other groups. In 1958, the Division maintained 16 hospitals, 26 outpatient clinics and 99 outpatient offices. Twelve of the hospitals provide general medical and surgical services, one is exclusively for patients with tuberculosis, two are for the treatment of narcotic addiction and other neuropsychiatric disorders and one provides care for persons with leprosy. The general hospitals are in major port cities — Boston, New York, Baltimore, New Orleans, Chicago, Detroit, San Francisco, and Seattle. In certain other places, depending upon the concentration of beneficiaries, outpatient clinics and outpatient offices have been established. Staffed by full-time personnel, the former provide com¬ prehensive medical, dental and allied health services. Local physi¬ cians conduct the outpatient offices in their private facilities on a part-time basis as needed. VOLUME OF SERVICES Inpatient admissions in all of the Public Health Service hospitals during 1958 totaled 49,501 — about the same as the previous year. The average daily census at 5,295 was decreased 1 percent. The number of outpatient visits increased to 1,098,278 — nearly 7 y2 percent. General hospitals. — The general hospitals admitted 44,410 patients in 1958 as compared with 44,584 in 1957. The average daily patient load remained substantially the same at 2,756. Days per admission at the general hospitals in 1958 averaged 22.7, as compared with 22.6 in 1957. Tuberculosis. — The Division’s tuberculosis hospital, the U. S. Pub¬ lic Health Service Hospital, Manhattan Beach, Brooklyn, New York, admitted 377 patients in 1958, a decrease of 11 percent. The average daily census dropped 8 percent, reflecting the current nation¬ wide trend in pulmonary tuberculosis management. All the accepted newer drugs in the treatment of pulmonary tuber¬ culosis are used at the hospital, and the staff keeps abreast of the status of experimental drugs and of therapeutic and surgical pro¬ cedures for diseases of the chest. The hospital maintains a modern pulmonary function laboratory for cardiopulmonary function studies and receives laboratory and consultant services from an outstanding community hospital. Leprosy.— The U. S. Public Health Service Hospital at Carville is the only hospital in the continental United States devoted exclu¬ sively to the treatment and rehabilitation of patients with leprosy. It is located on the eastern shore of the Mississippi — 75 miles north of New Orleans. Public Health Service 109 Anyone in the United States may be admitted as a patient in this hospital after the diagnosis of leprosy has been confirmed and he has signed a statement of willingness to be treated there. Services include complete medical, surgical and dental care as well as the specialized treatment to combat leprosy. Outstanding specialists from medical centers in New Orleans, notably those of Tulane Uni¬ versity and the University of Louisiana augment the resident staff. Besides its clinical services, the hospital offers a range of community activities with manifold opportunities to participate in religious, recreational and occupational endeavors. The sulfone drugs were first introduced at Carville in 1941. Most leprosy patients treated with these drugs experience improved gen¬ eral health. In many cases, disabling damage can be avoided if treatment is started when the disease is in its early stages. Admissions at Carville totaled 73 in 1958, compared with 61 the year before, while the average daily census decreased from 315 to 296. Narcotic addiction. — The U.S. Public Health Service hospitals at Lexington, Ky. and Fort Worth, Tex. are operated for the treatment of narcotic addicts as defined by Federal law. Mentally ill patients entitled to care as beneficiaries of the Federal Government are also admitted. In 1958, these hospitals admitted 4,641 patients, a 1 percent increase over 1957. Addict admissions were up 3 percent; prisoner and pro¬ bationer patients each by 5 percent; voluntary patients by 2 percent. The average daily census of addict patients declined 2 percent from 1,390 in 1957 to 1,367 in 1958. Voluntary patients account for the major portion — 87 percent — of the admissions, but for less than half — 42 percent — of the average daily census, reflecting the addicts’ weak¬ ened self control toward narcotics. MEDICARE The Dependents Medical Care Act, which became effective Decem¬ ber 7, 1956, authorized the Division’s hospitals and clinics to admit active duty and retired members of Federal uniformed services and their dependents and the dependents of deceased members of these services. Known as Medicare, this program resulted in increased utilization of Service facilities during the year. For example, admis¬ sions of uniformed service personnel and dependents in June 1958 totaled 1,126, a 12y2 percent increase over June 1957 ; the number of outpatient visits in June 1958 — 29,097 — was 18.9 percent greater. The June 1958 average daily census of 214 Department of Defense bene¬ ficiaries in PHS hospitals was 128 more than the PHS beneficiary load of 86 in Army, Navy, and Air Force hospitals. 110 Department of Health , Education, and Welfare, 1958 TRAINING More than 275 physicians, dentists, pharmacists and dietitians served internships and residencies at PHS hospitals. Ten of the hospitals had approval for the post-graduate training of physicians granted by the American Medical Association, Council on Medical Education and Hospitals. Eight hospitals were approved by the American Dental Association for dental internships. Dental resi¬ dency training programs in oral surgery and prosthodontia were being conducted at the Service hospitals at Staten Island and Seattle, respectively. Affiliations with colleges and technical schools afforded practical experience and hospital instruction to approximately 100 undergrad¬ uates in physical therapy, occupational therapy, vocational therapy, social service and medical technology. The hospital in Baltimore, Md, conducted an approved course for medical record librarians and the hospital at Staten Island, N.Y., provided the clinical nursing portion of the hospital corpsmen course given by the Coast Guard. Between 1947 and 1958, a total of 394 physicians completed ap¬ proved residencies in Division of Hospitals facilities. Throughout the history of the Service training and clinical experience gained in these hospitals have contributed importantly to many distinguished careers in health fields separate from direct care of patients. CLINICAL INVESTIGATIONS The hospital in New Orleans, in cooperation with Tulane Univer¬ sity, is conducting tests with various chemicals in the treatment of cancer by a closed perfusion method. The hospitals at Staten Island and Baltimore are conducting studies in cardiopulmonary hemo¬ dynamics. At the San Francisco hospital, research studies are being made on liver function and on the anatomy of the male breast. These are a few of the 39 research projects supported by the Divi¬ sion of Hospitals during the past year in 8 hospitals. At the hospital for leprosy, Carville, Louisiana, the Second Con¬ ference on Progress and Potentials in Leprosy Investigations was held in March 1958. More than 75 physicians and scientists were present to discuss furthering research in this disease. Basic research disciplines represented included anatomy, nutrition, bacteriology, pharmacology, virology and epidemiology. FEDERAL EMPLOYEE HEALTH SERVICES The Public Health Service helps Federal agencies to establish and maintain health services for Federal employees. Twenty-five health units in various Federal agencies are staffed and supervised by the Federal Employee Health Branch of the Division of Hospitals on a reimbursable contract basis. In fiscal year 1958, health services were Public Health Service 111 provided for about 46,500 Federal employees in the Washington, D.C., Denver, New York, and Boston areas through these units. The Department of Health, Education, and Welfare and several other Federal agencies last year inaugurated, through these units, health maintenance programs for key personnel. The programs in¬ clude physical examinations and complete medical history, plus all necessary routine laboratory procedures. FREEDMEN’S HOSPITAL There was a record total of 3,227 births, without a single maternal death, during the fiscal year 1958 at Freedmen’s Hospital. There were 14,083 inpatients admitted, an increase over the 13,7 15 reported for 1957. The daily average census remained unchanged at 361. Freedmen’s Hospital is a general medical and surgical hospital with facilities for treating chronic chest diseases. It also provides clinical instruction and experience for students of Howard Univer¬ sity, College of Medicine, and conducts approved teaching programs in nursing, dietetics, medical technology, pharmacy, social service, and hospital administration. The Hospital has a capacity of 320 general medical and surgical beds, 50 bassinets and 150 beds in a sep¬ arate annex for chronic chest diseases. Due to budget restrictions only 52 of the latter beds were in use at the year end. The outpatient service, consisting of 34 organized clinics and the emergency room, received 95,213 visits, compared with 91,022 in 1957. Approximately 38 clinical research projects were under study dur¬ ing the year, notably a series on various aspects of sickle cell anemia. Graduate medical and dental training was provided for 47 medical residents, 13 medical interns, 9 medical externs, 2 dental interns, and 8 clinical research fellows. The hospital serves also as a training facility for junior and senior medical students. The School of Nurs¬ ing had an enrollment of 114 students, 56 in the graduating class. Ten dietitians completed the internship offered by the hospital and approved by the American Dietetic Association. The Hospital continued its cooperation with the teaching program leading to a master’s degree in hospital administration, offering a L-year residency in this specialty. Conducted on a preoeptorship basis, this program meets standards acceptable to the American Hos¬ pital Association, the American College of Hospital Administrators, and the Association of University Programs in Hospital Adminis¬ tration. Two pharmacy graduates successfully completed internships during the year and one student from Howard University School of Social Work was accepted for field work training in medical social work. 112 Department of Health , Education, and Welfare, 1958 Foreign Quarantine No quarantinable diseases were introduced into the United States through international traffic this year. Yet, the tremendous increase in such traffic has created health threats to this country. In today’s world, time and distance, which formerly served as a protective barrier for the United States, have been greatly compressed. Thus, protecting the Nation against the importation of diseases remains a major re¬ sponsibility of the Public Health Service. Smallpox and yellow fever continued to occur along routes of international traffic to such an extent as to constitute serious threats to this country throughout the year. The requirement of smallpox vaccination for persons coming from abroad, citizens and aliens alike, is a major measure in protection of the United States against this disease of worldwide prevalence. For the fifth consecutive year the Nation was free from smallpox. The northward march of yellow fever through the jungles to the northern border of Guatemala necessitated further strengthening of measures to protect this country against the disease. The entomol- ogy program of the Division of Foreign Quarantine was developed further to carry on more intensive yellow fever mosquito survey and control activities in airports and dock areas in the yellow fever re¬ ceptive area of the United States around the Gulf of Mexico. The yellow fever mosquito, Aedes aegypti , was detected in a number of areas, from Florida to Texas. Plague, typhus, and louse-borne relapsing fever occurred only in localized areas of the world where they are traditionally endemic. Cholera occurred in rather explosive epidemics in the Orient, but did not invade Western Europe, the Pacific Ocean area, or the Americas. INTERNATIONAL TRAFFIC VOLUME Airplanes inspected for quarantine or immigration-medical pur¬ poses again showed a significant increase, from 61,892 in 1957 to 68,703 this year. The number of ships inspected remained nearly the same, 34,120 this year compared with 34,779 last year. Arriving persons subject to foreign quarantine regulations from overseas and interior Mexico increased from 5,061,621 to 5,217,627. Smallpox vaccinations by quarantine officers decreased from 541,891 to 418,292. The number of persons released subject to further medical examina¬ tion at destination increased from 23,173 to 58,083 ; persons detained in isolation at ports increased from 37 to 124. Pursuant to Public Law 85-58 of June 21, 1957, a total of 8,305 ship quarantine inspections were provided on overtime. To avoid costly delays to international commerce this law provides for inspec¬ tions to be made outside regular hours, with expenses paid in most Public Health Service 113 cases by transportation companies requesting the special service. Aircraft inspections on overtime numbered 5,140. MEDICAL EXAMINATIONS General program. — The number of aliens examined abroad by Public Plealtli Service officers decreased from 206,754 in 1957 to 190,526 this year; most of these were prospective immigrants. Those examined in this country increased from 2,598,741 to 2,870,292 ; these were chiefly crew members of ships and planes and temporary visi¬ tors. (Figures for this year include 3,474 refugees abroad and 4,835 in this country. In 1957 refugees came under special programs, and are not included here.) Among the persons examined abroad and in the United States, 5,403 were found to have diseases exclud¬ able under the immigration law. The categories were as follows: mental diseases and defects 302 cases abroad, 161 in this country; tuberculosis 2,977 abroad, 1,515 in this country (see following sec¬ tion) ; dangerous contagious diseases 108 abroad, 340 in this country; other physical conditions that may have caused exclusion or required the posting of a bond 16,725 abroad, 16,941 in this country. Immigration of certain aliens with tuberculosis. — Under a provi¬ sion of Public Law 85-316 effective till June 30, 1959, the exclusion provisions of the Immigration and Nationality Act are modified to permit an immediate family member of an American citizen or of a resident alien to immigrate to this country although afflicted with tuberculosis. The public health is protected through immigration regulations, prepared on the advice of the Division in consultation with the Tuberculosis Program, requiring these aliens to go promptly to a hospital for examination. The New York Quarantine Station checks on compliance and receives a medical evaluation, necessary X-ray films, and a report of final disposal of each case. A specified health officer or physician of a recognized tuberculosis hospital is responsible for supplying necessary care, in conformity with accepted local standards of medical practice. During the year 576 aliens with confirmed or suspected tubercu¬ losis were examined abroad by the Division of Foreign Quarantine under these provisions, and 455 at United States ports. (Aliens certified under these provisions are included in figures for “exclud¬ able” diseases in preceding section.) Farm placement. — In the seventh year of the farm placement pro¬ gram of recruiting agricultural workers from Mexico, 406,353 labor¬ ers were examined, with 11,634 rejections, at 3 migratory centers in Mexico; 424,477 examinations were made, with 4,886 rejections, at 5 reception centers in California, Arizona, and Texas. Plans were completed to conduct routine serologic testing for syphilis at the reception centers. This was made feasible by a new 114 Department of Health , Education , and Welfare, 1958 rapid plasma reagin test developed by the Communicable Disease Center, that permits a report of results within minutes. Trial of this test at the El Centro, California, reception center indicated that its general application to Mexican laborers would reveal a significant amount of syphilis which would be missed by physical inspection. OTHER QUARANTINE ACTIVITIES Foreign Quarantine Regulations were amended to strengthen and modernize provisions on yellow fever prevention, control of insects on ships and aircraft, and importation of dogs, cats, and monkeys. The changes recognize yellow fever provisions in amendments to International Sanitary Regulations issued by the World Health Organization and the longer effective periods of recently developed rabies vaccines for dogs. Entomological investigations on the Mexican border, in connection with medical examination of imported farm laborers, revealed fur¬ ther and conclusive evidence of resistance of body lice to certain insecticides. Plans were made to study this important resistance problem in more detail to determine its actual nature and extent and to search for more effective control measures. A revision of “Sanitary Measures for Travel of Aliens with Tuber¬ culosis” was published, chiefly to simplify and improve procedures for preventing the spread of infection. The measures apply to travel of aliens admitted to the United States as immigrants under special legislation or as nonimmigrants for treatment. Changes included clear-cut classification of cases as communicable or noncommunicable and provisions to help airlines avoid accepting passengers with tuberculosis in communicable form. Health Services for Indians More health services than ever before were made available during 1958 to the Indians and Alaska Natives through the Federal Govern¬ ment’s Indian health program. A new record was established in the numbers of persons served despite the fact that costs were held essen¬ tially to the 1957 level of expenditure during the third year of the program’s operation by the Public Health Service. Hospital admissions increased for the third successive year to a total of 71,000, including 15,000 in contract facilities. This increase oc¬ curred in spite of a dramatic reduction in tuberculosis morbidity and in spite of the fact that fewer tuberculosis patients required bed care in hospitals. The greater number of hospital admissions is attribut¬ able to increased care provided general patients. It also reflects a growing demand by beneficiaries for more medical services. This heavy hospital load points up the need for intensive efforts to reduce the increasing need for hospital care at the source by effective Public Health Service 115 disease prevention. The excessive tolls which preventable diseases still take in human life among Indians and Alaska Natives make it clear that prevention is the key to the greatest improvements attainable in their levels of health. Prevention of disease and health promotion received greater empha¬ sis during 1958. In extending preventive activities on reservations and in Indian communities, the field sanitation personnel alone made nearly 40,000 visits to Indian homes and institutions. Public health nurses intensified their efforts in Indian homes and communities. The Public Health Service operates 55 hospitals and provides serv¬ ices at more than 270 non-Federal hospitals on a reimbursable basis or through contracts. Preventive health services as well as thera¬ peutic care for ambulatory patients are provided by the Public Health Service at health centers, dispensaries in Indian boarding schools, field health stations, hospital outpatient clinics, and other locations totaling about 300. Approximately 160 private physicians and dentists, and 30 agencies of State health departments also provide services to Indians and Alaska Natives under contractual arrangements with the Public Health Service. The beneficiaries of the Indian health program number about 347,500 Indians (excluding those in Alaska) and about 37,500 Alaska Natives (including Indians, Aleuts, and Eskimos) , or a total of 385,000. Most of the Indians live in 24 States, and are scattered over about 250 reser¬ vations. These populations depend primarily upon the Public Health Service not only for the preventive services commonly provided by local health departments but also for a full range of medical, nursing, and dental care. The health problems of the Indians and Alaska Natives and the difficulties in reaching them with health services are unique. Nearly a fifth of all deaths among these groups result from infectious diseases which long have been under control in the general population. Their deaths from such preventable diseases as tuberculosis, gastroenteritis, influenza, and pneumonia are 3 to 6 times higher than in the population as a whole. Life expectancy among Indians and Alaska Natives is 10 years shorter than the 70-year life span which prevails generally. Whereas the average age at time of death in the general population is 62, among the Indians it is only 40. This early average age at death results largely from the excessive infant death rate among Indians. Twenty-two percent of all Indian deaths occur among in¬ fants, compared with a national average of only 7 percent. THERAPEUTIC SERVICES The 71,000 hospital admissions in 1958 represent an increase of 6 percent over last year. Reflecting successes in combating tuberculosis, the average daily census in Indian hospitals (not including contract 116 Department of Health , Education , and Welfare , 1958 facilities) decreased slightly to 2,600. The census of general pa¬ tients increased by 2.4 percent during the year. Visits for treatment and preventive services provided by hospital clinic staffs totaled nearly 575,000. Reflecting improvements in the operation of Indian hospitals, one additional hospital was accredited, bringing the total to 12 out of 55 now in operation. One small hospital at Cloquet, Minn., was closed and its services replaced by a modern community hospital which has a contract with the Public Health Service. Pharmacies were established in four additional hospitals. This expansion provides services for an additional 164 hospital patients and 38,000 outpatients. There now are 20 hospitals in the program which have pharmacies. Smaller facilities are provided with phar¬ macy services from central pharmacies. Prescriptions filled during the year totaled 255,000 for 249,000 outpatients. Both qualitative and quantitative improvements were made in treatment services rendered outside hospitals. Eleven Public Health Service physicians were added to provide such treatment, bringing the number serving at field health installations to 54 out of a total of 230. Use of contract physicians and dentists was increased, per¬ mitting more beneficiaries to receive services nearer to their homes. Total expenditures for contract care, both in hospitals and by private practitioners outside hospitals, amounted to $7,679,000. PREVENTIVE HEALTH SERVICES Qualitative improvement in public health nursing and health edu¬ cation services was achieved by means of increased staff training and professional development through institutes, scholarships, and accelerated training on the job. An audiovisual service was estab¬ lished in the field to develop health education materials for specific tribal groups. For the first time, it was possible to provide limited psychiatric services for disturbed school children. In response to the need to improve nutritional health among Indians, organized nutrition services were expanded to 2 of the pro¬ gram’s 7 geographic areas. Nutrition and dietetic services, still new to the Indian health program, now are available to 7.3 percent of the beneficiaries. A prime factor in the excessive incidence of enteric and other in¬ fectious diseases among Indians and Alaska Natives is the gross in¬ sanitary environment prevailing on reservations and in communities where the beneficiaries live. Use of polluted water hauled from remote sources, contamination of food, insect and rodent infestations, and dangerously overcrowded and inadequate housing are common among these peoples. Environmental sanitation activities of the Indian health program are designed to correct these conditions and practices. Public Health Service 117 The addition of 19 sanitarian aides, most of whom are Indians trained by the Service to work under the direction of sanitary engineers, per¬ mitted some expansion of sanitation services during the year. Sanitation surveys were completed for 4,000 water sources, nearly 20,000 waste disposal facilities, 192 Indian schools, and various other facilities. Technical assistance provided for the beneficiaries made it possible for them to improve or build at their own expense hundreds of safe water sources, nearly 1,000 sanitary privies, and nearly 3,000 refuse disposal facilities. However, the sanitary deficiencies on reser¬ vations and in native communities in Alaska are far too great to be overcome by the beneficiaries with their own limited resources. Under the terms of Public Law 85-137, enacted in August 1957, the Public Health Service built sewer and water facilities to serve the Indian colony at Elko, Nev. This project, carried out in cooperation with the Indians concerned and the city of Elko, was completed in February 1958 and turned over to the city government for continued operation and maintenance. TUBERCULOSIS CONTROL Between July 1955 and the end of the 1958 fiscal year, new tubercu¬ losis cases dropped 25 percent. The tuberculosis death rate among beneficiaries outside Alaska also declined 25 percent. Among Alaska Natives, the tuberculosis death rate dropped 57 percent. In spite of these spectacular gains in a relatively short space of time, the tubercu¬ losis death rate among Indians outside Alaska is still 4.4 times greater than the rate of 8.4 deaths per 100,000 annually among the Nation’s population as a whole. Among Alaska Natives, the tuberculosis death rate is more than 10 times this national average. In contrast with the situation 3 years ago, when there was a waiting list of tuberculosis patients who could not receive needed hospital care because of limitations in the Indian health program, there now is actually a small surplus of beds for such patients. Some hospital beds formerly required for tuberculosis patients now are being con¬ verted for general patients. It also has been possible to terminate some contracts with non-Federal sanatoria because of the elimination of the backlog of cases in need of hospital care and the reduction in the incidence of the disease in beneficiary populations. Continued progress in controlling tuberculosis will depend largely upon the adequacy of case finding, epidemiological investigations, and supervision of the increasing number of ambulatory patients receiving outpatient treatment with modern drugs. To facilitate case finding and followup of patients, an improved tuberculosis record system was extended to several additional field health installations. 118 Department of Health , Education , and Welfare , 1958 ORAL HEALTH SERVICES Clinical observations of oral health conditions among Indians and Alaska Natives indicate that the vast majority is in need of dental care. Defects ranged from rampant tooth decay to gross periodontal dis¬ ease. The 73,000 patients examined during the year required nearly 270,000 restorations, 114,000 extractions, and 24,000 prosthetic appliances. Visits to Indian health dental clinics increased by 18,500 and indi¬ vidual treatments increased by 33,000 over 1957. Contract dental care services were begun during the year to reach beneficiaries who had received little or no dental services in the past. Despite these gains, less than one-fifth of the beneficiary population received dental care during the year, and even the patients who were treated required 307,000 more individual treatments than could be provided. Because of the inability to provide dental care for all who need it, services are available primarily to school children. SERVICES TO MOTHERS AND CHILDREN Services to mothers and children, including prenatal care and well- baby supervision, were increased substantially. Nearly 18,000 prenatal examinations were given in 1958, compared with 13,000 in 1957. At the 16 school health centers outside of Alaska, visits to physicians in¬ creased 31 percent and visits to nurses increased 7 percent. During 1957, examinations in the field disclosed that trachoma, a virulent eye disease, was recurring among Indians in the Northwest and the Southwest. Inasmuch as this disease is relatively rare in the general population, very little in the way of professional literature was available for guidance of physicians who must diagnose and treat the condition among Indians. Accordingly, the Public Health Service commissioned its consultant in ophthalmology, a leading authority on trachoma, to write a medical text to meet this urgent need — the Trachoma Manual and Atlas . This text has also been made available for use in other parts of the world where trachoma is a serious health problem. Trachoma among Indians is being brought under control. The excessively high death rate among Indian children remains one of the most serious problems facing the Service’s Division of Indian Health. Of every 1,000 Indian infants born alive in 1956 — the latest year for which figures are available — 56 died within the first year. In the general population, only 26 out of each 1,000 infants born alive fail to survive beyond the first year. Encouraging progress is being made in reducing the Indian infant death rate. This death rate has dropped 15 percent since the Public Health Service assumed its present responsibilities for Indian health. Public Health Service 119 TRAINING OF INDIANS Approximately 100 Indians and Alaska Natives received training in health occupations during 1958 through the Division of Indian Health. Slightly more than half of these are practical nurses who were trained in the two accredited schools which the Service operates to provide practical nurses in its Indian hospitals. Others who received training to qualify them for employment in the Indian health program included sanitarian aides and dental as¬ sistants. In-service training also is provided for personnel in each of these categories, and for community workers (health) who are trained on the job under contract by faculties from the Schools of Public Health of the Universities of California and North Carolina. More than half of the employees of the Division of Indian Health are of Indian descent. CONSTRUCTION The Congress has authorized construction of 4 new hospitals, 15 field health facilities, and more than 70 new staff quarters. The new hospital at Shiprock, N. Mex., now is under construction, and those at Gallup, N. Mex., and Kotzebue, Alaska, will be under way in fiscal year 1959. Planning for the new hospital at Sells, Ariz., will be completed in 1959. All 15 of the new field health facilities are under construction, and 48 of the new housing units have been started. Five old hospitals are to be remodeled, and extensive repairs are being carried out on a number of other hospitals and health facilities. Procedures for participation by the Public Health Service in the construction of community hospitals to be used jointly by Indian beneficiaries and non-Indians were developed and approved. Such projects are to be carried out under the terms of Public Law 85-151, approved in August 1957. Health Facilities Construction Program Since the beginning of the hospital construction program in 1948, substantial gains have been made in meeting the need for general hospitals, and some gain in facilities for mental and chronic disease care. During the past decade new construction has been offset materially by increases in population, by obsolescence, and by the abandonment of old facilities as new facilities are constructed. Amendments to the original legislation have expanded the program until now nearly all types of facilities are eligible for aid, except offices of physicians and dentists. A program of research is helping to develop the most effective use of hospital facilities, services and resources. 120 Department of Health, Education, and Welfare, 1958 CHANGING NEEDS AND EMPHASIS Seventy-five percent of the need for general hospitals has now been met, according to inventories and statewide programs furnished by the States, as compared with 59 percent in 1948. Mental hospitals have fewer beds today in proportion to requirements than was reported in 1948 — 53 percent as compared with 55 percent. Tuberculosis fa¬ cilities are decreasing in number and capacity because of declining in¬ cidence of new cases. The Nation now has 70 percent of its total tuberculosis hospital need. Chronic care hospitals now provide only 14 percent of the beds needed for such care. The State plans on record January 1, 1958, show a remaining need of 888,000 additional beds for all types of hospitals. Besides this, 323,000 additional nursing home beds are needed for skilled nursing care, or three- fourths of the total requirements in this field. In 1958 the record shows a continued trend toward providing fa¬ cilities for long-term care, within the program of federally aided con¬ struction. This trend is evident in national totals, but it is most pronounced in the States which now have the largest proportion of need met for general hospitals. The top 13 States in this respect (first quartile) in 1958 assigned to general hospitals 44 percent of the new hospital bed program which received Federal aid and assigned 39 percent to chronic care hospitals and nursing homes. These States each have more than 80 percent of general hospital needs available. RESEARCH IN HOSPITAL MANAGEMENT Hospital research is also receiving added attention through in¬ creasing requests for grants available to universities, hospitals, and State and local governments. Direct intramural research is also conducted under this program. The statutory ceiling on research funds is $1,200,000 annually. As an example of intramural research, the better organization of hospital services around the medical and nursing needs of the patient was studied intensively by the Public Health Service in 1958. A pattern of services is being evolved which is known as “progressive patient care.” This pattern makes possible a high level of service, with the best use of medical and nursing personnel and a type of facility most suited to the patient’s need. It includes intensive care for critically ill patients, intermediate care for those requiring moder¬ ate amount of service, self care in a hotel type of setting for ambula¬ tory patients, and long-term care in a homelike atmosphere with a periodic evaluation of patient progress and with rehabilitation. These types of hospital care are supplemented by home care under medical direction, with opportunity for preventive services. Specific studies in this field are in progress at the Manchester Memorial Hospital, Manchester, Conn. Public Health Service 121 SCALE OF OPERATIONS The annual amount of Federal construction grants has varied, since the initial appropriation in 1948, from $65 million to $150 million. The 11 -year average, 1948-58, is $96 million annually. The total cost of projects assisted has averaged about three times the Federal contribution. The current active program on June 30, 1958, includes 1,330 projects in the construction or preliminary planning stages. These projects will provide 53,362 beds for inpatient care and 418 health units for outpatient care. Such units include public health centers, State health laboratories, diagnostic and treatment centers and rehabilitation facilities. The estimated cost of this active program is $1,323 million. This level of activity is higher than in any previous year. Likewise, the national volume of all new construction started, for health facil¬ ities, is rising and has nearly reached the postwar peak attained in 1951. The volume of all work placed in the fiscal year 1958 amounts to $921 million, a 25-percent increase over 1957. The volume of federally aided work placed in 1958 is $320 million, as compared with $170 million in 1957. LEGISLATION New legislation enacted in 1958 includes an amendment to Title VI of the Public Health Service Act, making available loans for hospital construction, in lieu of grants, from the funds appropriated for grants. Also, the statutory term of the F ederal program for hospital construction aid was extended for a period of 5 years after the fiscal year 1959, by a measure signed by the President August 14, 1958. Dental Resources Activities of the Division of Dental Resources are directed toward the goal of more and better dental care for a larger, more health- conscious population, in the face of an increasingly serious shortage of dentists. The Division has pioneered studies in long-range manpower requirements, educational experiments to help in training dentists to work with chairside assistants, and analyses of prepaid dental-care plans and their effect on demands for service. The Division also conducts technical research in malocclusion. An epidemiological measure of this condition developed by the Division was tested successfully in five field studies. The purpose is to devise a reliable method of assessing prevalence and incidence of malocculu- sion, so that preventive programs can be developed. SERIOUS MANPOWER SHORTAGE Because of inadequate dental school facilities, the Nation is not graduating enough dentists to pace population growth. This, plus 487270—59 - 9 122 Department of Health , Education , and Welfare , 1958 increased demands for service, is producing a critical manpower shortage. To determine how many more schools are needed, and where, the Division added a survey of New England to its series of regional manpower studies and began another for the Great Lakes States. The New England survey, prepared at the request of the New England Board of Higher Education, indicated that the most serious shortages in the region are developing in Connecticut and Massa¬ chusetts. Previous studies of the Southern and Western States, where shortages also exist, are being used as guides in expansion of training facilities. Other Division activities were designed to insure effective utiliza¬ tion of available manpower. Although chairside assistants enable a dentist to treat more patients, they are not universally employed be¬ cause most dentists were not taught to use them. In a project begun in 1957, six dental schools are cooperating with the Division in developing ways of training undergraduates to work effectively with assistants ; definite improvement has been shown both in quality and quantity of work of students using assistants. Other findings are expected to affect length and type of schooling given chairside as¬ sistants, timing of clinical and research training in dental schools, and contemplated modernization of undergraduate curriculum. STUDIES OF PREPAYMENT PLANS One of the most potentially important developments in dentistry is the current growth in number and size of prepaid dental care plans. Cost is generally considered the greatest single deterrent to purchase of dental care. Prepaid plans, which provide services at a planned expense to the member, may therefore make comprehensive care pos¬ sible for millions who have never had it. The Division conducted research in all phases of dental prepay¬ ment. Two reports, one of a study of the organization and operation of the nonprofit Washington State Dental Service Corporation and the other a digest of all known prepaid dental-care plans in the United States, were published. A third, a glossary of terms used in prepayment literature, was begun. Other studies undertaken were an analysis of patient utilization of the Nevada State Dental Society’s postpayment plan (in which dental care is financed through short¬ term loans) and a description of the operation of a dental care plan for public assistance beneficiaries in the State of Washington. Nearing completion were two studies that will show the variations in utilization patterns among different population groups. The first is a study of treatment sought by a group of persons of relatively low income served by the St. Louis Labor Health Institute. The second covers the use of clinic services by Public Health Service and Coast Guard beneficiaries. Public Health Service 123 Nursing Resources In Autumn, 1957, a group of nurse educators met at the University of Colorado to discuss how to interest graduate nursing students in nursing research. Early in 1958, nurse leaders and social scientists met at the University of California to find ways of directing more nursing research toward patient care, ways to improve family health. Later in the year, in Seattle, the Western Institutions for Higher Education in Nursing held a conference for the exchange of informa¬ tion on research projects in nursing. Another conference was planned in mid-summer to evaluate what has been accomplished in nursing research, and what still needs to be done. All of these conferences were sponsored and supported by the Division of Nursing Resources. The ground is slowly, surely and carefully being prepared for the growth and development of strongly patient-centered studies which may explain some of the mystifying and perplexing anomalies in nursing: Why is there not enough nursing when there are more nurses than ever ? What is nursing ? Who should nurse the patient ? What are we educating nurses to do ? Improving the supply of nursing which reaches patients, through study and application of knowledge, is one of the major responsibili¬ ties of the Division of Nursing Resources. This year, most of its efforts were applied to stimulating investigation of basic nursing problems affecting care of patients, conducting an intramural re¬ search program, and offering consultation to hospitals, States, and others serving community health needs. The chief of the Division conducted the first Inter- American Con¬ ference (Brazil) on improving nursing resources through studies of supply and demand based on techniques developed by the Division of Nursing Resources for use in the United States. NURSING AND PATIENT WELFARE Premature infants have been the object of considerable study, but now for the first time their behavior is being observed in an effort to establish some fundamental facts about the impact of nursing care on patient response to treatment. At Bellevue Hospital, New York, the Division is observing 100 premature infants to see what differences occur in weight gain, feeding ability, and infant behavior of babies receiving routine care compared to a study group for whom one simple additional nursing procedure has been added — an “artificial” back support. Infants in a control group, and infants with the supports, are being observed 42 days each. Premature infants, more than all other patients, are free to respond to stimuli without undue influence of remembered experiences. If the infants with the supports differ from 124 Department of Health, Education, and Welfare, 1958 the control group in weight gain, fretfulness, crying, or vomiting, the study may be able to establish a significant relationship between a specific nursing procedure and survival, or rate of growth. In any case, tools to further test such relationships will have been developed. A concurrent result of the study will be a wealth of new information on premature infant behavior for nurses, pediatricians, and psychologists. DO NURSES “KNOW” THEIR PATIENTS? The kind of care a nurse provides may be influenced by her ca¬ pacity to know and to understand her patients — and, from this un¬ derstanding, to perceive their emotional as well as physiological needs. Although empathy may not be a hard and fast requirement in nursing care, recognition of needs unquestionably is. For the past 2 years, the Division has been investigating student- nurse perception ability in 9 hospitals and 7 schools of nursing. Al¬ most 400 students were interviewed to find out whether their own views differed from those of the patients. Preliminary findings indicate that (1) students believe that they do not have adequate chance to know patients; (2) students often misjudge the importance of certain items which are important to patients; (3) students may “know best” the patients who present the fewest nursing problems; (4) patients are well aware that the nurse is “busy ;” they also have had impressed on them, they say, that their needs “are not to interfere with the nurses’ schedules and hospital routines.” While these findings are by no means conclusive, they suggest that the completed study may explain why many patients believe there are too few nurses. Quite possibly the results may also suggest that nurs¬ ing education could profit by some changes in the curriculum of the undergraduate program. These changes would be in the direction of helping faculties to recognize that nursing service practice in¬ fluences student nurse behavior more than theory. PROFESSIONAL NURSE TRAINEESHIPS During fiscal year 1958, $3 million was awarded to colleges and universities for grants to qualified registered nurses desiring advanced preparation in administration, supervision, and teaching. This pro¬ gram enabled 1130 registered nurses to enroll in 60 degree granting institutions. About half of these nurses had not previously been able to enroll in graduate programs in these specialties ; the remainder had been enrolled only part-time or intermittently. Purpose of the professional nurse traineeship program is to in¬ crease the pace at which professional nurses may be prepared for lead¬ ership positions in hospitals, community health programs, and in Public Health Service 125 schools of nursing. Good patient care, it was felt, depends upon not only the judgment and skill of the nurse at the bedside but also upon the assignment of nursing personnel according to the individual re¬ quirements of patients of all kinds. The quality of the “product” of the undergraduate nursing schools is determined largely by the prepa¬ ration of nurse faculties. Similarly, the correct assignment of person¬ nel assumes knowledge of management and personnel practices in re¬ lation to the needs of the sick. Advanced preparation in the special¬ ties of administration, supervision, and teaching, therefore, seems to offer the most economical and rapid approach to the improvement of nursing services. RESEARCH GRANTS AND FELLOWSHIPS The Division of Nursing Resources also administers a program of research grants and awards in the field of nursing. In 1958, 30 nurs¬ ing research grants were awarded under an appropriation of $725,000. Most of the grants were for investigations of nursing care of patients. Also studied were recruiting practices, attrition rates in nursing schools, and screening and selection of students. All projects include nurses as investigators or consultants; more and more are attracting social and behavioral scientists as members of the research team. The fellowship awards offer nurses the opportunity to prepare them¬ selves for research careers. During the year, 25 full-time fellowships, amounting to $71,400, were awarded; 47 units ($30,450) were also made available for part-time study. Medical Services for Federal Agencies The medical care programs of the Federal prisons, the Coast Guard, the Maritime Administration, and the Bureau of Employees’ Compen¬ sation were carried on by Public Health Service officers who are as¬ signed to these agencies on a reimbursable basis. UNITED STATES COAST GUARD, TREASURY DEPARTMENT Medical services were provided the Coast Guard’s ocean weather stations in the Atlantic and Pacific, the ships going to the Arctic and Antarctic, the Voice of America ship Courier , and other cruise vessels as needed. Both a doctor and a dentist went on the Bering Sea Patrol, often working as long as 16 hours a day. At the 26 Alaskan villages the ship visited, they examined Alaska Natives in family groups at health clinics in the school house. All the children were given eye, nose, throat, and chest examinations. A record number of 56 patients received medical treatment in one single day. During the entire patrol, the medical officer examined 3,741 persons, gave 1,027 X-rays, and treated 816 patients. 126 Department of Health, Education, and Welfare, 1958 The dental officer examined 976 patients and gave 2,856 treatments including 926 extractions, 23 restorations, and 49 X-rays. More than 800 of the patients received anesthesia. In all, 92 officers of the Public Health Service were on duty with the Coast Guard, including 32 physicians, 46 dentists, and 11 nurses. MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE Medical and dental care for the 720 cadet midshipmen and the 275 faculty and staff members of the U. S. Merchant Marine Academy, Kings Point, X. Y., was provided by the Public Health Service officers assigned to the Maritime Administration. There were 803 admissions to the academy’s Patten Hospital, or an average of 73 for each month of the school year. Outpatient treat¬ ments and services, including physical examinations and inoculations of cadets going on sea cruises, totaled 27,822. More than 11,000 dental treatments also were given. At Washington headquarters, the physician serving as chief medical officer of the Maritime Administration gave professional counsel to the Office of Seamen’s Services and the legal insurance department. BUREAU OF PRISONS, DEPARTMENT OF JUSTICE The Public Health Service continued to provide medical care to prisoners in the 30 institutions of the Federal prison system. The prison hospitals provided 431,353 hospital days of care, and their staffs performed 974 major and 5,674 minor operations. Outpatient departments gave 785,368 treatments and 30,989 physical examina¬ tions. Thirty babies were born and 43 prisoners died. Medical research was carried on in several institutions. A study of effects of d-lysergic acid was continued at the penitentiary in Atlanta, Ga., under guidance of Emory University staff members, and a project concerned with storage and excretion rates of DDT in human volun¬ teers went into its third year in Atlanta. A survey of incidence of histoplasmosis among prisoner patients at the Medical Center, Spring- field, Mo., was made; 39 percent of the patients were negative to his- toplasmin. Research at the National Training School for Boys, Washington, D. C. concerning the development of delinquent gangs was completed, in cooperation with the Catholic University. Prisoners in 22 institutions donated 8,828 pints of blood to Red Cross Blood Banks and to local hospitals. The medical staff provided psychiatric diagnostic studies of per¬ sons charged with criminal offenses about whom questions of mental competency are raised. Because of increasing public interest in de¬ termining criminal responsibility of offenders who have mental illness, a comprehensive study was begun by the Medical Section, Bureau of Public Health Service 127 Prisons, of 500 cases examined in the course of mental competency proceedings under sections 4244 and 4246 of the U. S. Code, Title 18. BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR Beneficiaries of the Federal Employees’ Compensation Act are en¬ titled to medical care, compensation for wage loss, and rehabilitation services for injuries in performance of duty and diseases caused by their employment. Medical officers of the Public Health Service as¬ signed to the Bureau of Employees’ Compensation administer the medical care program for their benefit. Medical facilities of the Serv¬ ice and of other Federal establishments are utilized where available; in many areas medical care is provided by private physicians. During fiscal 1958 there was a slight overall decrease in the total number of work-injury cases reported to the Bureau but a significant increase in cost of compensation and of medical care. Increased emphasis was given to special study of occupational dis¬ eases of obscure etiology and of conditions said to be caused by occu¬ pation. The Public Health Service hospital in San Francisco pro¬ vided facilities for special study of disability due to mustard-gas ex¬ posure. The Wright-Patterson Air Force Base Hospital, Dayton, Ohio, provided facilities for study of various occupational diseases, in a new specialty center for occupational medicine. More emphasis was also given to early vocational rehabilitation of injured employees, through frequent utilization of established re¬ habilitation centers, cooperation with Public Health Service facilities, and cooperation with State vocational rehabilitation offices. Bureau of State Services The Bureau of State Services has primary responsibility for the application of new knowledge to community health programs. The Bureau provides technical, financial, and consultative services to States and communities, and conducts applied research which is de¬ signed to improve health and prevent disease. In addition, the Bureau conducts programs which help to strengthen international health activities. Division of General Health Services The programs administered by the Division of General Health Services are: the Arctic Health Research Center, the National Office of Vital Statistics, program development, public health education, State grants, and professional training and traineeships. 128 Department of Health , Education , and Welfare , 1958 STATE GRANTS For fiscal year 1958, a total of $197,918,000 was available for grants- in-aid to States and Territories to conduct public health programs and to build hospitals and other health facilities. Because no funds were granted for poliomyelitis vaccine (the Poliomyelitis Vaccina¬ tion Assistance Act expired in fiscal 1957) the total amount is less than the previous year. However, the grants for general health were in¬ creased by $3 million and those for venereal disease control by $900,000. The amounts of actual payment and the purposes for which they were made are as follows : General health services _ $14, 934, 646. 00 Venereal disease special projects _ 1 1, 675, 964. 37 Tuberculosis control _ 4, 493, 988. 00 Mental health activities _ 3, 954, 997. 00 Cancer control _ . _ 2, 214, 023. 00 Heart disease control _ 2, 045, 540. 00 Medical facilities survey and planning _ 124, 408. 85 Construction of community facilities in defense im¬ pacted areas _ 13, 352. 00 Hospital and medical facilities construction _ 105, 291, 966. 43 Waste treatment works construction _ 16. 884, 274. 88 Water pollution control _ 2 2, 776, 515. 00 1 Includes supplies and services furnished in lieu of cash. 2 Includes $248,613.00 paid to interstate agencies. Other funds which were used to help strengthen State and local public health services were $1,854,000.57 for traineeships for profes¬ sional public health workers and $232,140.30 for training and demon¬ stration projects in air pollution control. ARCTIC HEALTH RESEARCH CENTER The Arctic Health Research Center cooperates with the Alaska Department of Health to improve public health and medical services in the area. Research at the Center is focused on solving problems associated with life in low temperature areas. One of these projects involves various tests to determine human adaptation to cold. Based on results of previous work with arctic animals, this project is being carried out in collaboration with investigators from the National Science Foundation, the University of Alaska, and foreign countries. Another Center project this year was a survey of 52 Alaskan vil¬ lages to determine whether the native population had antibodies against the three types of poliomyelitis virus. It was found that they had and this indicates that, contrary to previous medical opin¬ ion, Alaskan natives have had considerable poliomyelitis infection for many years. Serological tests made during the 1957 influenza pandemic showed that Asian influenza penetrated to the most remote villages. Sanitation studies continued on experimental water supplies, waste disposal and housing installations. Five experimental housing units Public Health Service 129 were completed which offer a radical departure from designs and materials used previously. NATIONAL OFFICE OF VITAL STATISTICS National vital statistics are derived from reports of births, deaths, fetal deaths, marriages, divorces, and notifiable diseases that are col¬ lected by registration officials. Such data provide a current basis for planning programs in public health, medical and demographic re¬ search, education, social welfare, business, and government. An important objective of the National Office of Vital Statistics is to secure complete and accurate registrations and to coordinate the registration and statistical practices of the States insofar as they af¬ fect interstate and international comparability of data. A signifi¬ cant milestone was the inauguration in January 1958 of the Divorce Registration Area with 14 States and 8 Territories, following by 1 year the inauguration of the Marriage Registration Area. The Seventh Revision of the “International Statistical Classifica¬ tion of Diseases, Injuries, and Causes of Death,” adopted by the World Health Organization for coding causes of death went into effect on January 1, 1958. As part of its selected studies series, NO VS issued the following reports : the study and recommendations made by the U. S. National Committee on Vital and Health Statistics on national vital statistics needs; a study on socioeconomic characteristics of recently married persons; an evaluation of obstetric and related data recorded on vital records and hospital records by the District of Columbia Health De¬ partment ; a study of the relation of live births and neonatal deaths to birth weight ; and a report of a special Advisory Committee on Vital Statistics Methods. PROGRAM DEVELOPMENT The Program Development Branch explored the need for new public health programs. It continued to serve as a focal point for work on problems of rural health generally, including the health of agricultural migrants. Effort was made to obtain continuity of health services to migrants, as they move from place to place. Meth¬ ods by which migrant health services are financed were studied, and more accurate information obtained about the migrant population. TRAINING Training opportunities continued to increase for potential and current employees in public health. In 1958, a total of 665 profes¬ sional health personnel was given advanced training under the public health traineeship program of the Health Amendments Act of 1956, compared with 363 last year. More people were also being trained 130 Department of Health , Education , and Welfare, 1958 under State and local health departments sponsorship, and schools of public health experienced a further increase in enrollment. PUBLIC HEALTH EDUCATION The Public Health Education Branch worked with State and local agencies to develop health education programs which would lead to desirable health habits. The Branch provided consultative services in health education tech¬ niques and methods to States and communities, to other units of the Public Health Service and the Department, and to voluntary agencies. It also conducted a number of research studies in the behavioral sciences. Prominent among these was a cooperative study in 5 cities on the effects of the Asian influenza epidemic on community life. Another study, which dealt with children with rheumatic fever, uncovered barriers to effective patient management which existed among patients, parents, physicians, and others. Other research projects were on: psychological factors which may predispose to heart disease; why people use or fail to use available free dental services ; and the social and personal consequences of cleft lip and palate in a sample population. PUBLIC HEALTH NURSING The development of scientific techniques to determine the needs for nursing staff of public health agencies, based on the policies and pro¬ grams of the individual agency, was a major accomplishment of the Public Health Nursing Branch during the year. Studies in work measurement and performance budgeting in pub¬ lic health nursing were conducted in four areas. As a result of these projects, health departments are able to plan more accurately for modifying and expanding services to patients without jeopardy to the ongoing program. A “Guide for Class Specifications for Nursing Positions in State and Local Public Health Programs” was published and distributed through the Division of Merit Systems. States used the Guide widely in determining qualification requirements of nursing personnel com¬ mensurate with their responsibilities. During the year, the Public Health Nursing Branch assisted various units of the Service in planning and evaluating public health nursing services. An experimental extension course in public health nursing was established by the Branch in cooperation with the University of Minnesota. It is designed for public health nurses, who are unable to leave their homes or work long enough to take all of the required public health courses on campus. Public Health Service 131 Division of Special Health Services The Division of Special Health Services is concerned with the problems of personal health maintenance. Emphasis is placed on chronic illness control and the health of the aged. Division programs are : medical aspects of air pollution and radiological health, accident prevention, occupational health, cancer, and control of tuberculosis, heart disease, and other chronic diseases. ACCIDENT PREVENTION The Accident Prevention Program worked to reduce the number of deaths and injuries from accidents — in the home, the school, and on the highway. Forty-five State health departments now conduct some kind of ac¬ cident prevention programs. The majority of those are centered on home and farm safety, but there is also a growing interest in motor vehicle safety. This interest has been stimulated by participation in such activities as the Cornell Automobile Crash Injury Studies, and meetings on the medical aspects of motor vehicle operator licensing sponsored by the Program. There is a total of 124 poison control centers in 40 States. The Public Health Service coordinates this activity through the National Clearinghouse for Poison Control Centers. During the year, local centers were encouraged to provide better emergency treatment facil¬ ities, including equipment and antidotes for various poisons. The Clearinghouse obtained information from manufacturers on formula¬ tion, toxicity, and recommended treatment in the event of accidental use of their household products. An important epidemiologic study of fires and explosions, with particular emphasis on petroleum products, began in Mississippi County, Ark., in cooperation with the State health department. An investigator is working with fire department officials and others to identify the causes and circumstances of fires. The Cornell Aeronautical Laboratory was awarded a contract to study the feasibility of building a driving simulator — a device for studying driver behavior under various conditions. CANCER CONTROL During the year, a new unit was established to conduct cancer con¬ trol activities. The unit works closely with physicians and health agencies to stimulate early detection of cancer. Informal 2-day discussions were held during the year in Atlanta, New York, and San Francisco to explore possible areas for action. These sessions were attended by representatives of professional medi¬ cal societies, State health departments, and voluntary health agencies. 132 Department of Health , Education , and Welfare , 1958 Among the recommendations were that health departments initiate the following activities : tumor registries ; tumor diagnostic and treatment clinics ; casefinding, including cervical cytology ; patient followup ac¬ tivities, and lay education. CHRONIC DISEASE CONTROL The Chronic Disease Program helps States and communities to pre¬ vent the disabling effects of long term illness. In 1958, the Program continued to emphasize the early detection of diabetes and glaucoma. In promotion of better health for the aging, standards were developed for workers in nursing homes, homes for the aged, chronic disease hospitals, and organized home care programs. A significant event of the year was the First National Conference on Nursing Homes and Homes for the Aged called by the Surgeon General to develop recommendations for raising the level of care in nursing homes. Basic .services, accreditation, financing, and regu¬ lation were among the major areas considered. To further glaucoma detection programs, demonstration equip¬ ment was furnished to the National Society for the Prevention of Blindness. Developmental work leading to an evaluation of the effectiveness of medical rehabilitation-restorative services began with a pilot study of cerebrovascular accident patients at the D. C. General Hospital, where 80 percent of those treated who were ambulatory at discharge, remained so after discharge. In another hospital without a medical rehabilitation program, only 35 percent were ambulatory at discharge. Among activities dealing with nutrition and weight control was a cooperative agreement with the Ohio Department of Health to provide the program with essential data on the operation of its “Meals on Wheels” program. A joint project with the Washington State Department of Health and the Council on Aging for Seattle and King County was estab¬ lished to study the health benefits from a program of supervised activities and counselling in an aged population. HEART DISEASE CONTROL The Heart Disease Control Program works with State and local health departments to establish and improve control activities. Some important current needs are for: rheumatic fever programs; better care of cardiac patients in areas unattended by physicians; multi¬ discipline training; epidemiological studies; and professional and public education in the application of basic research findings. A “Heart of the Home Program,” cosponsored with the Minnesota Department of Health, Minnesota Heart Association and the Uni- Public Health Service 133 versity of Minnesota, was developed to simplify household chores and otherwise assist homemakers with a cardiac condition. Screening activities included: a multi-phasic screening program in two Oklahoma counties using EKG, blood determination and pres¬ sure readings ; screening for hypertension among people in Wisconsin who had received mobile chest X-rays; a heart disease screening project among school children in Meso County, Colo. ; and city wide screening in Los Angeles to find new heart disease among people previously tested. A research study of the after-effects of severe heart illness, with reference to excessive disability, revealed that an initial emotional breakdown was related to better later adjustment or handling of emotional problems. Data collection began in Georgia among vegetarian and non-vege¬ tarian populations to test hypotheses relating fat intake to serum cholesterol levels. One hundred obese children and 100 children of average weight identified in Hagerstown, Md., in 1936, have been located and re¬ examined to learn to what extent obesity among adults is conditioned by childhood obesity. Also, an effort will be made to identify socio¬ logical factors associated with the inability to lose weight. OCCUPATIONAL HEALTH PROGRAM Protection against occupational disease and injury and stimulation of preventive health services for the working population are important functions of the Occupational Health Program. Through medical studies of the individual and engineering studies of the environment, pathological findings were correlated with ex¬ posure, all of which helped in designing control measures. One such study involved the relation of industrial noises to loss of hearing. Preliminary findings suggest that noise-induced hearing loss may occur earlier than had been expected; and continuous noise is more injurious than intermittent noise. Work is being done to learn the extent of permanent hearing loss under such conditions. In study of health hazards in uranium mining and milling, empha¬ sis is being placed on medical considerations, since European experi¬ ence showed that lung cancer began to appear in uranium miners after about 15 years of exposure. Because of high turnover among this mining group, annual censuses have been made to learn if medical reasons were responsible for some of the men leaving the industry. Silicosis remains the most significant occupational disease in the United States in terms of disability and compensation cost. These costs are estimated to be about $10 million yearly. A joint PHS-U. S. Bureau of Mines study began on the relation of silicosis to occupation, 134 Department of Health, Education, and Welfare, 1958 length of exposures, dust concentrations, the kind of dust and its particle size, and other environmental factors related to the problem. A medical phase of the study will seek X-ray evidence of silicosis among a sample of currently employed metal miners. Completion of a census of professional registered nurses employed full time in United States industry on January 1957 showed 16,223 individuals employed. Since this number represented a 32 percent increase over that found in a 1952 census, several universities and schools of nursing have expressed a desire to provide more educational opportunities for occupational health nurses. RADIOLOGICAL HEALTH MEDICAL PROGRAM During most of the fiscal year, the medical aspects of radiological health were centered in the Division of Special Health Services, and the engineering aspects in the Division of Sanitary Engineering Serv¬ ices. In March 1958, these programs were combined in a newly created Division — the Division of Radiological Health. Medical implications of ionizing radiation are based on the fact that effects on health are cumulative and irreversible. All sources of exposure must be considered in assessing and controlling the poten¬ tial hazard — fallout from nuclear testing, use of X-rays in medical- dental diagnosis and therapy, and occupational sources of exposure, among others. The Service recommended, in cooperation with State and local health departments, that X-ray equipment be maintained in optimum operating condition to reduce all unnecessary exposure, both to operators and the public. TUBERCULOSIS CONTROL During the year, the use of community chest X-rays to find unknown cases of tuberculosis was subjected to intensive review. On the advice of a group of experts in this field, the Service recommended that mass X-ray surveys be concentrated among groups known to be at high risk of tuberculosis infaction. This recommendation was based on changes in the extent of the tuberculosis problem and on the problem of low-level exposure to radiation. The Service also recommended that State and local au¬ thorities consider using the tuberculin skin test in school health pro¬ grams as the initial means of detecting tuberculosis. The Ad Hoc Advisory Committee to the Surgeon General recom¬ mended that large scale BCG vaccination programs are not indicated in this country and that its use be limited to groups where risk of exposure is high and other means of control are weak. The principal current research efforts of the program are directed at development of more effective prophylaxis methods. Studies on the effectiveness of isoniazid to prevent meningitis and other compli- Public Health Service 135 cations of primary tuberculosis in children were continued on 2,750 individuals in 32 clinics. The efficacy of isoniazid was also being tested among 27,000 persons in institutional populations, and house¬ hold and other close contacts of newly reported active cases of tuberculosis. Evaluation studies of antimicrobial therapy showed streptomycin plus pyrazinamide as used in a completed project, produced a more rapid reversal of infectiousness than isoniazid plus PAS, the most commonly used therapeutic regimen. Although the former regimen is more toxic than the latter, the first 12 weeks of treatment were rela¬ tively safe when most of the therapeutic effect was achieved. Special emphasis was placed on determining the needs of unhospi¬ talized patients for long term services. A pilot study of active tuber¬ culosis patients who follow medical recommendations, as compared with those who lapse from supervision, was made in Minneapolis. Division of Sanitary Engineering Services The Division of Sanitary Engineering cooperates with State and local health departments, industry, and other groups on environmen¬ tal health problems associated with air, water, and food. Division programs deal with the engineering aspects of such problems as air pollution, water supply and pollution control, milk and food sanita¬ tion, the sanitation of interstate carriers, radiological health, and professional training in sanitary engineering. ROBERT A. TAFT SANITARY ENGINEERING CENTER The Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio, is a national laboratory for research, specialized technical assistance, and advanced training in the activities of the Division. The Center cooperates with program personnel to develop new and improved testing procedures, and with industry and health departments in the application of these methods to local problems. Analysis of air pol¬ lution problems is given high priority, as well as a variety of condi¬ tions associated with the expanded use of ionizing radiation by in¬ dustry and others. AIR POLLUTION ENGINEERING PROGRAM Although research dominates current program activities, long range planning is aimed at cooperative action with State and local com¬ munities to help control community air pollution. Initial planning began for a National Conference on Air Pollu¬ tion to be held in Washington, D. C. on November 18-20, 1958. Research studies were under way in a variety of fields related to air pollution. Some of these studies involved cooperative work with other Federal agencies. For example, PHS specialists began work with the 136 Department of Health , Education , and Welfare , 1958 Department of Agriculture on the use of plants as indicators of air pollution. The Tennessee Valley Authority began studies on the dispersion of stack gases. Automobile exhaust research by the Service was accelerated at the request of the National Advisory Committee on Air Pollution and the Automobile Manufacturers Association. In a study of community air pollution in Nashville, Tenn., data were collected in order to determine the health effects of air pollution. In addition to possible medical implications, the study should help to determine the type and extent of air pollution over a metropolitan area. The National Air Sampling Network had 112 urban and 45 non- urban stations gathering data on the country’s air pollution problem. State and local authorities in every State collected and analyzed air samplings to define and identify the extent and variety of air pol¬ lutants. In cooperation with the National Cancer Institute, air samples were analyzed in eight cities for known carcinogenic and other substances. ENGINEERING RESOURCES AND TRAINING The Division continued to provide training and career development opportunities for the sanitary engineering profession. Under the pro¬ visions of Public Law 911, a total of 121 engineering traineeship awards was made. Special courses were sponsored to meet the increasing demands for engineering personnel in radiological programs. To stimulate interest in sanitary engineering as a career, material was produced for use among secondary school students. In cooperation with the National Science Foundation, work contin¬ ued on a roster of sanitary engineering manpower in the United States. GENERAL ENGINEERING Special citations, which are awarded annually to qualifying inter¬ state carrier companies, went to 12 vessel companies and 5 railroads for maintaining high sanitation standards in all operating units. Significant developments toward world-wide uniformity of stand¬ ards resulted from staff work with the Expert Committee on Airport Sanitation of the World Health Organization. Other international activities included cooperation with the Pan American Health Organ¬ ization on sanitation standards for tourist establishments in Central and South America. An expanded Maritime Service construction program required addi¬ tional inspection of potable water systems, food service categories, ratproofing, and general plumbing arrangements. In the airline pro¬ gram, inspections were made of individual aircraft, servicing areas, Public Health Service 137 and caterers similar to that done for many years on railroads. Since buses now carry water, serve food, and maintain restrooms aboard, interstate quarantine regulations were applied to all units as well as their servicing areas. To solve the problems of household waste disposal, a study was ini¬ tiated on individual household aerobic sewage treatment systems to develop criteria for evaluation, testing, and conditions for use. MILK AND FOOD SANITATION PROGRAM A continuing pilot study of milk samples from 10 milksheds of the Nation showed radioactivity to be well within the maximum permis¬ sible concentrations published by the National Committee on Radia¬ tion Protection and Measurement. Control of the sanitary quality of the aquatic environment was a primary activity of the shellfish sanitation program, and cooperative action with coastal States supplemented work with shippers and distributors. Improved biochemical and assay methods developed at SEC to determine paralytic shellfish poisoning showed increased re¬ liability and accuracy during unexpected outbreaks of the poison in West Coast shellfish species and certain marine clam beds. A final report on the joint University of California-Public Health Service Q fever pasteurization studies was released covering incidence, methodology, laboratory thermal inactivation, and commercial equip¬ ment studies. Study of the organism in dairy products other than milk is continuing at the University. New and potential reservoirs of food-borne infection and contamina¬ tion, including effects of disposal of radioactive wastes, received attention. Work continued with the States to correct deficiencies in the poultry processing industry. Scheduled for completion next year, the poultry sanitation demonstration project in Denver, Colo, made substantial progress. Other work involved cooperation with States on interstate milk shipment problems, and with industry and official health agencies on local regulations necessary for the vending of foods and beverages. RADIOLOGICAL HEALTH ENGINEERING PROGRAM Increasing use of ionizing radiation resulted in extended Public Health Service cooperative action with State and local groups ranging from specific technical matters to assistance in developing compre¬ hensive programs for radiation protection. Some of these activities included methods of reducing clinical exposure to X-rays ; monitoring programs to determine the extent of radioactive contamination ; and determination of the adequacy of proposed radioactive waste treat¬ ment and disposal facilities used in conjunction with reactors and use of radioisotopes. 487270—59 - 10 138 Department of Health , Education , and Welfare , 1958 Cooperative work on radiological health and safety was undertaken with the Maritime Administration on its nuclear powered merchant ship program, with the Navy on its Nuclear Propulsion Program, and with coastal authorities on monitoring of ships entering ports with cargoes having a potential radioactive hazard. The Service continued to carry out off-site monitoring activities at the Atomic Energy Commission Nevada nuclear test site, supple¬ mented by a medical liaison officer network. Under an agreement with the Atomic Energy Commission, the National Radiation Air and Water Surveillance Network was in¬ creased to 45 stations. This work was expanded to include analysis of weekly samples from 50 raw water supplies. WATER SUPPLY AND WATER POLLUTION CONTROL To provide a sound basis for pollution abatement programs, ac¬ tivities were directed toward the collection and analysis of data on existing water and waste treatment facilities and needs, the continuous collection of water quality data over a national network of 40 sampling stations, and studies of the economics of water pollu¬ tion. Research at the SEC and other field investigations helped measure the complex problems created by the manufacture of new chemical and synthetic products. The construction grants program and interstate enforcement activities are increasing the rate of con¬ struction of pollution abatement facilities by States and local com¬ munities. Inventories of community water supply facilities and municipal and industrial waste treatment works were completed. At the end of fiscal year 1958, Federal grants under Public Law 660 amounting to $85.3 million went to 1,038 communities in support of sewage treatment work construction totaling $441.8 million. About 97 percent of these grants went to communities under 125,000 population. Some sanitary engineering studies involved small sewage treatment plant design in the North Central United States ; design and cost of constructing sewage stabilization ponds, a less expensive method of sewage disposal now receiving greater attention and use by smaller communities ; and determination of sewage treatment plant financing problems by public bodies. Formal conferences were held to seek abatement of interstate pollu¬ tion involving the Potomac River in the metropolitan Washington area; the Missouri River at Kansas City; Mississippi interstate waters in the St. Louis area; and the Animas River in the Southwest for alleged radioactive and other wastes. Analysis continued of the adequacy of State water pollution control laws. Nine States requested and received advice on proposed water Public Health Service 139 pollution control legislation, and seven States enacted such laws during the year. Other major projects involved finding more effective treatment methods for Lake Michigan water, in cooperation with Northwestern University ; a study of the status of pollution in the New York Harbor area ; water quality effects of economic poisons used in spray programs for eradication of the gypsy moth ; the effects of hydroelectric plants on water quality for other water uses ; and the effects of tides and cur¬ rents on pollution. Communicable Disease Center The Communicable Disease Center operates as a working partner of the States in the control of infectious disease. It is located in Atlanta, Ga., with laboratories and field stations in various parts of the United States. The Center provides technical assistance to the States and develops practical tools in the form of knowledge or im¬ proved techniques to enable the States to carry out effective disease control programs. During the year, construction was started on new headquarters for the Center on 14 acres of land adjoining the Emory University campus. EPIDEMIC AND DISASTER AID CDC gave epidemic aid in 42 instances. Aid was given in connection with the Asian influenza epidemic, staphylococcal and other hospital- acquired infections, health problems on Indian reservations, and the East Pakistan outbreak of smallpox and cholera. Hurricane Audrey and floods in Texas, Louisiana, Arkansas, and Oklahoma accounted for 11 requests for disaster aid. REPRESENTATIVE FIELD AND LABORATORY STUDIES Asian Influenza Prior interest in respiratory diseases and international responsi¬ bilities in the influenza field prepared CDC to initiate its Influenza Surveillance Program in July and to serve as the principal laboratory resource during the Asian influenza epidemic. Functioning as strain study center and focal point for laboratory information, CDC also established contractual diagnostic and reference services in 37 States, Alaska, Hawaii, and Puerto Bico with special funds allocated by Con¬ gress. Typing reagents for Asian and older influenza strains, with instructions for their use, were prepared and distributed to 160 labora¬ tories. Investigations were conducted on the efficacy of influenza vaccines and the practicability of different immunization procedures. Detailed, current accounts on the progress of the epidemic were published weekly. 140 Department of Health , Education , and Welfare , 1958 Venereal Diseases The trend in cases of infectious syphilis in the United States con¬ tinued upward with 20 States and the District of Columbia reporting increases. This year there were 6,651 cases of lesion syphilis, 5.9 per¬ cent more than in 1957. A total of 125,978 cases of syphilis in all stages was reported by State health departments, a decline of 7 per¬ cent over last year. Deaths attributed to syphilis numbered 3,870. The number of reported cases of gonorrhea was 219,219, a slight in¬ crease over 1957. There were 49,484 cases of venereal disease reported among persons under 20 years of age. Thirty-four States reported increases in the proportion of venereal disease among this age group. Fifty-three percent of all infectious cases occurred among persons 15 to 24 years of age. Federal funds supported 93 venereal disease projects in 41 States. Activities included selective blood testing, contact interviewing and investigation, and cooperation with private physicians to improve morbidity reporting and extend epidemiologic services. Cluster testing, the new casefinding method that extends contact investigation to include blood testing of associates of patients and contacts, continues to be an excellent epidemiological tool and has been extended to 10 States. The relative sensitivity and specificity of treponemal and nontrep- onemal tests in the serodiagnosis of syphilis were evaluated in 15 laboratories employing 38 different procedures. This evaluation was conducted by the Serologic Evaluation and Kesearch Assembly. The search for an immunizing agent for syphilis continued both in Public Health Service and in other research laboratories. The Reiter protein antigen complement fixation test showed promise as a specific and economical treponemal test for syphilis. Poliomyelitis and the Polio-Like Diseases Incidence of poliomyelitis was about one-third that of 1956, with even more marked reduction in paralytic cases. A large proportion of the nonporalytic cases, some producing residual muscle weakness, was caused by Coxsackie Type B and ECHO viruses, but paralytic cases were usually true polio. A new pathogen responsible for epidemic meningitis and death in infants is being sought among unclassified bacteria isolated from affected newborn infants during two hospital outbreaks. Surveillance demonstrated the continued safety and effectiveness of the polio vaccine. Efforts are being made to simplify and improve diagnostic procedures for polio and the polio-like diseases. Public Health Service 141 Staphylococcal Infections Coordinated planning was begun for long-range control of staphy¬ lococcal and other hospital-acquired infections, which, in some in¬ stances, are caused by antibiotic resistant strains of bacteria. These are creating nursery-obstetrical and general medical problems, and producing surgical wound infections. Resurgence of these prob¬ lems after many years of relative freedom following the advent of the science of bacteriology and the development of aseptic techniques is a matter of serious concern. Viral Encephalitis Field investigations showed that mass infection of birds with East¬ ern encephalitis in fresh water swamps enables various mosquito species to spread the virus far afield; that Western encephalitis virus can survive through the winter in experimentally infected birds and mosquitoes ; and that the extreme efficiency of two mosquito species in transmitting St. Louis encephalitis would justify control measures in cities in risk areas. Rabies Wildlife rabies studies were continued in the Southeast, in New York, and in the newly established Southwestern Wildlife Rabies Station at the New Mexico State College. As broadly applied con¬ trol programs continue to reduce the urban rabies problem in dogs, control measures are being sought against the large reservoir of infec¬ tion in skunks, foxes, and other wildlife. Bat rabies has been re¬ ported from 19 States since 1953. Diarrheal Diseases Growing resistance of Salmonella typhimurium in fowl to tetra¬ cycline antibiotics has been detected, and the baseline of resistance in old cultures was established. Since tetracyclines are now common additives to animal diets, development of resistant bacteria must be watched closely. A 3-year investigation in eastern Kentucky showed that diarrheal disease morbidity, Shigella infections in preschool children, and Ascaris infections in the general population were inversely related to the availability of sanitary facilities. Anthrax An outbreak of anthrax in a New England textile mill included five cases of inhalation anthrax, four of which were fatal. This outbreak — the first in which inhalation anthrax occurred in epidemic form — was studied intensively because of its serious implications in occupational health and in national defense. Cases were traced to 142 Department of Health , Education, and Welfare, 1958 imported goat hair. No cutaneous or inhalation anthrax developed in vaccinated individuals. Plague In a simulated field test, the transfer of radioactive fleas between California meadow voles and domestic (Norway) rats indicated how sylvatic plague could be spread to urban areas in the enzootic western States. LABORATORY SERVICES AND NEW TECHNIQUES This year the Center identified over 42,000 troublesome isolates sent in by State and Territorial laboratories, Federal agencies, and for¬ eign countries. Because the wide range of diagnostic reagents, which are essential in the laboratory diagnosis of viral, fungal, bacterial, and parasitic diseases, is not available commercially, CDC created a special section to produce and evaluate hundreds of these materials. Kapid growth of virulent strains — but not avirulent variants — of many organisms (tubercle bacilli, other cultivable mycobacterial pathogens, brucella, Bacterium tularense , staphylococci, streptococci, typhoid bacilli, and Histoplasma capsulatum) was attained in human tissue culture cells, and the action of antibiotics on them was observed. Significant cytopathic changes were obtained in hamster kidney tissue cultures inoculated with fixed rabies virus after repeated pas¬ sage, and with arthropod-borne encephalitis viruses. This was the first time rabies virus has been propagated in the absence of nerv¬ ous tissue — the component of the present vaccine responsible for the paralytic syndrome sometimes encountered in humans. Use of the hamster kidney tissue system may simplify diagnostic immuno¬ logic studies in these important viral diseases and lead to an improved rabies vaccine and a modified live virus vaccine against encephalitis for human use. With increased availability of fluorescein dyes and improved label¬ ing procedures, considerable progress has been made in applying the fluorescent antibody techniques to the rapid detection and identifica¬ tion of various pathogens. Especially significant is the straining of rickettsiae and viruses either from tissue culture or from direct smears of infected organs. VECTOR CONTROL Continuation and extension of the progress already made in the con¬ trol of vector-borne diseases are threatened by the growing re¬ sistance to insecticides of many important disease vectors. A testing kit developed by CDC has been accepted by WHO as a standard method for worldwide use in determining the susceptibility of mos¬ quitoes to insecticides. Public Health Service 143 A pilot demonstration project has been activated in Pensacola, Florida, to obtain objective data on cost, methodology and practi¬ cality of eradicating Aedes aegypti , the urban vector of yellow fever, in the United States. A practical apparatus was developed for sampling large volumes of water for cercariae of Schistosoma mansoni to facilitate investiga¬ tion of the epidemiology of schistosomiasis in Puerto Rico. TRAINING More than 7,200 persons from State and local health departments, Federal agencies, academic institutions, industry, other organiza¬ tions, and from abroad, received organized training from CDC in various aspects of communicable disease control. Particular em¬ phasis was placed on courses in the principles of epidemiology and their application for all the professional members of the health team. Division of Dental Public Health The Division of Dental Public Health develops new methods of dental disease control and encourages their adoption by State and local health departments. States were given professional and technical assistance in dealing with such problems as personnel utilization, program planning and budget management, defining dental public health problems, ad¬ ministering dental health clinics, providing dental services for public assistance recipients, and carrying out inservice training programs. FLUORIDATION Fluoridation of community water supplies increased throughout the country. Over 34 million people in 1,709 communities, including a majority of the Ration’s 18 largest cities, were using fluoridated drink¬ ing water. About 90 percent of all public water supplies serve com¬ munities with less than 5,000 population. Analysis of national fluori¬ dation data showed that relatively few of these smaller communities have fluoridated their public water supplies. One problem associated with fluoridation has been a shortage of suitable fluoride compounds for use in community water supplies. Division research found that the very common substance, fluorspar, could be used. A demonstration now in progress in a small community shows that the use of fluorspar will reduce by two-thirds the current cost of fluoridation. A practical device developed by Division staff for fluoridation of individual home water supplies now makes possible the extension of fluoridation to rural and suburban populations not served by public water supplies. 144 Department of Health , Education , and Welfare , 1958 DENTAL STUDIES In New Mexico, a 2-year project was begun to explore the preva¬ lence and patterns of pyorrhea and other peridontal diseases. Staff assistance was supplied for a study on dental needs of people in nurs¬ ing homes in two Georgia counties ; for a Jefferson County, Mo. multi- phasic disease study of the aged which will include dental disease among ten conditions examined; and for a survey in Colorado to analyze dental services supplied in a State mental hospital. Division of International Health Through this Division, the Public Health Service participates in the activities of the World Health Organization, the Pan American Sanitary Organization, the South Pacific Commission, and other health agencies. It offers program and policy guidance to the Depart¬ ment of State on international health matters and to the International Cooperation Administration on training, educational and technical aid to United States Operations Missions abroad. At the invitation of Congress, the WHO held its Tenth Anniversary Commemorative Session in Minneapolis, Minn., on May 26-27, 1958. This was immediately followed by sessions of the Eleventh World Health Assembly which elected the Surgeon General its President. The Division completed special health studies on Taiwan, Hong Kong, Macao, Jordan, and Iran. This brings to 12 the number of studies made under the Division’s international epidemiology program which began in 1956. Reciprocal exchange missions in public health administration from the United States and the U. S. S. R. visited both countries late in 1957. This was supplemented by a January 1958 agreement signed by both countries covering a broad area of cultural and scientific exchange missions in the fields of medicine and public health. At the end of the fiscal year, 162 PHS officers (physicians, nurses, engineers, and other technicians) were assigned to field missions in which the United States participates abroad. Assistance by Ameri¬ can health technicians ranges from consultation on demonstration health projects to evaluation of established national health programs. In response to a request, the Surgeon General recommended to ICA that health activities be intensified in the control of tuberculosis, trachoma, schistosomiasis and in the improvement of sanitation and the construction of medical facilities. A total of 599 foreign health trainees from 76 countries was given supervision and guidance in securing medical and public health train¬ ing which will help them to develop health department programs when they return home. Public Health Service installations provided train¬ ing for 168 of the trainees and 266 were placed in academic or clinical centers for specialized graduate work. Public Health Service 145 Table 1. — Statement of appropriations , authorizations , obligations, and balances, fiscal year 1958 [In thousands] Funds available for obligation Appropriations Total. Appropriations, PHS. Control of tuberculosis _ Control of venereal diseases _ Assistance to States, general _ Control of communicable diseases _ Grants and special studies, Territory of Alaska _ Sanitary engineering activities (1958-59)... Sanitary engineering activities (1958) _ Foreign quarantine service _ Dependents medical care _ Hospitals and medical care (1958) _ Hospitals and medical care (1958-59) _ Hospitals and medical care (1957-58) _ Salaries and expenses, hospital construc¬ tion services _ Indian health activities (1958-59) _ Indian health activities (1958) _ Construction of Indian health facilities (annual) _ Construction of Indian health facilities (no year) _ Grants for hospital construction (1958-59). Grants for hospital construction (1957-58). Surveys and planning for hospital con¬ struction _ General research and services, 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, Cincinnati, Ohio. Arthritis and metabolic disease activities. . Allergy and infectious disease activities _ Neurology and blindness activities _ Operations, National Library of Medicine- Construction of library facilities _ Grants for waste treatment works con¬ struction _ Construction of Biologies Standards Lab¬ oratory Building _ Construction of surgical facilities _ Construction of Dental Research Building- Grants for construction of health research facilities _ Construction of animal quarters _ General office building _ Construction of research facilities _ Retired pay of commissioned officers _ Salaries and expenses _ National Institutes of Health manage¬ ment fund _ Appro¬ priations and authori¬ zations $565, 963 565, 846 7, 000 4, 415 22, 592 7, 050 2, 165 75 12, 640 3, 876 900 44, 399 150 1 121,200 14,026 56, 402 39, 217 35, 936 6, 430 20, 385 17, 400 21, 387 1,450 45, 000 30, 000 1,570 5, 100 Net transfers between appro¬ priations $2, 320 2, 320 51 88 114 122 172 147 i-l 224 675 147 50 97 114 1-119 160 Repay¬ ments for services $26, 537 26, 537 14 248 416 38 962 164 409 262 18 Prior year un¬ obligated balances $116,305 116, 142 2-615 11, 526 86, 083 1, 174 18 12, 379 3, 343 1,556 129 188 129 201 Total funds available $718, 477 710, 845 7,065 4.503 22, 954 7, 588 2,215 75 13, 774 4, 187 899 49, 032 150 1 1,499 400 40, 871 3, 130 11,526 121,200 86, 083 1, 174 14, 085 56. 403 39, 367 36, 084 6, 519 31 20, 744 17, 532 21,395 1,497 18 57, 379 3. 343 1,556 129 30,000 188 129 201 1,451 5, 301 19, 167 Amounts obligated $613, 720 607, 734 7, 051 4, 460 22, 870 7, 576 2, 211 26 13, 535 4, 131 899 48, 996 150 1 1, 492 158 40, 810 640 3,889 44, 847 85, 187 124 55, 455 39, 277 35, 974 6,505 20 20, 742 17, 525 21, 068 1,496 -7 47, 709 2, 745 8 28 30,000 34 67 97 1,451 5,280 19, 125 See footnotes at end of table. 146 Department of Health , Education , and Welfare , 1958 Table 1. — Statement of appropriations , authorizations , obligations , and balances , fiscal year 1958 — Continued Funds available for obligation Appropriations Appro¬ priations and authori¬ zations Net transfers between appro¬ priations Repay¬ ments for services Prior year un¬ obligated balances Total funds available Amounts obligated Appropriations, special project funds made available by other 7, 352 5,849 Salaries and expenses, Bureau of Prisons (transfer to HEW, PHS) _ _ 1, 751 73 1,748 72 American Sections/ International Com¬ mission, State (transfer to HEW, PHS). Operations, Federal Civil Defense Ad¬ ministration (transfer to HEW, PHS).. 175 174 Operating expenses, Atomic Energy Com¬ mission (transfer to HEW, PHS) _ —1 — 1 Research and development, Navy (trans¬ fer to HEW, PHS) _ 8 8 Farm labor supply revolving fund, Bureau of Employment Security (transfer to HEW, PHS) _ 373 347 Administrative expenses, Section 411, Mutual Security Agency Act, Execu¬ tive (transfer to HEW) _ 66 62 Technical cooperation, general executive (transfer to HEW) (no year) _ 1, 853 2, 948 79 1,209 2,153 77 Technical cooperation, general executive (transfer to HEW) (annual) _ Special assistance, general, executive (transfer to HEW)... _ President’s fund for Asian economic de¬ velopment, executive (transfer to HEW) _ _ _ 27 Gift funds donated for general and specific purposes . 116.7 162.7 279.4 136.9 Patients’ benefit fund, Public Health Service hospitals _ 24.2 20.0 44.2 29.9 Public Health Service unconditional gift fund _ . 25.0 105.4 130.4 84.3 Public Health Service conditional gift fund _ 67.5 37.3 104.8 22.7 i Adjusted by Treasury warrant. liquidation of contract authorizations obligated in 1957 fiscal year. Table 2. — Commissioned officers and civil service personnel as of June 30 , 1958 Public Health Service 147 Ip jg g P >> ^ 2 a i (N (M lO “ a § 2 ^ ® g -is £ +e ® as.03 »C05Tf05iH CO CM CM 05 CM O CM CO CM CM O COOt^t^COCMCMCMCM CM CM • 05 »-h 05 CO CO ^ 40 ^ CM fH 4CfCCM05N»0C0rH ’3 rd 2 H a> g c « 1-26 1 »o N ^ co p Prt-S £o2 0^3 l 03 CO t'- CS 03 ©coosoccNc^ro-^-- nojooNosOTfxr IH CO ®lO >-hS ° «a p o c ® !!|lps C3 .3 *3 a) 3 ^ j-T Ofx^^pL, g §: 2oooo|s .2 p p p p o p • 'p.2.2.2.2 co g K W M W 5QAAAO Q p'p M « _ p CO 03 M 3 3 C3 O t-,-i 2co£.2 ^|!l WCQOQ !§5« 3 r— ’ © © 3 -SQO^ goo ■hPPPP^PP ooooogoo^ g Ijs IS la !a £!2S « OfiQQP QQQ 5‘pOOOOOO ’H§PPPPPP ° p.2.2.2.2.2 .2 g £ *2 *2 *2 *3 @ ISSSSHS OOQQQQQQ See footnotes at end of table. Table 2. — Commissioned officers and civil service personnel as of June 30, 1958 — Continued 148 Department of Health , Education, and Welfare, 1958 3Ch sal .tf fits st ! O C3 5 ft ft -3 cs ■illls ^ bX) & 53 a §se a a c3.s 2 oS 1 r- — • i-< h tc o » ^cchcsh^inio ^rHNOO»OOOOiNtOtOCOCOCD ^WOJ^COOOOH^'vCH^DO '»OOONGONlNiO>OCOCON 'NiOOCOOO^CO^CO^HC^CO CX) CO ^ CO ^(NCOHN(NN OXWOOcDiCCOONNMOi- iOCOCOO(NWCCNCXhcOHt O^^Tt-rHlOC^^rHl-lNOO ”P Q 9 O Wr^J CD^^ TJ g © g g S m"W be P rd a P* I a«5 g "O 03 £ .P« S 0^ 03 ^ ^ ftJs ® g mO®®'3 p §> K> CO .ft , •B ® +a £ £ 0 O Jh ■ rH -,H .rH >H >H © ,5 y W © ^ 7,Sgto-81otnto-gm«pHp3:5 WKhHHHHq o O O O o 'a’oS'B'B’B'B'B’Br-H P P p P *"! ° a a a a a p p $.2 .2 .2 .2 “ g _2 2 .2 2 .2 .2 .2 -S !e2 I52 .2 '3 SB is c3 "S is is is is ;§ .S .5 -^< "5 o^lzi^ZlziZoAAAPft P5 "d a 's'ft. .2 a "« a Ph O C3 «1 ft «i+? OJU -§l g to -a o g,® BoB ° ©ft W S' O ft a M a "S fto «D « m (M Ph 00 ■" cn © co Table 3. — Research grants and awards , fiscal year 1958 Public Health Service 149 150 Department of Health, Education , and Welfare, 1958 £ § I!] 111 £S§ ISCSIS -r Sis : ; ; ; : : : ss«s«afessa agassss -T -1M§ fi M'O ^ a S 8 SSIslsISsl 8S3538SSSS ccrH-w^- (Nof ^ecrHrHecef -T..T IllSIslisI §331111 eO‘ .-T lO^^HOi'rH-rH-'wr gjlj1 sill : : d_ Hi *t§' !s?ssss“bs sesassssss ssssss^sssj sssjsssss III KSS S^S&S^SSS 5833333283 ES8S2?}®SS8 3S28852 !58g38*°2Sfe 2232335238 2&3S28' 8 ss S82232S SS |I !88g53£858 888g85288§ 338£8SS3828 gSS|SSg| i88Bss*88a agssssasaa 38SS83**S3 IIISIH ,-r 82§3g83538| 23S838388S82 3822333388 3S83S88 >^»p. 8838O500"58g8 ^8 ! ‘38 Sf3‘ 58 38 ;66QQf III IUI ^.|| j i i ; : : i i i : iiiimtu uUlllj mum m& i§ if §a3§||iii mu gl iSSS SSSSSggfcgg fcfcfcooofi Public Health Service 151 Office of Education Education in 1958 In 1958 American education entered one of its most challenging years. It was under fire at home for many reasons. The criticism was in¬ tensified by the Nation’s shortage of trained manpower and by the challenge of Soviet progress in education. Some of the criticisms were ivell founded ; some were not. However, American educators and school administrators have no desire merely to answer the criticisms and consider the matter settled. Instead they are examining the charges, reappraising their school systems, and earnestly seeking sources of strength, for they realize that informed criticism indicates health, vigor, and interest; that much of the cur¬ rent criticism can be channeled into creative action. Some critics of education have identified a single cause and an easy cure of the problems in education, but unfortunately there is no simple or easy solution to them. They vary from school district to school district and from State to State, and in size and degree of complexity. But one condition contributes to a solution — the recogni¬ tion that problems exist, that they are serious, that schools satisfac¬ tory to the 19th century are not suitable for the 20th, and that some¬ thing should be done. Furthermore educators and laymen generally agree on the basic aims of education, that it is a means of “making of men, free, conscious, self-reliant, fully developed men” who “by education learn to do by choice what other men do by constraint of fear.” They agree, in general, on the specific objectives of the schools. Through the recent White House Conference on Education citizens from all sections of the country reaffirmed their belief in the aims of education and agreed on the services they expect from schools. 487270-59- -11 153 154 Department of Health , Education , and Welfare, 1958 Apparently, then, our educational objectives have not changed ; they are based on the values fundamental in a democracy, and our values have not changed, but because the schools must answer the needs of society for educated men and women, they must change as society changes. The Office of Education One of the functions of the Office of Education is to investi¬ gate and to make known its findings on the status of education in the United States and to recommend measures for improve¬ ment. For that reason this report discusses the conditions, developments, and needs of education in 1958 as they were revealed by Office surveys, conferences which the Office spon¬ sored or in which staff members participated, reports from State departments of education, national associations, and other groups, and from other sources. It also briefly describes other Office functions and reports on its administration of pro¬ grams supported by Federal funds. In 1958 the Office had approximately 650 employees, and its budget for administration and operation was $4,700,000. It administered the following federally supported programs : Vocational education, $40,888,412 ; higher education, $5,051,000 ; school assistance to federally affected areas, $225,650,000; co¬ operative research, $2,300,000 ; and library services, $5,000,000. The Office is staffed with specialists in subject-matter fields, school and college administration, housing, special services, and the various phases of school operation. These specialists were educated in public and private colleges, universities, teachers colleges, and professional schools, and have had many years of experience as teachers and administrators in schools and col¬ leges throughout the country. Their primary interest is help¬ ing States and local communities improve their schools. As fiscal year 1958 came to a close the Office was reappraising its activities in the light of the responsibility education bears for the Nation’s welfare, of the Nation’s need for educated citizens, and of the citizens even greater need for education. There is reason for public confidence, for there is evidence that our basic school system is strong, that it is suited to the needs of the country and flexible enough to respond to changing demands, and that our best schools are surpassed by none. On the basis of sound Office of Education 155 evidence, the schools, working under severe limitations, did a good job in 1958. A few facts to support the statement follow : ^ For a total expenditure of $20 billion, or 4.5 percent of the gross national product of $440.3 billion, they provided school-housing, equipment, and instruction for 43 million persons. ^ School and college enrollments increased for the 13th consecutive year. The 1957-58 enrollment totaled 43,135,000 persons, or about 1 of every 4 in the Nation’s population, an all-time peak and an increase of 1,769,000 over 1956-57 (See table 1). Of the total U. S. population of persons between 6 and 17 years old in October 1957, 96.5 percent were enrolled in school. ^ Public and nonpublic elementary schools — kindergarten through grade 8 — enrolled 30,670,000 children, an increase of 959,000 ; secondary schools — grades 9 through 12 — enrolled 8,424,000, an increase of 604,000; colleges and universities, 3,450,000, an increase of 206,000 ; and other types of schools, 591,000, the same number as last year. Enrollment increase in the secondary grades was 7.7 percent and in the elementary grades 3.2 percent. ^ 94.4 percent of all children in the 5- to 13-year-old group were in school, and 89.5 percent of those in the 14- to 17-year-old group were in school as compared to 79.3 percent 10 years ago. 5,408,000 students were estimated to be in private elementary and secondary schools, an increase of 5.4 percent over last year. ► In urban areas 97 percent of the 6- to 17-year-old group were enrolled in October 1957 as compared with 96 percent in rural nonfarm areas and 95 percent in rural farm areas. ^ In the 30 years since 1927-28 the total enrollment in public secondary schools has risen by 75.8 percent. In the same period, enrollments in general science, biology, chemistry, physics, and the basic mathematics courses have risen 74 percent. Degree-granting colleges conferred a total of 411,000 degrees in 1956-57, 8.3 percent more than in 1955-56. Of the total conferred, 82.8 percent were bachelor’s degrees, 15.1 were master’s, and 2.1 were doctor’s. ^ The total number of teachers in U. S. public and non-public elementary and secondary schools at the beginning of the 1957-58 school year was approximately 1,412,000, an increase of 69,900 over 1956-57. There are also reasons for action; available evidence shows that our poorer schools justify much of the current criticism and that all schools must continuously improve. A few facts indicate the need : ► To equalize educational opportunity. The length of the school term in one State is 165.2 days, in another, 186.9 days ; in one State the average current expenditure per pupil is $158, in another $482 ; in one State the average salary of a teacher is $2,525 and in another, $5,750 ; in one State 88.7 percent of the elementary teachers do not have a degree, in another only 1.7 percent. ► To provide classrooms for 1.9 million children housed in crowded rooms or makeshift quarters. It is estimated that children on double shifts — the thousands who attend school only 4 hours a day — lose nearly 2 months of schooling during the year. 156 Department of Health , Education , and Welfare , 1958 ► To reorganize the school districts too small for efficient and economical operation and to offer an adequate curriculum. Nearly 35,000 of the 104,500 public elementary schools are still one-teacher schools. ► To improve education in rural districts. An Office study of 101 most rural counties showed striking variation ; in one county the average annual salary of the instructional staff was $1,676 and in another, $4,089 ; in one county the annual cost per pupil in average daily attendance was $110 and in another, $825. To erase the shortage of qualified teachers which was 135,000 or 14,300 more than in 1956-57. The average beginning teacher’s salary was $3,600 in 1958, about $1,000 less than a beginner of similar training earns in industry. ► To strengthen the high school curriculum, particularly in small high schools. In the fall of 1956, 36 percent of the public high schools did not offer chemistry ; 43 percent did not offer physics ; 19 percent did not offer plane geometry. (These were small high schools and enrolled only about 5 percent of all high school seniors in the country.) These facts indicate that our schools are good, that there is reason for confidence, but that there is no reason and no room for com¬ placency. There are important reasons for action, and there were strong indications that action was being taken or planned. Maga¬ zines, newspapers, and radio and television stations devoted increased space and time to education ; the U. S. Commissioner was invited to report on the status of education on a nationwide TV broadcasting system ; State legislatures, alumni associations, professional organiza¬ tions, groups of individuals, and others searched for means of im¬ proving their schools. Kecognizing the need for immediate improve¬ ment, the Administration submitted to the Congress a number of specific proposals for Federal aid to education. Financing Educational Services A major problem confronting the systems of public schools over the Nation is that of securing funds in sufficient amounts to enable boards of education to finance the kind of program the public wants. This total problem is usually considered in terms of specific possibili¬ ties of improving the financing of education in the States. Some of the possible improvements are identified in the following paragraphs. Property tax improvement. — Unreasonably low and inequitable valuations of property make the general property tax less effective than it might be as a source of funds for schools. State departments of taxation are adopting plans to assist assessors in using good assess¬ ment practices and in assessing property at an equal rate throughout the State. State distribution formulas. — State funds are more effective in rais¬ ing the unacceptably low expenditure levels of the less wealthy school districts when distributed as equalizing aids. This means that a sub- Office of Education 157 stantial portion of the State funds for education should be allocated to districts as equalizing funds. Educational finance can be greatly improved through the reconsid¬ eration of State distribution formulas and through the adoption of procedures that will help to raise the expenditure levels in the less wealthy school districts. Increased State support . — Suburban school districts in which thou¬ sands of new homes have been built in recent years are having increas¬ ing difficulties in financing school programs. Usually, these residen¬ tial communities rely entirely upon taxes on homes for local school support whereas other communities having establishments of business and industry in addition to homes have a broader tax base for local school revenue. These suburban residential communities are unable to secure tax revenue from business and industry in which their people are employed except as these are taxed by the State and the State funds redistributed to local school districts in proportion to measures of school need. Problems of financing the numerous suburban residen¬ tial communities indicate that a greater proportion of the revenues for education must be provided through State support funds to reduce the inequalities in the programs of education. Adoption of local nonproperty taxes. — As one solution to the diffi¬ culty encountered in approving larger budgets in local school districts, States are extending authority to levy local nonproperty taxes for school purposes. In response, hundreds of boards of education are considering and levying additional local nonproperty taxes such as sales taxes, payroll taxes, per capita taxes, and other local taxes on amusements, automobiles, cigarettes, hotel rooms, and deed transfers, as a means of securing additional revenues for schools. State assistance for school construction. — In 1950, only 19 States were providing assistance to local school districts for the financing of school construction, and these States were appropriating relatively small amounts compared to the capital outlay funds provided from local district sources. By 1958, the number providing this kind of assistance had increased to 35 States and 3 outlying parts of the United States. They are allotting to local school districts a total of 59 differ¬ ent funds for assistance in financing school facilities, and these funds are supplying about 9 percent of the total for school facilities. Federal funds for education. — The relatively small percentage of school support funds from Federal taxation revenues continues as a major subject discussed in financing education. Questions on this point deserve careful consideration. Does the Federal Government have an interest and obligation to raise the school support levels in States financially unable to support schools at a level acceptable to the people of the Nation? Has the total tax structure — local, State, 158 Department of Health, Education , and Welfare, 1958 and Federal — shifted to such an extent that the educational program in most of the States will not be supported at levels acceptable to the people unless the schools derive revenues in reasonable proportions from the tax sources available? Since the States have primary responsibility for public elementary and secondary schools, they provide funds and authorize local school districts to use local tax funds for public schools. For 1957-58, it is estimated that the Federal Government provided 4 percent, the States 41 percent, and local districts 55 percent of the total revenue for these public schools. In an effort to help States and local school districts with their school finance problems, the Office disseminates information through its pub¬ lications. One publication, entitled School Finance and School Busi¬ ness Management , provides an analysis of the school finance respon¬ sibilities and services in State departments of education. It should be useful in determining State and local policies on school finance and in reconsidering service rendered by the State educational agencies in school finance and school business management. Another publication, Federal Funds for Education , presents an analysis of 137 Federal programs in education provided by the various Federal departments, agencies, and offices. For these services in edu¬ cation, the Federal offices reported expenditures amounting to almost $2 billion for the 1956-57 school year. About 25 percent of these funds are administered by the Department of Health, Education, and Welfare and approximately 8 of this 25 percent by the Office. State School Administration The vast growth of public education has made it necessary for States to reorganize and revitalize their machinery for administering public educational programs. The outstanding development in this area in recent years has been the rapid growth of State departments of education, both in size and in professional stature. These depart¬ ments are staffed by highly trained specialists and technicians and are fast gaining recognition as State centers of educational leadership. The relationship between the Office and State departments has always been one of mutual assistance, and as problems and needs in education have increased, the cooperative relationship between the Office and State departments has become stronger. Much Office re¬ search and study are directed toward solving the problems State departments consider serious. In recent years the Office has made available basic information on the structure and organization of State departments, State boards of education, and on the various responsi¬ bilities of State departments of education. In fiscal 1958 the Office continued to develop and distribute information on State school Office of Education 159 administration and to provide advisory services to State departments of education and other State agencies. A few Office services are summarized below. A larger share of the American youth are being educated in non¬ public elementary and secondary schools. Nonpublic schools make reports to their private educational associations but very few to public education offices. Recognizing the need for more information on the nonpublic school, the Office conducted, in cooperation with the Study Commission of the Council of Chief State School Officers, a major study of State legislative practices relating to these institutions and published the findings under the title, The State and Nonpublic Schools. This study, the first of its kind ever made by the Office, describes the legal frame¬ work under which nonpublic schools are enabled to enjoy desirable freedom in their operation and are encouraged to provide educational programs in the public interest. In 1958 substantial gains were made in establishing and maintaining a sound basis for comparable educational information among States and among local school districts. By the year’s end, a number of States had incorporated into their accounting systems the standard classifications of the cooperatively developed handbook, Financial Accounting for Local and State School Systems , published by the Office in 1957. Several more had accepted the handbook’s recommen¬ dations and were putting them into practice. The Cooperative Project on Property Accounting for Local and State School Systems, begun in 1957, wTas advanced toward successful completion. Aimed at developing a property accounting handbook that will provide a firm basis for presenting information about school land, buildings, and equipment, the project moved through a series of national and regional conferences which utilized a great reservoir of experience from people in all regions of the country. Another facet of the problem of establishing comparable educa¬ tional data is the internal accounting for school activity money within individual schools — for example, money for athletics and school clubs. Millions of dollars are involved each year in school activity funds, but the lack of comparable data makes it impossible to obtain a clear picture of what is happening. The Office is therefore developing, in cooperation with a number of national educational associations, a handbook to standardize classifications and terminology used in ac¬ counting for school activity money and to provide guidelines to the handling of such money. School Building The people of the United States are spending billions of dollars on school construction, and Office records indicate that they are getting 160 Department of Health , Education , and Welfare , 1958 good value for their school building dollar. During the last 20 years costs of building materials and labor have increased 200 percent or more, but the cost of a classroom with related facilities has increased 150 percent. At the beginning of the school year 1956-57, there were 1,100,000 public elementary and secondary instruction rooms available in the continental United States. During the year, 68,800 new instruction rooms with related facilities were completed; and 16,300 were aban¬ doned because they had become obsolete or were not needed because of school district reorganization. In 1957-58 pupils were housed in 1.152.500 instruction rooms, which was 52,500 more than the number available in 1956-57. State departments of education reported that an additional 142,300 instruction rooms were needed, 64,700 to ac¬ commodate 1.9 million pupils enrolled in excess of normal capacity and 77,600 to replace rooms in unsatisfactory condition. A total of 70.500 classrooms in public schools were scheduled for completion during the school year. The 1.9 million children in excess of normal capacity were on half¬ day schedules, in overcrowded classrooms, makeshift facilities, or in rented quarters which were not designed for school work. Although the rate of school construction increased in 1958, the country still has a long way to go to remove the backlog, accommodate the increasing school enrollment, and take care of normal annual replacements. Since many groups — the general public, the Congress, the construction industry, economic analysts, and educators generally — need precise information, the Office has taken concrete steps to develop several new series of statistics for analyzing the progress of school construction from the fiscal standpoint. Data on bond sales for public elementary-secondary construction are being tabulated from standard statistical sources and analyzed each month to show the amount sold and the interest rates charged for each State. Data on school bond elections providing insight into an earlier stage of progress in financing school construction are being received from the Investment Bankers Association each month. Projections of the cost of public school construction in the years ahead have been made and are revised periodically as new data become available. In fiscal 1958 Office specialists assisted States and local districts in setting up criteria and procedures for school-plant maintenance and operation and periodic programs of renovation, rehabilitation, remodeling, and modernization. Since planning, construction, equip¬ ping, and management of the modern school plant require knowl¬ edge of many phases of building technology, including principles of design, construction, materials, management, and care, Office spe- Office of Education 161 cialists cooperated with technological organizations in a number of studies. Staff specialists also consulted with market analysts on school equipment, with State departments of education on the development of State guides to plant administration and on standards of per¬ formance of local districts, and with the Council of Chief State School Officers on developing a program of State school-plant serv¬ ices. They assisted State departments and local school systems in developing patterns of procedure in local school construction and essential long-range programs of school-plant planning and advised State and local officials on adaptation of housing to district reorgan¬ ization and curricular changes. In their research and studies specialists gave specific attention to the functional planning of school plants and to the effects of cur¬ riculum, instructional methods, and community programs on func¬ tional planning of school facilities, and to administrative facilities in school buildings and the selection of school sites. They made studies of elementary school-plant planning in cooperation with the National Council on Schoolhouse Construction. School District Organization The quality of a public school program depends in large measure on the size of the local school district, which is the area served by a single system of local school administration, usually a single board of education. The widespread reexamination of the public schools has stimulated efforts to improve local district organization. The funda¬ mental question back of reorganization is the ability of districts to provide modern educational programs. Can a small school district, usually defined as one enrolling fewer than 300 students, efficiently and economically provide a good school program ? A small school district has high per pupil costs and does not have a broad enough tax base to provide the school revenue it needs to employ a professionally trained administrator, to offer a varied curriculum, to build and equip science laboratories and a good library; to provide special services; or to employ and hold good teachers. Establishment of soundly organized local districts for administer¬ ing schools has long been a major problem in education. In the past 100 years some redistricting has been done in every State, but it has increased rapidly in recent years. Since 1945 the number of school districts has been cut drastically, from 103,000 in 1945-46 to about 54,000 in 1956-57, according to a Bureau of Census count. Responsibility for improving district organization rests with the States, for within constitutional limits a State legislature has com¬ plete power over district organization. However, most legislatures 162 Department of Health , Education , and Welfare , 1958 have not reorganized districts by legislative decree but have enacted laws prescribing procedures by which local people could take action. Since many laws have proved ineffective in reorganization, a move¬ ment has been underway for a number of years to make permissive- type reorganization programs more effective. To aid State and local school officials, laymen, and local planning groups, in 1958 the Office analyzed policies and procedures contribut¬ ing to or hindering success of programs carried on by States and pre¬ pared and published a manual of local planning techniques and proce¬ dures and a summary of State policies and procedures. School Boards Within the last few years the responsibilities of local boards of education have become heavy. As a result, the year 1958 brought an upsurge of interest in the work of local boards of education and in efforts to assist them in functioning more effectively. State school board associations have been established in every State and in some States they have 100 percent membership. State boards are becoming increasingly active; they are offering inservice training programs; publishing manuals, handbooks, periodicals; organizing workshops; maintaining close relationship with State legislatures ; and providing for visits between boards. Their operating budgets have been in¬ creased. Throughout the year the Office participated in the move¬ ment; staff members prepared and published an analysis of school board association periodicals and publications, and began work on an analysis of written statements of policies developed by boards. With a teacher shortage of major proportions, the need for sound personnel administrative practices and procedures continued to be important. Office specialists consulted with school officials on this aspect of school administration and began work on identifying specific personnel problems. After preliminary investigations they initiated a study of personnel handbooks and similar materials developed by local school systems and the organizational patterns for personnel administration. Office specialists analyzed a large number of surveys of school sys¬ tems to determine what standards for positions should be recommended for further testing and evaluation and began a study of State statu¬ tory provisions and factors in State school financing relating to posi¬ tions and services. Elementary Education The reawakening of interest in education and the determination of the people to shape their schools to meet the changing times and needs led elementary schools in 1958 to reassess their strengths and weak- Office of Education 163 nesses and to take a fresh look at some of their time-honored practices. The following paragraphs review briefly some of the developments and comment on current practices and needs in elementary education. ADMINISTRATIVE PRACTICE In the mounting variety of patterns and rapid growth of the size and numbers of elementary schools in recent years, certain established procedures and respected beliefs may have lost their original values. To this question, elementary education at large addressed itself during the past year. Among items of growing concern and increasing investigation were the following: Entrance age to school; class size and teacher-pupil ratio ; grouping policies as they relate to administrative management and to instructional programs ; pupil promotional policies ; reporting pupils’ progress to parents ; establishing bases for individual and group educational standards; effective educational guidance to pupils; pro¬ visions for meeting even wider ranges of individual pupil differences; increasing demands on the classroom teachers; effects of the shortage of qualified teachers and of inadequate school accommodations ; provi¬ sions for improving the efficiency of the experienced teachers; and the proper role of the school administrator as an educational leader. CURRICULUM School staff members responsible for leadership in determining ele¬ mentary school curriculum in the various school systems keep con¬ stantly in mind (1) the objectives of education in the United States, (2) emerging knowledge as it throws light on human growth and learning, and (3) the changing needs of our society. Last year, demands were made on elementary schools, as they were on others, for “more science,” “more mathematics,” and some in¬ novations were recommended without convincing proof of their value. The schools, with an eye on the continuing and basic needs of all children, attempted to meet these special demands. In many localities, curriculums were revised, special activities were organ¬ ized, and experimentation was widespread. Science in the elementary school, recognized as important by many educators over the past 25 years, was emphasized by schools, com¬ munities, and national organizations during 1958. Many schools in which science teaching had been more or less left to chance appointed curriculum committees to develop a science program. In elementary and high schools curriculum planners joined in urging that such programs be coordinated from kindergarten through the 12th grade. National organizations such as the National Science Teachers As¬ sociation, the National Association for Kesearch in Science Teach¬ ing, and the American Association for the Advancement of Science 164 Department of Health , Education , and Welfare , 1958 gave more time during their national meetings, more space in their publications, and more staff time to stimulating programs in ele¬ mentary schools than in the past. College science and education faculties in increasing numbers discussed the relation of science in the elementary school to the future supply of scientists and engineers. Recognizing the need for better understanding of other countries of the world, educators in elementary schools increased their efforts to encourage better teaching and production of better materials for use in the schools. Elementary schools in locations favorable to the development of fluency in a foreign language have traditionally taken advantage of their resources. Spanish, for example, has been taught in many southwestern schools and in Florida ; F rench in Louisiana and along the Canadian border in the northeast; German, Italian, and other languages according to the nationality predominance in the popula¬ tion and the availability of competent teachers. Recently, increased efforts have been made to locate and use resources in communities and colleges to teach children a second language. EDUCATION OF THE GIFTED OR TALENTED In the elementary schools improvement of education of the gifted or talented has taken three main directions: Grouping of gifted or talented, completely or partly; acceleration; enrichment in regular classrooms. Grouping of the more able children into special schools or special classes for only a part of the school day, ranging from an hour to a half day, has been tried in few localities. The plan of accelerating gifted children is also used in some com¬ munities, usually on a basis of individual selection, with careful guid¬ ance to insure that the child selected is not losing out in an important area of development. The method generally in use is that of enrich¬ ment in regular classrooms, with materials, methods, and experiences adapted to the abilities, interests, and needs of the learner. Serious handicaps to the success of this plan are, in many localities, the large numbers of students assigned to teachers, shortages of materials to meet variations in ability, and the reduced school day. EDUCATION IN GRADES 4-5-6 In response to repeated requests for information about the education of children in grades 4-6, the Office in 1958 completed a study of edu¬ cation in these grades. The report of the study interprets research in the characteristics and needs of 9- to 12-year-old children ; summarizes opinions expressed in 40 regional conferences involving, in all, ap¬ proximately 1,300 supervisors, principals, and teachers who deal with children of these ages in 415 rural and urban school systems in 35 States and the District of Columbia ; and analyzes observations in these Office of Education 165 grades in 68 of the systems. It also describes content of the curriculum and methods used in guiding children and in providing them with challenging experiences. Although the report shows that a variety of experiences are being used, it also shows considerable uniformity in content and in methods and that many schools are experimenting with new methods and in the use of newer materials and aids to teaching. The report points out situations that educators across the country have repeatedly brought to attention — situations in contemporary life that seem to place too great responsibility upon children of these ages. Some of the situations result from parents being absent from the home ; some from pressures of immature boy-girl dating; others from too great pressure on them to take part in too many in-school or out-of¬ school activities; or in some communities from scarcity of desirable activities. The study reveals how some schools seek home-school- community cooperation in dealing with the needs and problems of children. KINDERGARTENS The growth of kindergartens as a beginning unit of the elementary school shows marked progress. In a decade public and private kinder¬ garten enrollments had increased by 121 percent ; now, 46 percent of the 5-year-olds are in kindergarten in contrast to 28 percent in 1947. Children who live in cities of 25,000 and under have opportunities which only children in large cities had a little more than a decade ago. EXCEPTIONAL CHILDREN Even though States and local school systems still have much to do before programs for exceptional children will reach all of the 4 mil¬ lion who need them, the year 1958 saw major progress toward (1) extending school programs to serve more exceptional children, (2) acquiring more knowledge about exceptional children and the kind of instruction they need, (3) securing more and better qualified persons to teach and to give leadership in State and local school systems and in colleges and universities preparing teachers of exceptional chil¬ dren. Evidence of progress was seen in mounting school enrollments in special education, studies of the rural problem, multistate activities, and renewed efforts to coordinate the work of national organizations individually concerned with one of the various types of exceptional children. State education agencies, many of which had increased re¬ sources in funds and personnel, played a major leadership role in these developments. The extent and direction of this growth cannot be determined until the results of the current statistical survey of special education for exceptional children become available. The sharpest gains were undoubtedly made in the urban areas. 166 Department of Health, Education, and Welfare , 1958 Preliminary reports indicate that, of all the handicapped, the mentally retarded made the largest gain in school enrollments. It is not likely that such rapid advances would have been made without the organized support of parent and other lay groups at the local, State, and national levels, particularly as these groups have been encouraged by the National Association for Retarded Children. The lack of scientific knowledge about the various aspects of educa¬ tion of exceptional children has been generally recognized. Some information has been accumulated through the efforts of individual schools, clinics, and research centers in universities and large school systems, but the progress of valuable studies has often been hampered by lack of funds to carry forward the research needed. The avail¬ ability of funds for research has marked a turning point. Some progress was made in 1958 in securing adequate numbers of qualified special educators. The annual directory of special educa¬ tion staffs in State departments of education showed by far the greatest annual increase in such personnel since 1950, with the largest increase in supervisors of education for mentally retarded. Even in the face of a shortage of teachers much attention was being given to improvement of professional preparation of teachers for handicapped and gifted children. On this matter the Office published two more reports from its nationwide collaborative study. Secondary Education The discussion, study, and demand for more and better education in 1958 brought with them a growing realization of the importance of secondary schools to the Nation : that the strength of American life depends heavily on the strength of the Nation’s secondary schools and that there is a growing relationship between education and na¬ tional security, domestic and foreign policy. Although there were no sweeping reforms in curriculums and methods, many secondary schools did improve their programs through additions and the refinement of courses to meet more nearly the abilities, needs, and interests of pupils. Perhaps one of the most significant developments was the emphasis on programs and courses designed to challenge the capacities of talented pupils. This con¬ cern was reflected in the Office activities, State educational agencies, and professional organizations. In addition, numerous projects were concerned with reappraisal of course content and methods in science (particularly physics) , math¬ ematics, and modern foreign languages. Secondary school teachers, college and university professors, citizen groups, and Office spe¬ cialists participated in many of these projects. Office specialists fur¬ nished background information, national statistics, and professional Office of Education 167 advice. As the year ended, proposals of these groups were being applied and evaluated in selected secondary schools. Because of the new significance attached to foreign language study, the Office made an analysis of foreign language laboratories. Data for 1957-58 revealed that although 240 colleges had language labora¬ tories only 60 high schools had electronic equipment for drill in hear¬ ing and speaking the foreign languages offered. Schools which have used electronic equipment for developing aural-oral skills reported enthusiastically on it. A publication of the Office, Modem Foreign Languages in the High School , emphasized the importance of (1) in¬ creased offerings in modern languages in the high school, (2) longer sequences of study, and (3) greater emphasis on effective use of the foreign language. Problems , Needs , and Trends in Science and Mathematics In the past year attention was focused on the improvement of science and mathematics in the public schools and particularly, on the most critical problems in those fields. Brief background in¬ formation will perhaps point up the needs and clarify measures in¬ troduced to resolve some of the problems. CRITICAL PROBLEM AREAS AND NEEDS The accelerated pace at which wTe are moving toward a culture that is dominated by science and technology has placed new demands on the teaching of science and mathematics. To maintain our place of eminence in basic scientific research will require the training of an increasing number of scientists. At the same time the larger group of nonspecialized citizens will need more and better training in science and mathematics to be able to live effectively in the space age. Programs in science and mathematics education are closely related both to scientific manpower and to the available supply of teachers of these subjects. Recent statistics show that despite the great need for science and mathematics teachers fully one-third of those college graduates who are prepared to teach science and mathematics are lost to the teaching profession because the public schools are outbid for the services of the best qualified members of this group. We are failing to realize the fullest potential of a considerable por¬ tion of the academically talented youth. Two factors are basic to this problem: (1) The failure of many able young people to pursue their education beyond the high school and (2) the failure of the schools to identify academic talent at an early age and then make the best possible provision for its development. Solution of this problem 168 Department of Health , Education , and Welfare , 1958 is vitally necessary to our future scientific and technological well being and our national defense. One factor in the scientific shortage is the lack of effective guidance counseling. The school guidance counselor is a key person in a stu¬ dent’s choice of his school program and his career, yet fewer than 10 percent of the guidance counselors in the public schools have back¬ grounds of preparation in science and mathematics. The early identi¬ fication through testing and the proper guidance of young people with interest and ability in science and mathematics is therefore a problem of first priority facing educators. Both State and local departments of education are greatly under¬ staffed with consultants in science and mathematics. Fewer than ten State departments of education employ specialists in these fields, al¬ though most States provide at least one supervisor and sometimes more for music, art, and other subjects. Long-range improvement is impossible unless personnel are provided who can assume the initiative and responsibility for continuing programs. Most curriculums in science and mathematics have not kept pace with the rapid advances in these fields. There is a vital need for revis¬ ing and updating both the materials and the methods of instruction in science and mathematics. Instruction in science and mathematics requires specialized facilities and equipment, and teachers of these subjects must have the best of teaching aids, including textbooks, laboratory manuals, and audio¬ visual materials. In many places where science and mathematics are taught facilities and equipment are in critical shortage. These condi¬ tions will continue to be a bottleneck to any long-range improvement of teaching until they are remedied on a nationwide scale. SURVEY OF SCIENCE AND MATHEMATICS MAJORS To provide early information on the probable supply of profes¬ sionally trained scientific manpower, the Office, in consultation with the National Science Foundation, initiated a nationwide survey of junior year men and women majoring in science and mathematics in colleges and universities. The major fields listed on the survey ques¬ tionnaire correspond to the major fields used in the Office annual survey of earned degrees. As the junior-year survey is repeated, annually or biennially, the data will provide the basis for future projections of number of bachelor’s degrees, information on changes and trends in science and mathematics majors, and on “dropout rates” in the various scientific fields. The first reports of the survey showed that in November 1957 ap¬ proximately 50,500 junior-year students were majoring in science or mathematics, or 12.9 percent of all junior-year students. On the basis Office of Education 169 of the survey, it is estimated that between 40,000 and 45,000 persons will earn bachelor’s degrees in science and mathematics in the 1958-59 school year as compared to 33,800 in 1956-57. TRENDS IN TEACHING There is very little available information on the national level deal¬ ing with the general status of science and mathematics teaching. A few studies on limited aspects of the problems have been made by certain States, but the most recent nationwide data are now nearly 10 years old. The current interest in improving education in these sub¬ jects has directed attention to the need for information on the present status of science and mathematics teaching. To provide such in¬ formation, the Office, during the past year, planned a series of compre¬ hensive studies on the status of science and mathematics in public high schools, in public junior high schools, in public elementary schools, and in teacher education institutions. Before the year ended the first of these studies was in progress. Data were obtained from school principals and from teachers of science and mathematics in a representative sample population of the high schools. The questionnaires used in the study covered most of the major problems in each field. In 1954 the Office conducted a study which provided useful in¬ formation on offerings and enrollments in science and mathematics. The study was repeated in 1956, and a small but encouraging improve¬ ment was found in enrollments, both in science and mathematics. The rapid advances in science and mathematics over the last few years have created a need for updating the training of high school teachers of these subjects. A number of associations and agencies are sponsoring or conducting programs to meet this need. The National Science Foundation has for the past few years made large grants of money to colleges and universities for conducting summer and aca¬ demic year institutes for high school and college teachers of science and mathematics. This agency is now planning an expanded pro¬ gram which may offer institutes for teachers in the junior high schools and for elementary school supervisors. The American Association for the Advancement of Science, in cooperation with the American Association of Colleges of Teacher Education, is conducting a pro¬ gram for the improvement of teacher education in science and mathe¬ matics. The Office maintains close cooperation with such projects. During the past year the Office of Education, in cooperation with representative scientific, mathematical, and educational organiza¬ tions, held a national conference on the curriculum in high school science and mathematics. The report of this conference sets forth guidelines for improving the teaching of science and mathematics. 487270—59 - 12 170 Department of Health , Education , and Welfare , 1958 The Office gave considerable attention last year to identifying, guiding, and providing for the academically talented student in sci¬ ence and mathematics. Specialists in these subjects participated in a conference held by the National Education Association on problems of the talented student, and the Office published a study on the prob¬ lem as it relates to science and mathematics. Over the country there appears to be a trend toward developing and providing better facilities, equipment, and teaching aids in science and mathematics. In 1958 both the National Education Association and the Office of Education conducted research studies related to facilities and equipment. In addition to the two national programs several experiments are being conducted by other groups in teaching science and mathematics by television. In response to the need for focusing research on improvement in teaching mathematics and science, the Office published a bulletin in each field which analyzes and interprets the current research. In addi¬ tion, Office specialists in these subjects worked with other organiza¬ tions in defining the unresolved problems and in discussing research studies needed to solve them. Retention of Students The Department of Labor predicts that by 1965 the United States will probably need 45,000 more doctors, 75,000 more college-trained nurses, nearly 500,000 more elementary and high school teachers and 120,000 more college teachers ; and that skilled trades will need 250,000 more trained workers each year just to maintain the present skilled force. Our schools and colleges must prepare persons to fill these needs, yet each year millions of young boys and girls drop out of high school, and others who complete high school do not go on to college. A number of recent studies show the seriousness of the education problem. One study made by the Educational Testing Service, Prince¬ ton, N. J., for the National Science Foundation, found that between 60,000 and 100,000 of the highly able high school graduates with apti¬ tude and interest in college do not go because of financial reasons but that a group of the same size and ability do not go because they lack interest and motivation. That means that one-third of the top 30 percent of high school graduates, between 120,000 and 200,000, do not continue their education — a serious waste of intellectual resources of the Nation and a serious loss to the students who are shutting the door to occupational opportunity and the rewards of intellectual achieve¬ ment. In addition to the loss of superior students who graduate from high school but do not go on to college, considerable numbers of students of high ability drop out of high school before graduation. A nationwide study conducted by the Office, covering the period 1950-54, indicated that during this 4-year period about 300,000 high Office of Education 171 school graduates who wTere in the top 30 percent of their classes did not go on to college. An additional 240,000, also in the top 30 percent, attended only night school or other irregular college classes. Further¬ more about 1 in 4 students who enter college drop out by the end of the first year. Altogether about 6 out of 10 who enter college are graduated. The Office study found that more than one-fifth of those who dropped out were in the top 20 percent of their high school grad¬ uating classes. Since the high schools must prepare students for college and since the greatest loss of students occurs at the 10th or 11th grade level, they must make the major effort to hold students, particularly the academi¬ cally talented. On the average from 15 to 20 percent of the high school students may be classified as academically talented. Studies, research, and surveys have found that some measures can reduce such loss. They are ( 1 ) improved testing of student aptitudes and use of cumulative records so that potential ability can be identified at an early stage of education; (2) skilled counseling and guidance to en¬ courage students to stay in high school, to prepare for college, to se¬ lect academic courses suited to their talents; (3) united community effort to get students to return to school; and (4) scholarships. GUIDANCE AND COUNSELING Although the teacher still has the primary responsibility for helping pupils attain their maximum development she cannot be expected to provide all the services required in modern education. And even if teachers had the time to provide all necessary services, many services require technical training which some teachers have not had, for ex¬ ample, administering and interpreting standardized tests. To aid the teachers and to provide for students, more and more schools are employing guidance counselors. Guidance counselors are specialists who identify individual differ¬ ences, give tests to determine students’ abilities, aptitudes, and talents and to measure their progress ; advise them on choice of courses and vocations; help them solve their mental, physical, or emotional prob¬ lems; and estimate the educational needs of the community and methods of meeting them. Guidance counselors work closely with parents, teachers, school administrators, and local recreation and wel¬ fare officials. Guidance specialists in a school system, working closely with the teacher can provide information essential to making adaptations, such as special classes for the gifted or retarded, special equipment and in¬ structional materials, and special group procedures in the classroom. In other words the guidance counselor helps the teacher identify special needs and abilities, interpret them, and provide the kind of education needed to meet them. In the high school he helps the stu- 172 Department of Health , Education , and Welfare, 1958 dent, in consultation with his parents, plan his educational program, high school, vocational, and college; informs him of occupational opportunities; and helps him make a satisfactory transition from school to work. School people in general agree that schools should have 1 counselor to every 300 students, but in the country as a whole we have the equivalent of about 12,000 full time counselors for 8 y2 million students or 1 to every 710. Experience has shown that testing is valuable in guiding students into educational programs and careers suited to them and in measur¬ ing student abilities. A study by the Educational Testing Service found that even among the top 10 percent of high school graduates 1 out of every 5 picked on the basis of grades alone as having abilities in engineering did not live up to expectations in college, but that of the students selected on the basis of scholastic aptitude tests in com¬ bination with analyses of high school grades, only 1 out of 12 did not do as well as expected. Other studies support this finding. Only 6 States require that public schools maintain cumulative records on their students. Yet millions of children change schools each year. During 1956, the last year for which a record is available, of the total population of 38,210,000 children between the ages of 5 and 17 years, more than 7,000,000 moved from one place to another. In all States and Territories an official of the department of educa¬ tion is responsible for guidance services, for helping local schools improve their programs; 20 years ago only New York State had as¬ signed a person to such work. The number of States that have estab¬ lished certification standards for guidance workers has increased by 25 percent in the past year, from 32 in 1956 to 40 in 1957. Most States require a State teaching license and a master’s degree, or equivalent, in guidance training for certification. The trend in the use of guidance counseling has been upward for several years, and there are indications that it will continue upward, for the increase in juvenile delinquency, in the number of working mothers, and in the complexity of life will progressively call for the employment of more people who understand children. As a result of the increased interest the Office received many re¬ quests for educational and occupational information — on methods of improving counseling techniques, techniques of attacking the school- retention problem, on student personnel services in institutions of higher education, and on inservice and preservice education of teachers. In addition to responding to requests for service and con¬ sultation, the Office conducted a number of studies during the year, including studies of the retention of students in high schools in large cities, individual analysis in educational and vocational guidance, preparation of guidance and student personnel workers, effective Office of Education 173 guidance practices in local schools, certification requirements for guidance workers, and the organizational pattern of student person¬ nel programs. Specialists in guidance prepared and distributed pamphlets, circulars, and leaflets on occupational and educational information. Audiovisual Aids to Education Education is now benefiting from increased use of audiovisual aids, including films, radio and television, recordings, slides, pictures, charts, maps, and others. Research and experience have shown that such aids, particularly television and films, used by capable teachers as supplement to classroom instruction, are of value in making teach¬ ing more effective. Educational television has many uses. It can be used effectively by administrators, local boards, and others to present their ideas to local communities and to gain community support for school programs. It can be used to improve classroom teaching, for even a few courses taught by master teachers and put on film can stimulate teachers by suggesting new methods and ideas. It can be used to give in¬ struction to the homebound and to adults. And last, and perhaps more important, it can be used in the classroom. Educational uses of both radio and television showed substantial gains in fiscal year 1958. Eight educational FM radio stations com¬ pleted within the year brought the total on the air to 201, and the number of educational television stations on the air increased from 29 to 32, with 4 others nearing completion at the end of 1958. More¬ over, most of these stations were operating maximum broadcast schedules. Especially significant was the increasing emphasis on direct- teaching use of television. Over 600 credit courses — elementary and high school courses for in-school viewing and high school, college, and adult-education courses for home viewing — were broadcast on television in 1958, an increase of nearly 50 percent over 1957. More and more city school systems used air time made available to them by local commercial TV stations for broadcasting regular school subjects. Research and experimentation in teaching by television are being directed, increasingly, towards methods of TV-teaching, instructional content, lesson format, and instructional organization. In all, 160 ex¬ periments were being made. Perhaps the most comprehensive project at the public school level is the Washington County, Maryland, Proj¬ ect at Hagerstown; it involves direct teaching of the four basic 174 Department of Health , Education , and Welfare , 1958 subjects, plus music and art, at all grade levels, intermediate through high school, on a countywide basis, by closed-circuit television. Even though there is widespread recognition that radio and tele¬ vision have added new dimensions to teaching and even though ex¬ perience has shown that their value depends on the skill, imagination, and flexibility of the teacher, many teachers are not using such aids and students preparing to teach are not being taught to use them. Further research is needed on the application of the new techniques. The Office cooperates with organizations and groups concerned with educational television, issues directories of university courses and school participation, publishes bibliographies and listings, and provides other services to applicants for educational channels, advises on organization and finance, and reviews the results of uses of educa¬ tional television. It also maintains close contact with most of the groups conducting research and experiments, and staff members par¬ ticipate in workshops training teachers to use educational television. The Office called a National Conference on Educational Television, May 26, 27, and 28, 1958. Participants from the 51 national organi¬ zations represented pointed up new developments and trends and attempted to identify broad principles that might serve as guidelines to future developments in television. As part of its program to strengthen State and local educational resources of audiovisual aids, the Office prepared a directory of 16mm film libraries, identifying 3,660 such loan and rental sources; pre¬ pared directories of key audiovisual staff members in the Federal and State Governments and in large city public libraries and school sys¬ tems. Staff members continued work on studies of audiovisual education in State departments of education and in large city school systems; continued to provide services related to the audiovisual materials of the U. S. Government, including cataloging new films for Library of Congress cards, administering the Government’s contract covering the sale of films, and sponsoring a seminar on the problems of governmental production and use of films. Vocational Education In fiscal 1958 a total of more than $40 million in Federal funds was distributed to the States and Territories to aid vocational education of less than college grade in agriculture, home economics, trade and in¬ dustry, the distributive occupations, the fishing trades and industry, and practical nurse education. In 1958 enrollment in vocational classes exceeded 3.5 million, the largest number of students ever enrolled in vocational education. Of the total about half were in secondary schools, grades 9 to 12; the Office of Education 175 others, adults who had left the full-time secondary school, were in part-time and evening classes. Current social, economic, and industrial conditions focussed atten¬ tion on vocational education in 1958. The changing characteristics of agriculture, the increasing industrialization of industry, and the in¬ creasing numbers of women in the labor force all led to new demands for programs and for expansion of existing programs in vocational education. Programs of vocational education designed to prepare persons for useful employment in specilic occupational fields require that the instructors have the abilities and skills of workers in the occupations. Securing such workers to serve as teachers becomes an acute problem because many of them have greater earning opportunity in their oc¬ cupational field than in schools as teachers of vocational subjects. There is a constant need to change the vocational curriculum of the schools to keep programs abreast of the times. The rapidity with which changes are being made is perhaps more pronounced than in any other decade. Since such changes make new demands on teachers and on colleges and universities, inservice training must be provided for employed teachers to help them make the adjustments needed. Throughout the year the Office cooperated with vocational leaders in their efforts to provide efficient and effective programs. A few Office activities are summarized below. After months of work with the States the revision of policies for the administration of vocational education was completed and the revised statements were published. Administration of Vocational Education in Practical Nurse Training was issued to assist States in developing practical nurse training programs under provisions of Public Law 911, 84th Congress. The National Advisory Committee on Practical Nurse Education, which held its first meeting in January, submitted a report to the U. S. Commissioner of Education making suggestions for the administration of the practical nurse education program. Other studies included: A nationwide survey of farm mechanics teaching in vocational agriculture to determine the current status of such programs and the need for improvement ; a status study of pro¬ grams in vocational agriculture for young farmers, in cooperation with the American Vocational Association, to identify characteristics of successful programs ; a review of unpublished theses in home eco¬ nomics to identify research techniques and findings of value to home economics education; a long-range cooperative research study of characteristics of prospective teachers as related to success in teach¬ ing home economics; a research report on the placements of coop¬ erative part-time students in distributive education, in cooperation 176 Department of Health , Education, and Welfare, 1958 with the Central Begion Association of State Supervisors and Teacher Trainers of Distributive Education; a study of effective practices in both adult and cooperative distributive education pro¬ grams in metropolitan areas; and a series of studies of cooperative students employed in hazardous occupations, in cooperation with the Bureau of Labor Standards, U. S. Department of Labor. Adult Education In response to the need, various groups throughout the country are sponsoring adult education programs, among them, public school sys¬ tems, industry, labor unions, the Armed Forces, farm organizations, and civic associations. Most of the groups hold to at least one or more of the following purposes: To help the individual adult remedy the defects and fill gaps in his earlier schooling ; to show him how to function effectively in a rapidly changing world ; to help him understand and adjust to changes that take place in him as he grows older; and to develop in him the desire for continued self-improve¬ ment and self-fulfillment. In their efforts to provide interesting and informative programs, these groups are being encouraged and aided by public libraries, institutions of higher education, churches, radio and television systems, and Government agencies. One of the most significant developments in recent years has been the growth of adult education programs in the public school systems. By statute and regulation many States specifically authorize the establishment of such programs, and in States where no specific statutory authority exists, public school districts are providing for the educational needs of adults. In every State some districts are conducting public school programs for adults. They are of five main types: (1) Americanization of aliens; (2) elementary grade classes; (3) high school grade classes; (4) general education classes; and (5) education and training in arts, crafts, and recreational skills. One or more of the five types are now provided for in the statutes and regulations of 47 States. Public school classes for adults are generally financed by a combina¬ tion of ways — by State aid, authorized if not appropriated ; by local school funds but no State aid ; by other public funds or private funds but no school funds, State or local; and by State and Federal funds made available for vocational education. A majority of the States require that teachers of adult classes be certified by the State, and most of them require that teachers who give courses for credit have a reg¬ ular teacher certificate. There is widespread evidence that in 1958 vocational education, college extension, and many other groups improved their programs, Office of Education 177 increased enrollments, and, in general, made better provisions for meet¬ ing the needs of adults for education. An estimated 9 million persons attended adult education classes, according to a national survey, the first of its kind. It was conducted by the Bureau of the Census at the request of the Office of Education and financed by a $10,000 grant from the Fund for Adult Education. The survey covered only organized adult classes and series of adult education meetings. It is estimated that altogether between 30 and 35 million adults participated in all kinds of adult courses, including correspondence, individual instruction, private lessons, one-time group meetings, courses offered on radio and television, self-directed study, on-the-job training, and training conducted by the Armed Forces. The Office of Education served adult education in a number of ways: By publishing articles; participating in national, State, and local meetings, workshops, and conferences; consulting with State and organization leaders and with officials of other Government agencies. Staff members completed three important studies: (1) The report of the national survey made by the Bureau of the Census in their Octo¬ ber 1957 population survey; (2) a study of adult education services, goals, plans, and programs of State departments of education; and (3) a bibliography of education for the aging, the first to be pub¬ lished in this country. And they prepared a publication, Adult Ed¬ ucation in Amencan Education Week, copies of which were distrib¬ uted by the National Education Association in 10,000 kits to public school and community leaders. The Office assisted the Federal Council on Aging and the Special Staff on Aging of the Department of Health, Education, and Welfare in survey of services and programs for the aging ; a number of univer¬ sities and colleges and the Joint Federal State Council on the Aging in a series of conferences; and the National Association of Public School Adult Educators in sponsoring a National Institute for State directors of general adult education to stimulate enrichment of public school adult education curriculums. A staff member continued to serve as consultant to the National Commission for Adult Literacy, a non-government agency established by the Adult Education Asso¬ ciation of the U. S. A. International Education Today, our children need to learn more about the world than many of them are now taught; they need broadened training in languages, natural science, the social sciences, and the humanities; and they particularly need to learn more about the non- western world. 178 Department of Health , Education , and Welfare , 1958 One of the traditional responsibilities of the Office of Education is to help Americans understand international developments in educa¬ tion. A more recent Office responsibility is to mobilize and service American educational resources for the improvement of international understanding and for technical assistance to the emerging nations. International educational exchanges have become a primary means of maintaining a climate of public opinion overseas favorable to the United States and towards American policy. Each year, thousands of Americans are sent overseas, and even larger numbers of persons from other countries are brought here to study, to do research, to lecture, and to observe in the expectation that they will learn to understand us and will remain our friends when they return. There is a growing American population overseas. Thousands of American teachers are annually recruited to staff schools for Ameri¬ can children around the world. Such demands are being met through a series of programs, both Federal and private, although they repre¬ sent a growing drain on strained educational resources. OFFICE ACTIVITIES When the Soviet Union launched the first man-made satellite, Americans suddenly became aware of the immense technical progress achieved in the USSR. Furthermore they realized that progress was founded on Soviet education. Since Soviet education is a rapidly evolving enterprise, continuing research and personal observation by American educators of Soviet schools are required. In recognition of that need a representative of the Office went to Moscow to arrange, in cooperation with the De¬ partment of State, for an interchange of books and other educational materials and of teams of 10 educators between the U. S. A. and the USSR. Some of the materials received from Soviet authorities have contributed to our understanding of education as an instrument of communist policy. This growing collection is a center for research on Soviet education, since the Office makes available to the public in¬ formation on Soviet education. The American team, headed by the U. S. Commissioner of Education, completed its visit to the Soviet Union and will issue a report of its findings in fiscal year 1959. A Soviet team is expected to arrive here during the 1959 fiscal year. Research in comparative education was continued to provide au¬ thoritative information needed by other Federal and State agencies, educators, leaders in international programs concerned with education, and the general public. Special reports on education in 10 foreign countries (Burma, Ghana, Indonesia, Iran, Iraq, Pakistan, Sudan, Thailand, Turkey, and Viet-Nam) were prepared for use in a U. S. Government project concerned with educational activities abroad to which the U. S. Gov- Office of Education 179 ernment or private agencies contribute funds. Work was continued on studies started in 1957 including bulletins on education in Brazil, Haiti, Israel, and Japan; comparative education bibliographies; the teaching of professional education subjects in northern Europe; and the functions and organization of ministries of education in nearly 70 countries. New studies were started on teacher education in cer¬ tain European countries and on education in the Soviet Zone of Germany. The Office exchanges its studies with educational organizations and institutions abroad, ministries of education, and other foreign gov¬ ernment agencies. Requests for additional copies and for permission to use our material reflect widespread interest. The Office of Education interprets foreign educational credentials as a service to agencies, to U. S. citizens who have studied abroad, and to foreign citizens. The Office provides this service by analyzing data in some 40 languages and by maintaining and developing ac¬ cess to information on education around the world. The responsibilities of the Office have increased in size and geo¬ graphic coverage. By the close of fiscal year 1958, thousands of vet¬ erans and unnumbered other United States citizens had studied abroad. More than 40,000 foreign students were enrolled in U. S. educational institutions. Requests for assistance increased from 2,283 in 1946-47 after postwar exchange programs had begun to oper¬ ate to 4,070 in 1957-58. One of the most important developments during the year was the application of the United States Government for membership in the International Bureau of Education. Since the Bureau is an inter¬ national center of educational research and provides for a wide exchange of information, the Government has sent delegates to many of the annual International Conferences on Public Education at Geneva, which are cosponsored by the International Bureau of Educa¬ tion and by the United Nations Educational, Scientific, and Cultural Organization, but the U. S. delegations have not enjoyed the full privileges and benefits that membership insures. Office specialists in many fields prepared information for publica¬ tion by the United Nations and contributed to UNESCO reports. The Educational Materials Laboratory expanded its services and undertook new ones. The Office cooperated with the International Cooperation Administration in developing educational materials for use overseas. A 6-month workshop was organized, in cooperation with George Washington University and the ICA, in which 20 teach¬ ers, writers, and illustrators from 13 countries of Asia, the Near East, Africa, and Latin America participated. They were selected and financed by ICA. The program included (1) orientation to educa- 180 Department of Health , Education , and Welfare , 1958 tion in the United States, (2) lectures and field trips, (3) planning and writing individual projects, and (4) two group projects: The Workshop Sampler and The Workshop Weekly. The laboratory acquired some 1,500 items of educational material, consulted with visitors, and responded to requests for assistance from American teachers in locating teaching aids for developing interna¬ tional understanding and knowledge of world affairs and from edu¬ cators abroad seeking information on U. S. educational materials. The Office provided the Department of State with statistical tabula¬ tions on government-sponsored grantees entering and leaving this country during the year, a service it has given annually since 1952, including numbers and types of grantees by country of destination or origin, State of origin or destination, fields of specialization, age groupings, and veterans’ status. In addition to providing this information, the Office prepared rec¬ ords giving the name, address, category, specialty, occupation, and institution of placement of every foreign grantee entering this coun¬ try during 1958. In 1958, the Office of Education continued its assistance to the Inter¬ national Cooperation Administration by arranging training programs for 644 participants from 47 countries, an increase of 102 participants over fiscal year 1957. The largest number of participants came from Thailand and Indonesia. The participants included elementary and secondary school teachers, university professors, educational super¬ visors and administrators at local, provincial, and ministerial levels, and represented a variety of fields. They came to the United States for periods of training ranging from 2 months to 2 years, but the majority of them completed programs of approximately 11 months. There was an increase in the number of special projects to meet the needs of special groups. These included 11 Japanese professors in university-industry relations, 10 Brazilians in secondary education, 9 Guatemalans in secondary education and administration, 7 Spanish professors in technical education, 6 Korean administrators and super¬ visors in trade and industrial education, 5 Vietnamese professors in the organization and administration of higher education, and 3 Somali officials in elementary and secondary educational administration. During Christmas vacation, 150 participants attended special cul¬ tural programs designed to promote an understanding of American life. The largest program was at the Center for Continuing Edu¬ cation of the University of Georgia for 66 educators from 8 countries. The Office cooperated with the International Education Exchange Service, Department of State, in arranging educational programs for 352 visiting educators from 54 countries during the year. Included were 27 teachers and administrators from Central America who took Office of Education 181 part in a special 30-day teacher development workshop at the Uni¬ versity of Puerto Rico. The regular program consisted of two groups in elementary education, five in secondary education, five in English as a second language, two in American civilization, one in vocational education, and one seminar in elementary and secondary education. The considerable interest of educators from abroad in coming to the United States to observe educational practices through this pro¬ gram is indicated by the number of applicants for the limited number of grants available in some countries. For example, in Norway, 115 teachers applied for 6 grants; in Japan, 604 teachers and administrators applied for 25 grants ; in Singapore, 129 teachers applied for 4 grants; in Italy, more than 400 educators applied for 27 grants; and in Egypt, 70 teachers applied for 9 grants. The 30-day teacher development workshops conducted in Spanish at the University of Puerto Rico have attracted great interest among Latin American educators. During the program year, arrangements were made for more than 550 American teachers to participate in teacher exchanges. Among these were the first teacher interchanges between the United States and Cuba. For the first time, American teachers of Spanish were selected to participate in a summer seminar in Colombia, and Ameri¬ can history teachers were selected for a seminar in Italy. Over 40 countries, including Colonial Areas of the United King¬ dom, now engage in teacher exchange activities with the United States, and there are six summer seminars for American teachers. A seminar for American school administrators was announced during this year; 20 American school administrators will study educational systems in France and The Netherlands early in 1959. Evaluative studies and statements in superintendents’ reports in¬ dicate that exchange teachers have been remarkably successful in promoting a better international understanding. American educa¬ tional associations are showing increased interest in having foreign educators participate in their conferences and annual conventions. The Office provides services to visitors from many countries who are not participants in official programs. These visitors are referred to the Office by other Government agencies, by foreign governments, by educational and other agencies, or they visit the Office on their own initiative. The Office of Education continued to work with the International Cooperation Administration in the development of technical assist¬ ance programs in education in 45 countries. The Office also utilized the competencies of its specialized staff in furnishing technical support on special educational problems of these educators in the countries where they work. This professional 182 Department of Health , Education , and Welfare, 1958 assistance included the provision of Department publications of gen¬ eral and special interest to overseas educational specialists ; annotated summaries of recent educational materials; and assistance on a va¬ riety of educational problems. Higher Education Numerous studies of population growth and projections of school and college enrollments leave no doubt that higher education will be confronted with unparalleled opportunities and with enormous re¬ sponsibilities in* the years immediately ahead. Enrollments in the colleges and universities will reach 6 million by 1970, about double the number enrolled in the fall of 1957. During this brief period, faculties will have to be increased and facilities expanded to provide programs of quality and diversity adequate to the new demands. Colleges will have to recruit annually, on the average, between 15,000 and 22,500 new teachers to keep pace with growing enrollments and to fill vacancies created by resignations and retirements. The grad¬ uate schools now award doctorates to about 9,000 persons annually, but only about half of them enter college teaching; the other half go into government, business, or industry. A large percentage of new college teachers will have to be recruited from the ranks of those who do not hold the doctor’s degree. In fact, the percent of new full-time college teachers employed in 1956-57 holding the doctor’s degree was 23.5 compared with 40.5 percent of full-time teachers in 1953-54 who held this degree. The employ¬ ment of less well qualified teachers at a time when enrollments are rising rapidly threatens the quality of higher education. This manpower situation is intensified by the even greater need for qualified teachers in the elementary and secondary schools. In 1957-58 there was a shortage of 135,000 teachers in public and non¬ public schools. More than 91,500 teachers, or about 6.5 percent of the total teaching staff in the elementary and secondary schools, were emergency teachers, which means that they did not meet the State’s requirements for the lowest teaching certificate. Turnover among teachers was high — about 7.5 percent of the qualified teachers. This does not include teachers who moved from one teaching job to another. Colleges and universities must therefore expand their own teaching staffs and at the same time increase the flow of qualified teachers into the elementary and secondary schools from a common manpower res¬ ervoir of college graduates. To provide information on what some institutions are doing about the shortage, the Office has under way two special projects: One on procedures employed by colleges and universities to meet faculty shortages and the other on salaries and conditions affecting faculty services. In addition it has initiated a survey of beginning teachers. Office of Education 183 USE AND EXTENSION OF FACILITIES The growing pressures of college enrollments require the maximal use of existing facilities and the development of well-considered plans for expansion. Studies already made show that generally with more efficient space utilization a considerable increase in enrollments could be accommodated in present classrooms and laboratories. To provide precise information on a national basis about present facilities and future needs, the Office is making a comprehensive inventory of col¬ lege and university physical facilities. It has also undertaken a study of summer sessions on the use made of facilities during the summer months. This study will also provide information on pro¬ grams, use of faculty, and other phases of summer institutional operations. One important means of providing for increased enrollments is the establishment of junior or community colleges. State and local boards of education and citizens’ groups need criteria by which to decide when, where, and under what conditions a junior college or community college can and should be established. The Office has undertaken a study to produce such criteria. DEVELOPMENT AND MODIFICATION OF EDUCATIONAL PROGRAMS Studies of educational programs offered have been completed or are under way as follows: Engineering enrollments and degrees granted; social science requirements in bachelor’s degree programs irrespective of major subjects; 5-year programs for the preparation of secondary school teachers ; organized occupational curriculums and enrollments; and college and university programs in business and public administration. IMPROVEMENT OF ORGANIZATION AND ADMINISTRATION As college enrollments increase, the magnitude and complexity of institutional operations will also increase. Moreover, as State-sup¬ ported institutions expand their programs, the coordination of de¬ velopments within a State becomes increasingly important. Prob¬ lems of organization and administration to promote high quality pro¬ grams and at the same time achieve efficiency and economies within an institution also demand consideration. To aid State boards, State legislatures, and the boards and administrations of individual in¬ stitutions in dealing with such problems, the Office has under way a number of projects, some new, some continuing or recurring. Espe¬ cially noteworthy are the following : 1. A study of the structure and functions of State boards responsible for the coordination and control of institutions of higher education. 2. An annual analysis of legislative enactments and proposals for legislation by State legislatures. 184 Department of Health , Education , and Welfare, 1958 3. A round-up report on the efforts of voluntary agencies and associations to plan and coordinate interinstitutional activities. 4. An analysis of the processes and procedures by which administrative policy in higher education is determined at both the State and the institutional level. ASSISTANCE IN PLANNING AND CONDUCTING SURVEYS The demands for higher education and the resources for meeting these demands vary widely from one State to another. Each State must therefore appraise its resources and facilities in higher education in relation to its future needs. The Office is called upon repeatedly to assist in designing such studies, to suggest competent staff to conduct the studies, and to read and evaluate reports of the studies. Occa¬ sionally, as time permits, the staff members assume responsibility for making a survey. LEGISLATIVE PROPOSALS In July 1957 the President’s Committee on Education Beyond the High School, appointed by President Eisenhower in the spring of 1956, issued its Second Report to the President . The Committee’s final report makes 47 recommendations dealing with the need for col¬ lege and university teachers, the need for financial assistance to stu¬ dents, the expansion and diversity of educational opportunities, fi¬ nancing higher education, and the relation of the Federal Govern¬ ment to education beyond the high school. Immediately after the Committee issued its report Secretary F olsom appointed a task force on higher education consisting of members of his staff and of the staff of the Office of Education, with the Commis¬ sioner of Education as chairman, to review the findings and recom¬ mendations of the Committee, to consider its implications for the work of the Office and for legislation, and to develop a program of legislation. The task force carefully devised proposals for legislation on education which were presented to the President and approved by him. The proposals, introduced in both branches of the Congress in January 1958, were for financial assistance for students in higher education; aid for foreign language institutes and for foreign language centers to teach languages for which instruction is not readily available but which is needed in the United States; aid for fellow¬ ships and the expansion of graduate education ; assistance for strength¬ ening science, mathematics, and modern foreign language instruction in public schools; aid for guidance, counseling, and testing of stu¬ dents in secondary schools; and assistance to State departments of education for the improvement of statistical services. At the end of the fiscal year the proposals were being considered by the Congress and widely supported by the public. Office of Education 183 RESEARCH AND STUDIES IN HIGHER EDUCATION Among the Office reports and studies in higher education made during the year are the following : A directory of higher educational institutions ; baccalaureate degrees conferred by American colleges in the 17th and 18th centuries; survey of State legislation relating to higher education, July 1, 1956 to June 30, 1957 ; organized occupational curriculums, enrollments, and graduates in 1956 ; and financial aid for graduate students and for undergraduates. Assistance to Schools in Federally Affected Areas Public Laws 874 and 815 were enacted by the 81st Congress in Sep¬ tember 1950 to provide Federal assistance to school districts on which activities of the United States had placed serious financial burdens. Public Law 874 provides assistance for current operating expenses and Public Law 815 provides assistance for school construction. In general these two laws recognize as a financial burden the education of children who reside on, or reside with a parent employed on, tax-ex¬ empt Federal property such as military bases, atomic energy installa¬ tions, reclamation projects, Indian reservations, and National forests. Where Federal contract activities with private plants cause a sud¬ den and substantial increase in school enrollment, Federal assistance is authorized if the school district can show budgetary need for the Federal funds. Approximately $126 million was paid to school districts under P. L. 874 in fiscal year 1958, on account of 140,000 children who resided on Federal property and 1,110,000 children who either resided on Federal property or resided with a parent employed on Federal property. This is a slight increase over fiscal year 1957 in the number of children for whom payments were made and an increase of approximately $14 million in payments. These were attending school in 3,330 school dis¬ tricts which had an estimated enrollment of 7.75 million children, or about one-fourth of all children attending public elementary and secondary schools in the United States. The table below presents the significant figures for the 8 years the program has been in effect. Fiscal year Number of eligible applicants Net entitle¬ ments of applicant dis¬ tricts— all sections Total current expenditures of applicant districts Percent of total current expenditures financed by P. L. 874 funds 1951 _ 1,172 $29, 000, 000 47, 815, 000 $520, 370, 000 825, 926, 541 1, 040, 424, 071 1, 284, 960, 000 1, 450, 700, 000 1, 754, 530, 000 2, 156, 450, 000 *2, 500, 000, 000 5.6 1952 _ 1, 763 5.8 1953 _ 2, 212 2, 524 2,683 2,860 3, 331 *3, 330 57, 700, 000 71, 850, 000 5.5 1954 _ 5.6 1955 _ . 75, 275, 000 85, 750, 000 112, 370, 000 *126, 000, 000 5.2 1956 _ 4.9 1957 _ 5. 2 1958 _ *5.0 *Estimated. 487270—59 - 13 186 Department of Health , Education, and Welfare, 1958 The volume of school construction approved under P. L. 815 con¬ tinued at about the same level in fiscal year 1958 as in each of the past several years. During the year $74,519,000 was reserved for 349 projects under all sections of the law. One of the principal reasons for the continued high level of school construction assistance is the construction of housing units for military personnel under title VIII of the National Housing Act — the Capehart Housing Program. Payments made during the year were for increases in school en¬ rollment of federally connected children in the 2-year increase period, from July 1, 1956, to June 30, 1958, and from July 1, 1957, to June 30, 1959. Fiscal year 1958 marked the first year of operation under an amendment to the law which moved the increase period forward 1 year at a time rather than 2 years, the period used during the past 6 years. A total of $826,050,000 has been appropriated by the Congress for P. L. 815 through June 30, 1959. This amount includes $56,950,000 appropriated in fiscal year 1958 to meet existing obligations through the 1959 fiscal year. Of the total appropriated, $821,325,000 has been used for project construction and $4,725,000 for services provided by other Federal agencies. When projects included under existing authorizations are com¬ pleted, this program will have provided 1,500 new elementary and secondary schools, 2,200 additions to elementary and secondary schools, 37,235 classrooms and related facilities to house an estimated 1,117,050 children. This total includes 190 projects which will provide an estimated 1,140 classrooms for approximately 33,000 children, mostly Indian children, living on Indian reservation land. LEGISLATION Under existing legislation P. L. 874 ends June 30, 1958, and no applications can be submitted beyond June 30, 1959, under P. L. 815. After an extensive review and study of these two programs the Depart¬ ment of Health, Education, and Welfare submitted recommendations to the Congress early in January 1958 for amendment and extension of the two acts to bring Federal payments more nearly in line with the financial burden on school districts caused by Federal activities under present conditions. After extensive hearings by the House Committee on Education and Labor a bill was reported and passed the House on April 27, 1958, which extended on a permanent basis as¬ sistance under both laws for school districts educating those children who lived on Federal property or with a parent employed on Federal property, and extended all other categories of Federal impact until June 30, 1961. The bill as passed by Congress and signed by the President included a number of amendments, some liberalizing the benefits under both laws and others restricting Federal payments. Office of Education 187 Cooperative Research The Cooperative Research Program (P. L. 531, 83d Cong.) has been designed to permit the Office to increase the quantity of and add depth to its research by supporting such work in colleges and univer¬ sities and State school systems throughout the country. The proce¬ dure offers many advantages; for example, (1) it affords a means for gathering together the ideas of hundreds of highly qualified, profes¬ sional persons and selecting from among them those which seem most promising; (2) it secures the services of persons with knowledge, training, and experience in the special techniques and skills needed to do research; (3) it provides opportunities for training research per¬ sonnel; (4) it permits the utilization of research facilities and labora¬ tories in the schools and colleges; and, (5) because it requires the co¬ operating institution or agency to contribute either services or facili¬ ties, it yields a greater volume of research than could otherwise be purchased for the Federal funds expended. The purpose of the Cooperative Research Program is to develop new knowledge about the educational process and to devise new applications of existing knowledge. To accomplish this purpose, the program must be directed toward gathering information about the fundamental processes of education. For example, educators need far more information than is currently available about the extent and nature of individual differences — information which explains not only the intellectual functioning of the mentally retarded, the nor¬ mal, and the gifted but also the subtle personality distinctions existing within each of these groups. Under present procedure proposals for specific research projects from institutions of higher education and from State departments of education are reviewed within the Office and then submitted to the Office of Education Research Advisory Committee for evaluation. This Committee, consisting of nine specialists in research appointed by the U. S. Commissioner of Education, evaluates all proposals on the basis of the (1) significance of the problem for education, (2) soundness of the research design, (3) personnel and facilities avail¬ able for the research, and (4) economic efficiency or relationship of the proposed expenditure to the procedures and probable outcomes. When a proposal is recommended by the Committee and approved by the Commissioner a contract is negotiated directly with the institu¬ tion or agency. Although the Office provides most of the funds, the cooperating institution or agency also contributes to the total cost of each project, usually by providing professional services and facilities. During 1958 the Office received 172 proposals for projects under the program, and the advisory Committee recommended 50 of them for approval. The appropriation available for this second year of pro- 188 Department of Health, Education, and Welfare, 1958 gram operation was $2.3 million. More than half was needed to con¬ tinue the support of projects begun during the first year, and the re¬ mainder — approximately $960,000 — was used for the initiation of new projects. By the year’s end, 64 new contracts had been signed. Among them were 11 dealing with the education of the mentally re¬ tarded, 10 with the identification and development of gifted students, and 8 with the selection and career development of teachers and ad¬ ministrators, and guidance and counseling. The Federal funds expended in the first 2 years of program opera¬ tion were disbursed in 31 States, the Territory of Alaska, and the Dis¬ trict of Columbia. A total of 53 colleges and universities and 12 State departments of education participated. The length of the projects initiated ranged from 3 months to 5 years, but the average length was about 2 years. The total cost of the projects ranged from $1,500 to $600,000, with an average of $64,000 for projects on the mentally retarded and $33,000 for other projects. The average total cost for all projects was $49,000. A total of 14 reports on projects completed during the year were received by the Office; 9 were on the education of the mentally re¬ tarded; 2 on gifted students; 2 on teachers; and 1 on child develop¬ ment. To disseminate results of the program the Office plans to hold seminars on the information gained; to conduct clinics for the im¬ provement of existing techniques and the development of new tech¬ niques; to publish reports and articles in professional journals and periodicals; to demonstrate new procedures and techniques at meet¬ ings of various organizations ; to urge researchers to talk about their work to local groups; and to give general publicity to the projects being supported. Libraries Libraries in 1958 continued to improve and extend their sendees but not rapidly enough to meet the needs of an expanding popula¬ tion with ever-increasing demands for information. Recruiting trained librarians was a major problem for all libraries. There was greater interest in work simplification and cooperative practices among libraries to decrease duplication of effort. Larger units of library service were being more rapidly organized, and in- service training programs for professional and clerical employees were receiving increased attention. Throughout 1958, the Office continued working toward one of its basic objectives: to improve the resources, services, and facilities of Office of Education 189 school, college, research, special, State, and public libraries and to provide information on education for librarianship. SCHOOL LIBRARIES Chapter 6 of the Biennial Burney of Education in the United States , 1952-5^ “Statistics of Public School Libraries, 1953-54,” indicates the need to strengthen programs for recruiting and training profes¬ sional school librarians who are especially needed in the elementary schools. The study reveals that only 3,41(5 professional school librar¬ ians were available for service to 104,365 elementary schools in 1953-54, and that schools reporting library expenditures for 1953-54 spent $25,222,207 on library materials for an enrollment of 24,017,371 stu¬ dents, or $1.05 per pupil, which is far below the minimum recom¬ mended by American Library Association. An examination of official announcements issued by nearly 1,900 higher education institutions in 1956-57 revealed that 563, or nearly one-third, were endeavoring to meet the prevailing demand for school librarians through programs in school library education. The pro¬ liferation of library courses has raised some questions about standards for professional preparation of school librarians and has created problems in accreditation of many programs. PUBLIC LIBRARIES Three statistical surveys of public libraries were conducted and re¬ ports issued during 1958. A survey of county and regional libraries for fiscal year 1956 included responses from 148 library systems as against 120 for the year before, reflecting a rapid increase in the development of centralized library units. The responses also revealed increased per capita income and use of larger systems. Statistics of Public Libraries in Cities with Populations of 100,000 or More: Fiscal Year 1957, reported increases on all items covered, with a 4.2 percent increase in book circulation in 1957 over 1956 and a total increase since 1950 of 27.1 percent. Salaries accounted for 72.9 percent of the total operating expenditures; books and periodi¬ cals, 12.2 percent ; and audiovisual materials, 0.4 percent. Statistics of Public Library Systems in Cities with Populations of 50,000 to 99,999 : Fiscal 1957, showed that the total number of volumes owned by public library systems in this population group had in¬ creased 14.5 percent between 1952 and 1957 and 4.1 percent between 1956 and 1957. Overall operating expenditures for libraries had in¬ creased, salaries by 11.4 percent over 1956. Book and periodical ex¬ penditures absorbed 15 percent of total operating expenditures and audiovisual materials an additional 0.7 percent. 190 Department of Health, Education, and Welfare, 1958 LIBRARY SERVICES FOR THE AGED One Office responsibility is the coordinating of library service with other forms of adult education. To learn what public libraries were doing to meet the needs of old people, the American Library Associa¬ tion, in cooperation with the Office, conducted a survey of all public libraries in places with populations of 2,500 and over. The 1,391 replies showed that provision of books, publicizing of available materials, provision of shut-in service, and working with other com¬ munity agencies were the most frequently offered services. GRANTS FOR LIBRARY SERVICES The Library Services Act (Public Law 597, 84th Cong.) authorizes the expenditure of $7.5 million a year for 5 years, beginning July 1, 1956, to improve and extend library service to rural areas with no service or with inadequate service. The contribution of the act to the development and improvement of public library services to rural areas increased in the second year of the program. F orty-five States and the Territories of Alaska, Hawaii, Guam, Puerto Rico, and the Virgin Islands participated in the 1958 program and shared in the $5-million grant. State and local matching funds raised the total budgets of the 50 State and Territorial programs to $15,464,175. State plans indicate that over 300 rural counties with populations totaling more than 7 y2 million children and adults were receiving new or improved library services under the program in 1958. State, local, and Federal funds totaling $7 million have been combined to buy books and other informational materials. More than 90 book¬ mobiles and 30 other vehicles were bought to bring materials to rural families. State library agencies responsible for administering State plans have added more than 100 experienced librarians and more than 80 clerks and bookmobile operators to improve their service. The programs under the act have also aroused much interest in the development of public library service. There have been many inquiries about county and regional library service and other co¬ operative library programs including the centralized processing of books, scholarship programs, and inservice training in modern library techniques. This interest has resulted in an increasingly active com¬ munications and held work program by the Office staff with the States and Territories. Office of Education 191 Table 1. — Enrollment in the continental United States, 1956—57 and 1957—58 [Office of Education estimates] School Year 1956-57 1957-58 Kindergarten through grade 8: 25, 283, 000 4, 267, 000 26, 000 19, 000 116, 000 26, 037, 000 4, 466, 000 26. 000 20,000 121, 000 Total kindergarten through grade 8 - 29, 711,000 30, 670, 000 Grades 9-12: Public school system (regular full-time) - 6, 876, 000 866, 000 11,000 1,000 66, 000 7, 399, 000 942, 000 11,000 1,000 71, 000 Private and parochial schools (regular full-time) _ Federal schools for Indians Federal schools under P. L. 874 _ _ . . _ __ _ _ _ Other _ - _ _ - - _ _ _ _ . _ . Total grades 9-12 7, 820, 000 8, 424, 000 Total elementary and secondary _ _ _ _ _ 37.531,000 39, 094, 000 Higher education: Universities, colleges, professional schools, including junior colleges and normal schools. . . 3. 244, 000 3, 450. 000 Other schools: Private commercial schools (day and evening). 500, 000 91,000 500, 000 91.000 Nurse training schools (not affiliated with colleges and universities) _ Total other schools. _ _ _ 591, 000 591.000 Grand total . .. _ _ . 41, 366, 000 43, 135, 000 Table 2. — Supply and demand for elementary and secondary public and non¬ public school teachers, 1957—58 Item Elementary and secondary Supply Total teachers 1956-57 1 1, 342, 100 89, 400 Less emergency teachers 1 956-57.. . . . ... Total qualified teachers 1956-57. - _ _ _ _ . . _ .. _ _ 1,252,700 94,000 Less 7.5 percent turnover of qualified teachers 2.. _ . . . _ . . __ _ _ Qualified teachers returning for 1957-58 _ _ 1, 158, 700 22,000 81,400 Emergency teachers qualifying for 1957-58.. . _ _ New supply of qualified teachers (80.8 percent of elementary and 63.2 percent of high school teachers trained in 1956-57) _ _ _ . . . _ Total qualified supply 1957-58 _ _ ..... _ 1, 262, 100 Demand Total teachers 1956-57 1 _ 1, 342, 100 55, 000 Teachers needed to meet increase in enrollment in 1957-58 _ Total demand 1957-58. . _ . 1, 397, 100 Shortage of qualified supply — _ _ _ _ 135, 000 1 The number of elementary and secondary school teachers in the public school system, in the Ml of 1956, was 1,197,000 (Office of Education Circular No. 490). To this must be added an estimated 145,001 teache s in nonpublic schools (private and parochial), in model and practice schools, in subcollegiate departments of colleges and universities, in residential schools for exceptional children, and in schools operated under Federal auspices. 2 Turnover, as used here, includes only those who leave the profession of teaching through death, re¬ tirement, marriage, or to take a position in some other field. Changes of positions from one school system to another are not included. Table 3. — Grants 1 to States: Office of Education , fiscal year 1958 192 Department of Health , Education , and Welfare , 1958 Total § 1 i 1' 5, 866, 313. 24 3,153, 971.08 2, 961,128.54 32, 482, 922. 63 5, 413, 342. 44 2, 731,547. 68 436, 454. 32 120, 480. 68 7, 459, 206. 62 7, 141,017. 33 1, 746, 686. 20 4, 688, 914. 31 2, 132, 660. 96 1, 369, 041. 79 5, 156, 774. 22 2, 209, 073. 30 2, 963, 054. 79 1, 309, 683. 64 8, 915, 034. 94 3, 768, 402. 15 7, 784, 773. 56 1, 553, 765. 38 2, 314, 833. 49 3, 853, 113.40 1, 239, 408. 05 School construc¬ tion (Public Law 815) O ?2 1 ? 1, 724, 620. 70 1, 353, 622. 90 1, 193, 352. 74 13, 463, 109. 30 2, 118, 474. 20 947, 142. 69 30, 030. 00 3, 453, 326. 17 2, 103, 986. 68 695, 455. 00 528, 947. 00 508, 700. 00 15, 452. 58 1,251,594. 34 94, 386. 00 1, 178, 000. 00 59, 425. 00 3, 542, 116. 80 511, 526. 00 5, 648, 584. 13 397,411.99 325, 523. 34 1, 262, 294. 08 504, 443. 97 Maintenance and operation of schools (Public Law 874) 2 $104, 143, 294. 48 2, 812, 276. 81 1, 447, 936. 18 780, 380. 82 16, 609, 142. 54 2, 802, 531. 09 1,258, 202. 72 147, 032. 36 3, 171, 216. 63 3, 640, 764. 01 679, 225. 01 2, 152, 758. 48 555, 253. 87 309, 805. 91 3, 138, 396. 15 787, 576. 28 830, 262. 56 837, 927. 32 4, 740, 494. 75 2, 280, 616. 48 488, 584. 69 66, 205. 88 787, 136. 02 1, 225, 615. 52 382, 989. 97 Cooperative vocational education - $39, 192, 367. 87 1, 089, 230. 30 216, 420. 74 784, 291. 27 2, 076, 551. 32 340, 527. 15 370, 367. 29 186, 219. 00 120, 480. 68 641, 711. 56 1, 142, 747. 36 233, 722. 43 1, 707, 523. 32 959, 462. 50 845, 033. 63 606, 129. 03 1, 079, 990. 05 747, 853. 68 229, 966. 26 473, 051. 54 780, 983. 95 1, 367, 498. 24 872, 948. 71 979, 427. 07 1, 135, 819. 43 216, 796. 54 Library services C* $4, 892, 032. 00 S8S388 i amm ; 95, 308. 00 149, 159. 00 62, 412. 00 142, 780. 00 102, 604. 00 71, 649. 00 147, 746. 00 110, 170. 00 103, 250. 00 66, 000. 00 78, 487. 00 146, 547. 00 117, 448. 00 131, 012. 00 119, 936. 00 59, 282. 00 Colleges for agri¬ culture and mechanic arts N $5, 051, 500. 00 100, 541. 43 77, 477. 26 89, 047. 71 175, 599. 47 83, 218. 00 90, 022. 98 73, 172. 96 97, 644. 26 104, 360. 28 75, 871. 76 156, 905. 51 109, 244. 59 96, 145. 67 89, 005. 70 99, 374. 97 96, 768. 55 79, 115. 06 93, 371. 85 116, 788. 72 133, 559. 50 99, 750. 80 91, 735. 06 109, 448. 37 75, 895. 57 h 5 a) Office of Education 193 SSSkS 88S38S388S3S £8£S;SS8£S!8 888S8 iiiis sisiissiis g§i!H!s?ii mm mm mmmt mmmm mm _-_r^-cotC 0 1 IO Tf r-< CO I-l * 00 tO O to tD ! 05 t** 0500 Strengthening other social services. — Progress made in strength¬ ening other social services is reflected in the provisions of the States’ services plans developed in 1957, following the 1956 amendments to the Social Security Act reaffirming the importance of providing social services to help needy persons make fuller use of their own capacities for more independent living. The problems most frequently identified for which States would provide services, in the order named, were those health, employment, ] lousing, family relations, and children’s problems which required short-time or tangible services. The problems least frequently identi¬ fied for which services would be provided were those emotional prob¬ lems of members of broken families, unmarried parents, or the ill which required more intensive casework service or other help over longer periods of time. Almost all emphasized the use of other com¬ munity resources, with particular emphasis on cooperation with State vocational rehabilitation services and employment services. Many States recognized special responsibility for children and other persons in hazardous situations, and for community planning although only a few assigned staff specifically to the latter area. Because of limitations in staff qualifications and time, many States attempted to define responsibility for services realistically, either by limiting the problems for which services would be provided, limiting the scope of services to those required in the determination of eligibil¬ ity for money payments, or limiting services to those that could be provided during regular contacts for eligibility purposes. With better administrative planning, some States are gradually offering services to larger numbers of families and individuals. In addition to the help given through the day-by-day activity of reg¬ ular staff, a few States have also developed special services, such as homemaker services, volunteer service units, and foster home care for the aged. Some States are augmenting the skills of their casework staff with consultant services from medical social workers, home economists, and other specialists. Special projects in a few agencies are demonstrating the potential value of providing appropriate serv- 32 Department of Health , Education, and Welfare, 1959 ices, and the benefits of cooperative effort among public and voluntary agencies and other community groups. There are also other evidences of increasingly effective utilization of community resources. Broad guidelines have been established by the Bureau to help the States strengthen the service aspects of their programs. Emphasis has been on administrative planning to assure statewide provision of services, as well as development of policies and guides that are realistic in view of workloads, skill of staff, and the availability of support¬ ing functions of consultation, supervision, and staff development. In addition, a plan was initiated for discussion with each State to deter¬ mine specific areas in which further Bureau help was needed. The Bureau has also been working with other units in the Department and with national voluntary social agencies both in the utilization of available resources and in the development of additional needed services. During the past year, for example, in developing services for the aging, Bureau staff worked with the Department’s special committees in planning for the White House Conference on Aging, and participated in the National Leadership Training Institute held at the University of Michigan in preparation for the Conference; with the American Public Welfare Association’s Committee on Aging in developing statements on social service needs of older people and on the community planning responsibilities of public welfare; and with the National Social Welfare Assembly’s Committee on Aging in developing a project directed toward protective service needs of older persons, and in planning a seminar on social services for older people in the fall of 1959. There was also participation in a meeting of all national agencies concerned with aging called by the National Social Welfare Assembly. Continuing effort to promote the use of homemaker service is evi¬ denced in the Bureau’s cooperative work with the National Com¬ mittee on Homemaker Service, and in its participation in the second National Conference on Homemaker and Belated Services held in February 1959 under the joint sponsorship of constituent units in the Department and many national voluntary social and health agen¬ cies. To deal more effectively with emotional problems of needy per¬ sons and strained relationships, the Bureau has initiated work with the Department’s National Institute of Mental Health, and joint ef¬ forts have continued with the Family Service Association of America. Further work has continued with the Children’s Bureau toward utilizing the full potentials of both aid to dependent children and child welfare services programs in dealing constructively with the factors contributing to the dependency of children. A policy state¬ ment has been developed clarifying the functions and responsibilities Social Security Administration 33 of each program in providing services to children in their own homes, the ways in which the two programs work cooperatively in providing these services, and the allocation of costs of services to children in families receiving public assistance. A working group from both bureaus is also developing a plan of cooperative activity to promote better understanding of the factors involved in illegitimacy and to identify State administrative planning essential to provide effective services in dealing with the needs and problems of unmarried mothers and their children. In addition, the two bureaus are planning to provide joint consultation to State agencies in areas of mutual concern. Similarly, joint planning by the Bureau and the Office of Vocational Rehabilitation continues to strengthen the relationships between these two programs in the States and to make more extensive use of voca¬ tional rehabilitation resources. Bureau staff also participated in the departmental consideration of proposals relating to extension of programs for rehabilitative services and in developing proposals for extending such services through public welfare agencies, as well as in departmental consideration of program goals on community planning. Material was prepared on the considerations involved in working with individuals and families whose condition seriously affects their ability to manage their personal affairs, and in clarifying the role of public assistance in providing services to older people. Study of many facets of the broad range of problems contributing to dependency, the pooling of the knowledge, skills, and resources of many related professions and disciplines, and emphasis on the broad rehabilitation potentials of public assistance programs are beginning to show results in many States. But low assistance standards, heavy workloads, lack of professional training of most staff, and the dearth of community resources limit opportunities to provide extensive serv¬ ices. States are therefore giving more attention to methods for improving staff competence and other administrative planning that will facilitate the provision of services. Efforts to improve staff training and skill. — Since 1937, some States have made limited use of Federal funds for sharing costs incurred in granting educational leave to employees; others have not. In 1950, only about 23 percent of the 30,000 persons employed in social work positions in State and local public assistance agencies had some social work training, but less than 4 percent had completed graduate work. Although Congress, in 1956, authorized appropriation of Federal funds to better assist the States in meeting the costs of training, funds have not been appropriated to implement this amendment. At first, anticipation of specific Federal funds for training resulted in changes in some State laws and increased State appropriations to 34 Department of Health , Education , and Welfare , 1959 enable participation in the new Federal training provisions and evaluation of staff needs and long-range planning for staff develop¬ ment in many States. Efforts to improve the skill of some personnel were increased. By 1959, 39 State public assistance agencies had 402 people on educational leave (283 with and 119 without pay) at schools of social work. With no funds available under the 1956 authorization for training, other alternatives of increasing staff competence and making more effective use of professionally trained staff are being explored. An example of the latter is the work initiated on the Educational Stand¬ ards project to define appropriate job functions in relation to the educational background of public assistance staff. To further this effort, Bureau staff have been working with an advisory committee representing State public welfare agencies, schools of social work, the Department’s Division of State Merit Systems, national social welfare organizations, and other Federal agencies to consider differen¬ tial use of staff with varying educational background, and how best to test the use of workers with full graduate professional training and those with an undergraduate academic degree. In addition to providing technical assistance requested by 15 State agencies and 5 schools of social work, the Bureau issued a report on “Staff Development as an Integral Part of Administration.” Bureau staff participated in the consideration given to the training needs of staff in providing services for the aging by the Council on Social Work Education and the American Public Welfare Association’s Com¬ mittee on Social Work Education and Personnel, as well as other as¬ pects of training by these groups and the National Association of Social Workers’ Commission on Education. Bureau staff also partici¬ pated in an interbureau training committee with the Chil¬ dren’s Bureau in clarifying basic principles relating to staff development and other areas of common concern. Efforts to improve administrative and fiscal methods . — Heavy workloads limit the opportunity to provide services in many instances. For example, in the old-age assistance program in 1958, 27 States had average caseloads per worker of more than 200 (in 19 of these States they ranged from 255 to over 500) ; and in aid to dependent children, 20 States had average caseloads of more than 100 (in 6, they ranged from 158 to 237). Continuing attention was therefore directed to working with States on needed improvements in organization, staffing patterns, and workload management to permit the best service possi¬ ble within staff time available. A number of States also attempted to simplify their standards of assistance. In addition to providing technical assistance requested by 11 States and making 6 management surveys of specific State situations, a con- Social Security Administration 35 ference on workload standards and management was held in Wash¬ ington, D.C., with State agencies in Region III ; and a biregional conference (Regions VIII and IX) on administrative management of large urban agencies in San Francisco, with representatives from 5 States and 7 large urban areas, focused on workload distribution and staffing patterns, workload management, and analysis and simpli¬ fication of procedures. A conference was held in Washington, D.C., with a group of State welfare finance officers on the use of mechanical processing equipment and other methods for efficient fiscal operations in public assistance administration. Bureau staff also participated in regional conferences of the American Public Welfare Association in sessions on administrative management methods and procedures for work improvement. Guide materials are being developed for State agency use in (a) developing a State system of written instructions, (b) case recording, and (c) conducting organization and management surveys of State and local agencies; and a statement is being prepared on State super¬ vision of local agencies. Two publications were issued in the “How They Do It” series : “Guides for County Boards,” using material from Indiana and Iowa, and “Simplification of the Caseworker’s Job,” using material from Maine. Other administrative developments. — To assure that Federal grants were spent by the States for the purposes for which they were ap¬ propriated, Bureau staff made administrative reviews of State and local operations in 25 States. Significant review findings were sum¬ marized for administrative use by Bureau and State agency staff. Also, technical assistance was provided to several States in making their own reviews of administration and in using their findings. Growing interest in public assistance and concern especially with the social problems highlighted in the aid to dependent children pro¬ gram were evidenced by an increasing number of requests for infor¬ mation from individuals, organizations, writers, journalists, Mem¬ bers of Congress, and other agencies. An exhibit, “Your Whole Com¬ munity Benefits,” was prepared for use at national and State meetings. Materials interpreting aspects of the program were developed and made available to schools of social work, State and local agencies, and other interested individuals and groups. Related Social Welfare Activities As part of the Bureau’s broad public welfare responsibilities, par¬ ticipation has continued (1) in international social welfare develop¬ ments, and (2) in planning for emergency welfare services, services to repatriated American nationals and to refugees from other parts of the world. 36 Department of Health, Education, and Welfare, 1959 International activities. — The Bureau Director continued to serve as chairman of the Interdepartmental Committee on International Social W elf are Policy. Bureau staff also participated in the preparation and review of technical materials for use at United Nations and other international meetings, such as the United Nations expert group on social welfare meeting in January 1959; in planning the National Social Welfare Assembly’s international workshop in Washington, D.C., in October; and in preparing a fact sheet relating to voluntary and public agency activities in resettling refugees and immigrants. A Bureau staff member was one of the Social Security delegation (part of the East- West Exchange arranged by the Department of State) to the U.S.S.R. to study the Soviet system of social security. She also participated in conferences with the Soviet team on their return exchange visit. Bureau staff in regional offices provided consultation and planned or arranged observation programs in cooperation with State and local public and voluntary welfare agencies for visitors from 34 countries. In the central office, staff specialists continued to provide consultation to foreign visitors and to international groups referred by various Government agencies. Emergency welfare services. — An allotment of limited funds to the Department by the Office of Civil and Defense Mobilization under Reorganization Plan No. 1 of 1958 and the Independent Offices Ap¬ propriation enabled the Bureau to resume activities on previously delegated defense programs of emergency financial assistance and emergency clothing; and to participate with the OCDM in activities and resumption of negotiations relating to the Social Security Ad¬ ministration’s assumption of basic responsibility for the full range of emergency welfare services. Bureau staff worked with the OCDM in the development of an Annex on Emergency Welfare to the National Plan for Civil and Defense Mobilization ; and with the OCDM and the SSA in drafting proposals for Department responsibility in emergency welfare serv¬ ices. Staff participated in Civil Defense Operation Alert 1959 (re¬ gional relocation phases) and in planning for the national relocation phase in August. Services to refugees and immigrants. — A Bureau staff member served on the departmental Committee on Refugees and Immigrants which is planning for the implementation of the report of the depart¬ mental Task Force. The Bureau representative attended a meeting with an ad hoc committee of national voluntary agencies concerned with refugees held in New York City in February 1959, and assisted in the development of statements and position papers on legislation and program planning for services to refugees and immigrants. Social Security Administration 37 Repatriation of American citizens. — The Bureau has continued to assist the Department of State in arranging for the reception and care of repatriated American nationals who need special help upon arrival in this country. During fiscal 1959, services were requested for 215 such persons. Their most pressing needs were for funds for transportation beyond the port of entry and provisions for hospitaliz¬ ing mentally ill repatriates who have no State residence. Culminating a long period of program development and interde¬ partmental negotiation, draft legislation was submitted to the Con¬ gress to provide a statutory base and appropriation authority to enable the Federal Government to assume its proper share of the ex¬ pense of these services. Similarly, interdepartmental negotiations have facilitated joint work between the Bureau’s regional staff, Army Port Commanders, and selected State and local public welfare authori¬ ties in implementing program and maintaining standby readiness. Children’s Bureau Some Facts and Figures About Parents and Children Since 1954 the annual number of live births has exceeded 4 mil¬ lion. The number decreased very slightly in 1958 and the provi¬ sional crude birth rate also dropped to 24.5 per 1,000 population. Nevertheless, both numbers and rates are well above the level of the 1930^0 decade. The estimated number of children under 18 in the civilian popula¬ tion of the United States in 1958, excluding Alaska and Hawaii, was over 61 million, or 35.7 percent of the total population. Provisional statistics indicate that the infant mortality rate increased again slightly in 1958. Thirty-one States experienced an increase as compared with the previous year. For children age 1 year to 20, accidents are the leading cause of death at all ages ; for children age 5 and over, cancer is second among leading causes. Births out of wedlock continue to increase. The reported number for 1957 was 201,700; the ratio per 1,000 live births increased from 46.5 to 47.4 and the rate per 1,000 unmarried women age 15-44 years from 20.2 to 20.9. Forty percent of the unmarried mothers in 1957 were under 20 years of age. In March 1958, nearly 7.5 million mothers with children under 18, about 29 percent of such mothers, were in the labor force. Nearly 3 million had children under 6, a little over 20 percent of such mothers. 38 Department of Health , Education , and Welfare , 1959 Most children under 18, at least 87 percent of them, have a home with both parents. But in 1958 of the 25.8 million families with children under 18, about 11 percent or 2.8 million were broken homes. Most of these, 2.4 million, were homes in which only the mother was present. Juvenile delinquency court cases more than doubled between 1948 and 1957 while the child population in the vulnerable age group — 10 through 17 — increased by only 28 percent. In 1957 there were more than 600,000 cases of delinquency involving about 520,000 children. Major Bureau Trends In fulfilling its special charge from Congress to be the focal point of Federal concern for child life and the well-being of the Nation’s children, the Children’s Bureau marked 1959 as a year of peak activity in many areas. In the cooperative Federal-State programs for maternal and child health, crippled children and child welfare, for which the Bureau administered grants to the States totaling $43,500,000, the burgeon¬ ing child population placed capacity demand upon all forms of services. Through its publications and reports the Bureau provided a maximum volume of information about child life and services to children. Congress voted the Bureau a supplemental appropriation of $1,500,000 in crippled children’s funds for services for children with congenital heart disease. The year 1959 was also marked by events which forecast significant developments in the future. Planning for the 1960 White House Conference on Children and Youth occupied a major portion of Bureau effort and staff time. Under congressional mandate, the Bureau was actively participating in the preparation of two wide- reaching reports due in Congress by January 1, 1960 — that of the Advisory Council on Child Welfare Services and the Joint Children’s Bureau-National Institute of Mental Health Study of Juvenile Delinquency. The Bureau participated in the presentation of testi¬ mony on a number of important legislative proposals, such as those relating to the protection of children from abroad who are adopted by American citizens, a program for international health research, and juvenile delinquency. At the request of Congress, the Bureau was exploring means to further aid the immunization of children against polio. As statistics showed a continuing rise in illegitimate births, the Bureau undertook, with the Bureau of Public Assistance, to draft a plan which would promote better understanding of factors involved in the problem and to improve public welfare services for unmarried parents. At the same time, it gave renewed support to strengthening Social Security Administration 39 two relatively undeveloped social instruments — homemaker service and day care. The National Conference on Homemaker and Related Services climaxed a 2-year joint effort of public and voluntary agencies to promote this program. With the Women’s Bureau, Department of Labor, the Children’s Bureau made a joint survey of the resources of national organizations with day-care services. 1960 White House Conference on Children and Youth In May 1958 the President announced March 1960 as the date for the Sixth White House Conference on Children and Youth and asked the Secretary of the Department of Health, Education, and Welfare to invite State and Territorial Governors to appoint special commit¬ tees to begin a stocktaking on problems of the young. Such a con¬ ference has been held every 10 years since President Theodore Roose¬ velt convened the first in 1909. The President asked the Children’s Bureau to serve again as the focal point in the Federal Government for the conference planning. The Council of National Organizations, the National Council of State Committees on Children and Youth, and the Interdepartmental Committee on Children and Youth are among the organizations cooperating with the White House Conference staff. Hundreds of thousands of citizens, both adults and young people, have been enlisted to work on State and local committees for the 1960 White House Conference. They are making it clear that they see the Conference also as a forum for an exchange of critical views on American values and on the American way of bringing up children. The material coming to the White House Conference staff from the States reflects a general concern with the effects of rapid change on children and youth — change both in the past decade and in the years to come. Reports of State Committees reveal that to help children and youth “realize their full potential for a creative life in freedom and dignity” responsible adults feel the need to define and maintain the moral and ethical values of our society as against the material ones ; to raise our educational standards and to broaden and improve educa¬ tional opportunities for all kinds of children and youth, whether gifted, handicapped or average. They are particularly concerned with the need for strengthening family life. Increasing concern is being given to groups of children with special problems which seem to have increased and to have been aggravated in the past decade — youth in conflict with society ; children and youth who are physically, mentally, emotionally, or socially handicapped: children who are neglected or deserted; children who drop out of 40 Department of Health, Education, and Welfare , 1959 school for lack of adequate training or adequate guidance. There is concern also about youngsters who marry too young ; and about young¬ sters who seem to have little sense of responsibility, few values or goals, and few interests other than themselves. State Committees see the White House Conference as a great opportunity for focusing public attention on these needs and for building mechanisms to meet them. In an address to the National Conference on Social Welfare, May 25, 1959, Mr. Ephraim Gomberg, Director, White House Conference, said : ... We refer to the White House Conference on Children and Youth as a process rather than a 6-day series of meetings — a process in which citizen preparation, citizen financing, citizen participation and citizen followup underpin every bit of the comprehensive planning now underway. The 6 days of meetings in Washington are not the Golden Anniversary Con¬ ference. Rather they are the focal point of interest in 1960 — the view from the mountain top after 12 months of preparation and climbing. Those 6 days are intended to provide a memorable view, a perspective, a forum for discussion, a classroom of learning. But they will be followed by 10 years of preparing for and of scaling other mountains of achievement in communities and States. . . . Federal Interdepartmental Committee on Children and Youth The Interdepartmental Committee on Children and Youth, estab¬ lished in 1948 to provide an opportunity for the exchange of informa¬ tion among Federal agencies with program interests in children, has held regular monthly meetings during the past year. Among the subjects presented for discussion were : the cooperative extension pro¬ gram, marriage and divorce trends in the United States, the program for aid-to-dependent children, and research progress in mental subnormality. The Interdepartmental Committee was requested by the President’s National Committee for the 1960 White House Conference on Children and Youth to serve as the main channel for Federal agency participa¬ tion in the forthcoming White House Conference. This assignment involves providing Federal agency participation in policy and pro¬ gram determination for the Conference, in keeping Federal agencies informed of developments in Conference planning, in making avail¬ able to the White House Conference the knowledge, resources and ex¬ perience of Government agencies and in post- Conference followup activities. One of the major activities of the Interdepartmental Committee has been the development of a chart book on children and youth to be published for use at the 1960 White House Conference. The National Council of State Committees for Children and Youth, with which the Interdepartmental Committee has a close relationship, held a workshop in Washington, D.C., January 15-16, 1959, on State Social Security Administration 41 preparation for the 1960 White House Conference. One hundred four representatives of 41 State Committees participated along with mem¬ bers of the Children’s Bureau, the White House Conference staff, and representatives of many of the ICC Y agencies. Programs of the Bureau RESEARCH IN CHILD LIFE Research activities of the Children’s Bureau take a variety of forms. One study concerns situations, conditions, or processes to furnish in¬ formation — and sometimes ammunition — for promoting the welfare of children. An example is a study, begun in 1959 in cooperation with National Office of Vital Statistics, on the incidence of cystic fibrosis. The first phase provided national estimates of hospitalized cases during 1952-53. The second phase is a pilot study to develop method¬ ology for a national survey (Phase 3) of cases known to physicians in their private or clinic practice. Other special studies completed or in process in 1959 were the fol¬ lowup of 500 nonagency adoptions; the analysis of staff turnover in child welfare and family agencies ; a study, made in cooperation with the Bureau of the Census, of child care arrangements by working mothers; the application of “performance budgeting” reported in Cost Analysis in Child Welfare Services. In this same category are plans now under way for community studies to fill a yawning in¬ formation gap about the beliefs and behavior of American teenagers who do not present acute problems — as a basis for more effective ap¬ proaches to juvenile delinquency and other youth difficulties. Another type of activity draws on research done by others. A preliminary roundup of research bearing on the effects of having mothers work outside the home was issued in 1959 for staff use only, pending final editing. An analysis of efforts to evaluate psycho¬ social change in individuals was presented in Some Guide Lines for Evaluative Research. More strictly on the reporting end, Bulletins 8 and 9 of Research Relating to Children carry on the Bureau’s run¬ ning inventory of current nonmedical research. The Bureau also gathers or compiles statistics for use by a wide public, inside and outside of Government. Seven numbers of the ongoing Statistical Series (Nos. 48-54) were completed during the fiscal year, covering various aspects of juvenile delinquency and child health and welfare. Trends in Programs Administered by the Chil¬ dren's Bureau was revised and an edition issued for the 1960 White House Conference. Major staff assistance was given to the chart book for the Conference, a compilation of statistical data about children, prepared by the Interdepartmental Committee on Children and Youth. 530344-60- 4 42 Department of Health , Education , and Welfare , 1959 Staff members also worked with States and national organizations in improving data-gathering methods and reporting forms relat¬ ing to such concerns as maternal and child health, mental retardation, police reporting of juvenile delinquency, institutional child popula¬ tions, etc., and gave research consultation or participated in working groups for State and local departments and for national organizations concerned with the welfare of children. Impetus to research developments was given by staff members through more than a score of articles, papers and reports published in professional journals widely circulated among the many practi¬ tioners, teachers, and scholars who look to the Bureau for informa¬ tion about what is done, learned, and needed with regard to the well¬ being of children. MATERNAL AND CHILD HEALTH SERVICES All States, the District of Columbia, Puerto Rico, and the Virgin Islands receive Federal funds to extend and improve services for promoting health of mothers and children. For the fiscal year 1959, the appropriation for maternal and child health remained the same, that is, $16,500,000, with $1 million ear¬ marked for services to mentally retarded children. Ongoing programs of the State maternal and child health agencies continued to make major contributions to the health of the Nation. State maternal and child health reports showed that about 257,000 mothers received services at maternity medical clinics in 1958. In addition, public health nurses served 554,000 mothers before or after delivery. About 601,000 infants and 826,000 other children received health supervision through well-child clinics. In addition, health depart¬ ment programs provided nursing service for over 3,018,000 infants and other children. Over 2,700,000 children were vaccinated for smallpox, and over 3,100,000 were immunized for diphtheria by State and local health departments through grants provided by the maternal and child health programs. Polio immunization through these programs reached 5,100,000 children. Activities and services of maternal and child health programs on behalf of mentally retarded children and their families continued to expand in 1959. Of 44 State health departments offering special services to the retarded, 36 reported serving 6,704 children and their families during the past calendar year. There was a steady move¬ ment toward earlier casefinding and identification ; 30.3 percent of the new cases seen during the year were under 4 years of age and 74.6 per¬ cent were under 9 years of age. Applications continued to exceed the capacity of the centers to accept children for diagnosis, evaluation, and Social Security Administration 43 treatment, but new methods of reducing waiting lists are resulting in services to a larger number of families. More selectivity and flexibil¬ ity in the use of diagnostic approaches, more efficient use of local resources, greater stress on training local generalized personnel, and assignment of preliminary screening responsibility to local services are some of the techniques being used. During the year three biregional conferences were held. These in¬ volved the administrative and technical clinical staff in six regions and afforded an opportunity for exchanging information and sharing ideas and experience. A highlight of the year was a meeting of the Children’s Bureau’s Technical Committee on Clinical Programs for Mentally Retarded Children called primarily to discuss an action program to prevent the mental retardation associated with phenylketonuria. As a result guides for screening and treatment of affected children are being developed. The recommendations made by this Committee were sub¬ sequently endorsed unanimously by the American Association for Mental Deficiency. Pilot studies to identify affected families are already in progress in several States, among them Michigan, Oklahoma, and California. After 22 years of decline, infant mortality rates rose from a record low of 26.0 in 1956 to provisional rates of 26.4 in 1957, and 26.9 in 1958. Concern over this increase in infant mortality has resulted in efforts to pinpoint specific causes, or at least to determine whether cer¬ tain areas or groups in the population are chiefly responsible for the rise. As a result of several studies which show an association between lack of prenatal care and increased neonatal mortality, a number of States and cities have established new clinic facilities for maternity patients in areas inadequately covered. Partly as a result of higher neonatal mortality and partly because of interest in controlling hospital-acquired staphylococcal infections, consultation by maternal and child health personnel to hospitals is increasing. Some States have been able to employ new staff for this service. A number of States report that the number of requests for hospital consultation exceeds their ability to meet these requests. A number of State health departments have published new hospital manuals emphasizing the care of newborn infants and the control of infections in nurseries. A number of institutes on this subject were held in the States during the past year. Interest in special problems of the adolescent has taken concrete form in the development of services for this age group. A number of new clinics for adolescents were started during the year. Although all these clinics are essentially medical clinics, a very broad service to adolescents is being offered, including help with social, emotional and intellectual problems. 44 Department of Health , Education , and Welfare, 1959 Since a high percentage of accidents involve children, a number of State maternal and child health divisions now employ personnel specifically assigned to accident prevention and poison control activi¬ ties. During the year a number of studies of childhood accidents were made by these States to find clues for prevention. As in former years a great deal of attention has been given to train¬ ing professional persons who serve mothers and children. Two im¬ portant conferences were held at schools of public health. An Institute on Perinatal Casualties was held at the University of Minnesota in cooperation with the University of Michigan and the maternal and child health and crippled children’s agencies of the two States. A regional conference on child growth and development was held at the Johns Hopkins University School of Public Health in cooperation with the Maryland State Department of Health. Institutes for physicians and nurses on the care of premature in¬ fants were given at the New York-Cornell Medical Center. The fac¬ ulty from this Center also led institutes in neighboring States. Other courses in the care of prematures were given in various parts of Flor¬ ida by the staff of the premature center in Miami. CRIPPLED CHILDREN’S SERVICES All the States (excepting Arizona) , the District of Columbia, Puerto Rico, the Virgin Islands, and Guam are participating in the crippled children’s program. Although the State agency auspices vary, the objective is uniform, namely : to locate children who require care and to provide restoration through diagnosis, medical and surgical treat¬ ment, and alleviation of unfavorable social and psychological influ¬ ences which adversely affect the degree and duration of the disability. The appropriation for crippled children’s services is $15 million, $5 I million less than the amount authorized. A new peak was reached in 1958 in the number of handicapped chil¬ dren served under federally aided programs, preliminary figures from State reports indicate. Of the 325,000 children cared for during the year, 255,000 were examined in clinics; about 71,000 received physi¬ cians’ services through home or office visits. About 53,000 children were hospitalized. Convalescent home care was given to the smallest group, around 3,800. Shortage of funds continued to plague the crippled children’s pro¬ gram. Not only were medical care costs higher but caseloads were heavier due to an increasing child population, to relatively larger num¬ bers of children in low-income families, to extension of services to new i categories of children, to improved casefinding, and to advances in therapy making a larger number of children amenable to treatment. In a few States a larger number of families were unable to pay for private care because of unemployment. Social Security Administration 45 In many States crippled children’s programs have had to be cur¬ tailed because of insufficient funds at the very time demand for serv¬ ices is increasing, particularly in areas where programs have been improved, where services provided have not been available previously, and where new developments in medical diagnosis and treatment are being applied. These include such diagnostic categories as congenital heart disease, speech and hearing defects, cleft lip and cleft palate, and neurological impairments. Among the States where services have been curtailed, except for the most urgent or severe problems, are Colorado, Idaho, Montana, Wyo¬ ming, Kentucky, and North Carolina. Three States established wait¬ ing lists for surgery beginning in the third quarter ; Missouri, Puerto Rico, and West Virginia have long waiting lists. Should this trend continue, the number of children whose severe and permanent dis¬ ability could have been prevented or alleviated will undoubtedly increase. Further, extension of services to children with malignancies, cystic fibrosis, nephrosis and other metabolic diseases will not be possible. The pressing need for crippled children’s funds was alleviated somewhat this spring when Congress earmarked $1^2 million for fiscal years 1959 and 1960 for care of children with congenital heart disease. Beginning in 1939, when the increased crippled children’s appro¬ priation was made in part so that rheumatic fever programs could be developed, Congress has shown a preference for appropriations given for specific purposes. This was also demonstrated in 1957 when $1 million of maternal and child health funds were earmarked for programs for mental retardation. States are increasingly aware of the needs of multiple handicapped children such as the deaf-blind. During the year the Children’s Rehabilitation Unit of the University of Kansas Medical Center evaluated nine such children and through their efforts the State legislature passed a bill providing out-of-State education for severely handicapped children such as the deaf-blind for whom special educational opportunities are not available in Kansas. During the year a conference was held at the Child Amputee Center, Grand Rapids, Mich., sponsored by the National Research Council’s Committee on Children’s Prosthetics Problems, and the Children’s Bureau, to which were invited the directors of 12 major child amputee clinics. Agreement was reached on areas of clinical program studies to be carried out cooperatively by all 12 clinics. This includes testing a new artificial leg, studying problems of fitting artificial arms, and studies of the optimal age for fitting babies with artificial arms. The Harvard School of Public Health, in cooperation with the 46 Department of Health , Education , and Welfare , 1959 Children’s Cancer Research Foundation and the Massachusetts De¬ partment of Public Health, sponsored an institute on leukemia and other malignant neoplasms in childhood for maternal and child health and crippled children’s directors. The importance of early diagnosis was stressed and the newer medical and surgical treatments which have improved prognosis for cancer in children were discussed. The availability of services in the congenital heart programs has led to the discovery of many children previously unrecognized. In 1950, 2,207 children received physicians’ services for congenital heart disease under State crippled children’s programs; in 1958, 12,164 (preliminary), nearly 6 times as many. The rapid and brilliant scientific advances which have occurred in the diagnosis and treatment of congenital heart disease have created widespread interest. The past 2 or 3 years have seen the development of professional teams and facilities for care of children with congenital heart disease in medical centers and hospitals in many States. This development of State centers has resulted in fewer children leaving their own State for care in regional centers. Increasing interest with resulting development of programs for children with cystic fibrosis has been taking place, especially in the northeastern States. The caseload for children with this condition has been increasing. Many training institutes have included the subject of cystic fibrosis. CHILD WELFARE SERVICES The year 1959 stands out as a momentous one for the child welfare services program. The potentially far-reaching and challenging ram- t ifications of the 1958 amendments to the child welfare provisions of Title V, part 3, of the Social Security Act for strengthening services for all children in this country is increasingly evident even in the i relatively short period of time since their Presidential approval on August 28, 1958. With child welfare funds now available to urban as well as to rural areas, States have an opportunity to participate in improving community living for children and families in a dimension not heretofore possible. In addition, the amendments : 1. Broadened the provision with respect to return of runaway children to their own communities to permit use of funds for children up to 18 years of age and to maintain the child pend¬ ing his return for a period not exceeding 15 days. 2. Increased the authorization of Federal child welfare services funds from $12 million to $17 million. 3. Authorized reallotment of these funds. In accordance with this provision, reallotment was made to 15 States (February 1, 1959) of funds released by 4 States. That States, have made Social Security Administration 47 effective use of these additional funds is evidenced by the fact that the amount of Federal funds on hand in the Federal Treasury on June 30, 1959, was only $166,701.34. This repre¬ sents 1.4 percent remaining in the Treasury in 1959 as con¬ trasted with 4.6 percent in 1958. 4. Added a new requirement for matching Federal child welfare services funds with State funds, beginning July 1, 1959. 5. Extended the program to Guam, as of the same date. The Bureau’s regional child welfare representative was in Guam before the end of the 1959 fiscal year to confer on the develop¬ ment of the basic plan and 1960 annual budget. Another 1958 amendment to the Social Security Act (Title IX) established an Advisory Council on Child Welfare Services to report to the Secretary and the Congress by January 1, 1960. At its first meeting, May 4 and 5, the Council concerned itself chiefly with deter¬ mining the scope of future deliberations and procedures for carrying out the congressional directive. Plans were made for a maximum of three future meetings before the end of 1959. A working paper pre¬ pared by the Bureau was requested by the Council for consideration at its next meeting. The Bureau has requested from States and national voluntary agencies information on developments and needs in child welfare programs as well as suggestions for future changes in Federal legislation. As the fiscal year ended, plans were underway for an evaluation of the effect of the 1958 amendments. They have opened a new era in the grant program for child welfare services. Their effect in strength¬ ening State and local child welfare programs along with recommen¬ dations anticipated from the Advisory Council on Child Welfare Services, will lay a foundation for the future of public child welfare services throughout the Nation. A meeting with State Welfare Administrators and Child Welfare Directors, in October 1958, afforded opportunity for a discussion of draft materials on new procedures to carry out the above provisions. A report of the Conference is included in The Changing Scene in Child Welfare — Child Welfare Reports No. 9. Subsequently, these revised procedures were issued in official form, and prior to the fiscal year’s end were incorporated along with procedures for implementing the requirement for “matching” in the Handbook for Child Welfare Services . Revised regulations were also in draft. Uniformly, reports from the regional offices and from the States themselves have indicated a positive reaction to the new legislative base. A great deal of thought and care has gone into considering the most effective utilization of combined State and Federal funds to strengthen child welfare programs ; State agencies have received new impetus for program expansion and development. 48 Department of Health, Education, and Welfare, 1959 Demonstrable progress was made in 1959 in advancing knowledge of children’s needs through joint planning between levels of govern¬ ment and between citizens and voluntary and public agencies in de¬ termining optimum ways of providing needed services. Particular stress was laid on strengthening family life and services to children in their own homes. A joint committee of the Children’s Bureau and Bureau of Public Assistance prepared a statement on relationships between the two programs in providing services to chil¬ dren in the families who also receive public assistance. A plan for allocating costs of such services between these two grant-in-aid pro¬ grams was also developed. Consultation to State and local welfare agencies and citizen groups by the Bureau’s Specialist on Services to Children in Their Own Homes has emphasized coordination in plan¬ ning and providing services. Results of the special survey conducted for the Bureau by the Bu¬ reau of the Census (May 1958) on arrangements for care of children of working mothers revealed that some 400,000 children under age 12 must care for themselves while their mothers work. Another 24,000 children under age 3 and 67,000 between ages 3 and 5 were re¬ ported receiving some type of group care. The effects of group care upon very young children, or of substandard or “no care” arrange¬ ments for any of these youngsters, is a matter of grave concern to the Bureau. In quick followup, a questionnaire on day care programs and facilities was developed jointly with the Women’s Bureau in the Department of Labor and sent to some 284 national welfare, health, service, and women’s organizations. Preliminary analysis of the re¬ turns testified to the widespread interest in this area of service. Bu¬ reau planning with the Women’s Bureau for a Day Care Conference was underway at the year’s end. Another highlight of the year was the staging in Chicago in Febru¬ ary 1959 of the most widely representative conference on homemaker service ever held in this country. The careful preliminary planning involved study groups in New York, Chicago, San Francisco, Cleve¬ land, Raleigh, Denver, and Trenton; 26 national voluntary agencies; and 8 units of Health, Education, and Welfare. Participants received 12 descriptive statements of agency programs; reports of the pre¬ conference study groups ; a nationwide study of services ; and a popu¬ larly written pamphlet, CB Folder No. 46 — Homemaker Service. Recommendations of significance to State programs were — 1. For a multidiscipline study and evaluation of the existing variations in homemaker service programs. 2. That the Department of Health, Education, and Welfare “en¬ courage and assist States in developing homemaker service by continuing and expanding the consultation service it presently provides.” Social Security Administration 49 Significant advances have been made nationally this year in the preparation of legislative guides and model laws pertaining to child life. It is expected that these will have a substantial and positive effect upon future State legislative action. Four legislative work¬ shops have been conducted by the Bureau’s Specialist on Child Wel¬ fare Legislation on draft materials on parental rights and principles of adoption legislation. Participants included the Office of the Gen¬ eral Counsel and Bureau personnel in the central office and seven regional offices. Publication of the Standard Family Court Act in 1959 provided another major development in child welfare services. Proposed as a model for State legislation, it provides for unified jurisdiction within family courts for issues arising from family con¬ flicts such as divorce, adoption, support, paternity, delinquency, neg¬ lect, and allied problems. Reorganization of the Bureau’s Division of Social Services afforded opportunity for staff to work this past year not only with national organizations in the field of child welfare, but in many related fields as well. Consultations were given to a number of local volun¬ tary and public agencies and institutions. Through the media of planning councils staff members have worked with citizens and lay groups; through appointment on national or regional or local pro¬ fessional committees they have helped to improve practices and stand¬ ards for care. A conference of Lutheran, Methodist, and Episcopal national officers with five Southeastern State welfare department licensing consultants is one result of the new emphasis. The scope of the Bureau’s joint activities in 1959 with a variety of agencies and governmental units reflects the broad ramifications of its child welfare program. Cooperative efforts have continued with the American Association on Mental Deficiency, training schools, schools of social work, and the Council on Social Work Education in the field of social services for mentally retarded children. The Division has worked jointly with the Child Welfare League of America, Family Service Association of America, Rational Travelers Aid Society, National Urban League, United Community Funds and Councils of America, the Salvation Army, the American Social Health Assn., and Florence Crittenton Home Association on problems related to the unmarried mother. Although the proportion of teenage unmarried mothers to the total number of unmarried mothers has re¬ mained fairly constant, there was an increase of 5.2 percent between 1956 and 1957 in births to adolescent unmarried mothers. Community concern over this trend has taken many forms. The Bureau noted a substantial increase in the number of letters it received requesting information about the problem, as well as suggested resources or pre¬ ventive measures. Study committees have been appointed in a number 50 Department of Health , Education , and Welfare , 1959 of States and urban centers to survey the magnitude of the problem, assess services and resources and make recommendations for next steps. Division staff is working with Bureau of Public Assistance staff on a cooperative approach to identifying the factors involved in illegiti¬ macy and the planning essential to provide effective services to un¬ married mothers and their children. An East Coast Migratory Farm Labor Conference had participation from the fields of health, welfare, labor and industry, education, em¬ ployment security, industrial relations, law enforcement, agriculture and markets, social security, vocational rehabilitation and church wel¬ fare services. The Mid-American Conference on Migratory Labor in¬ volved participants from 19 States. Joint sponsors were the Council of State Governments and the President’s Committee on Migratory Labor. Division of Social Services staff participated in preliminary planning and acted as workshop leaders in some of the sessions on the needs of children of migrant workers. Among the staff training developments during the year, the Bureau and the Child Welfare League of America completed a statement on the knowledge and skills essential for practice in the field of child wel¬ fare for use in the curriculum study directed by the Council on Social Work Education. A record $1,199,381.80 was budgeted by States as of J une 30, 1959, for educational leave under their child welfare serv¬ ices program, holding promise for some future easing of trained staff shortages. Also, the Bureau took a first step in exploring the problem of how States can make effective differential use of available staff. A selected group of representatives from public child welfare and volun¬ tary agencies was invited to Washington by the Bureau for a 2-day session on such differential use of staff, particularly case aides, for those aspects of the child welfare job which can be isolated as not re¬ quiring professional knowledge and skills. This, it is hoped, will be the beginning of broader-scale controlled experimentation. Division staff participated with the Bureau of Public Assistance in an inter- Bureau Committee in clarifying basic principles relating to staff development. JUVENILE DELINQUENCY SERVICE Interest in the problem of juvenile delinquency continued high throughout the country. More than 20 bills relating to delinquency were introduced in the past session of Congress. Several volumes of testimony were taken by two congressional subcommittees which heard witnesses testify on these bills. At the end of fiscal 1959, the sub¬ committees had reported out bills which were awaiting action of the full committees. This widespread interest generated requests for the services of the Bureau’s juvenile delinquency specialists to a point far beyond Social Security Administration 51 their preseht capacity. The 10 staff specialists on delinquency responded to more than 800 requests for services. Three hundred and twenty-two of these requests from 32 States, the District of Columbia, Virgin Islands, and Puerto Rico were served by field consultations. Consultations were provided to 147 persons in the Washington office and to 366 through correspondence. In addition, approximately 60 foreign visitors from 24 countries received program information and technical assistance through office interviews. Among official planning and coordinating agencies, there is a grow¬ ing conviction that more must be learned about how to prevent juve¬ nile delinquency, that new preventive techniques and programs should be tried and tested, and research intensified to measure the effective¬ ness of those already in use. In the fall of 1958 with Children’s Bureau staff attending, admin¬ istrative personnel representing the youth commissions of 14 States came together to discuss their common concern — how to increase the prevention of juvenile delinquency. This was the first meeting for this purpose of personnel in State governments with leadership re¬ sponsibilities to combat juvenile delinquency. A decision was made to meet again early in fall 1959 and to act on a proposal for a perma¬ nent organization. In response to the expressed interest of municipal youth commis¬ sions, the Children’s Bureau convened a meeting of their representa¬ tives in the fall of 1958, with nine directors from seven States. These commissions are seeking to develop a teamwork approach among con¬ cerned public and private agencies to reduce delinquency. They are especially interested in developing ways and means of converting citi¬ zen concern into positive action. The Children’s Bureau staff also helped in planning a conference on “The Role of Pediatric Services in the Prevention of Juvenile Delinquency,” sponsored by the Amer¬ ican Academy of Pediatrics. The current interest of pediatricians in delinquency prevention is significant since they are as close to chil¬ dren and families as any other professional group. Interest in training continued to gain. Staff members participated in numerous workshops and institutes. Considerable material was secured and is being adapted for training purposes. In 1959, a number of police administrators were emphasizing the total departmental role in relation to children and youth rather than the responsibility of a small corps of juvenile specialists. Greater stress and responsibility were being placed on the patrol force for investigating and disposing of children’s cases. A trend continued for police departments to withdraw from recreation and other activi¬ ties normally the responsibility of other agencies. The development of the Standard F amily Court Act and Standard Juvenile Court Act (a cooperative venture of the National Probation 52 Department of Health , Education , and Welfare , 1959 and Parole Association, the National Council of Juvenile Court Judges and the Children’s Bureau) has brought about a more critical and realistic look at the principles and procedures involved in juvenile and family court operation. The substantial agreement among the three agencies on the principles involved should prove to be a mile¬ stone in the development of juvenile and family courts. State agencies showed increased awareness of the necessity of pro¬ viding juvenile court and probation and detention consultations. A number of States have added such consultants to their staffs. For the first time, a special workshop devoted to the subject of State con¬ sultant services to juvenile courts was held at the National Institute on Crime and Delinquency. Considerable interest continued in forestry camps as a means of pro¬ viding a constructive and unique institutional experience for delin¬ quent boys. The interest is being manifested in the actual construc¬ tion and development of camps as well as in discussions. There are wide variations in these programs. Experimentation is essential and that course is being pursued in some States. Many States continue to face problems of overcrowding in institu¬ tions. This has led many to build additional cottages on their grounds to accommodate more children. In some States new institutions have been started and, as indicated above, a considerable number of camps have been initiated. Also, to meet this problem, some schools have had to reduce the length of stay. Three major publications were completed : Administration and Staff Training in Institutions for Juvenile Delinquents (CB Pub. 377), was developed in cooperation with the National Association of Train¬ ing Schools and Juvenile Agencies, National Conference of Superin¬ tendents of Training Schools and Reformatories, National Conference of Superintendents of Girls’ Training Schools and the Graduate School of Social Work of Rutgers University; the Standard Family Court Act and the Standard Juvenile Court Act were the result of a joint project of the National Probation and Parole Association, the National Council of Juvenile Court Judges, and the Children’s Bureau (printed by the National Probation and Parole Association). Cooperative work was also carried on with the Council of Social Work Education, the American Public Welfare Association, and the Child Welfare League of America. INTERNATIONAL COOPERATION At the Executive Board meeting of UNICEF in the spring of 1958, the Chief of the Children’s Bureau, as Chairman of the U.S. Delega¬ tion, made a proposal for a study of how UNICEF aid might be ex¬ panded into the field of social services for children, beginning with , institutions and day care centers. During the subsequent year such a Social Security Administration 53 study was carried out by the Bureau of Social Affairs. Enthusiasti¬ cally received by the Executive Board in the spring of 1959, the study forms the background for a new program to be undertaken gradually. With the aid of a special consultant from the United Kingdom, the Bureau of Social Affairs and UNICEF will work with countries in developing new programs for children requiring care outside their own homes. Staff members of the Bureau reviewed material and worked on the development of position papers for the Session of the United Nations Social Commission in New York in April and for the Session of the Economic and Social Council of the United Nations in Geneva in June. Material in the field of maternal and child health was provided for the use of the U.S. Delegate at meetings of the South Pacific Commis¬ sion, and for the use of the U.S. Delegates to the World Health Organization Assembly. The Bureau’s heavy foreign correspondence continued, with a shift in geographic emphasis. The past year has brought a sharply in¬ creased number of requests for information and materials from Afri¬ can countries south of the Sahara. This reflects the increasing in¬ terest and activity of the United Nations and its specialized agencies and of the U.S. International Cooperation Administration in that part of the world. Under a cooperative program with the International Cooperation Administration of the State Department, the Bureau’s international staff recruits Americans for maternal and child health and child wel¬ fare positions abroad, provides technical materials and information as requested, and plans and arranges training programs for persons from other countries. In 1959 the trend in requests for recruiting was to¬ ward the social services, in the general field of child welfare, and in medical social services in national health programs. In training activities the trend toward training in the specialties of pediatrics and obstetrics for doctors and nurses continued, with a smaller number in the general area of maternal and child health. Nine maternal and child health and child welfare specialists re¬ cruited and backstopped by the Bureau worked as consultants and teachers in eight countries. Two nurses, one obstetric and one pedi¬ atric, were in Guatemala, one pediatric nurse in Brazil, one nurse- midwife in Bolivia, and one pediatric nurse in India. A maternal and child health physician was in Paraguay and another in Iraq. In the first 6 months of 1959 a medical social worker arrived in Peru and a child welfare worker went to El Salvador. During the year, programs of study and observation in this country were planned and arranged for 84 long-term trainees, an increase of 10 percent over 1958. The total of 84 included 39 physicians; IT 54 Department of Health, Education , and Welfare, 1959 nurses; 1 administrator of a program for handicapped children; 3 medical social workers ; 1 health educator and 23 specialists in various aspects of child and youth welfare. They came from 35 countries under auspices of the International Cooperation Administration, the United Nations, the World Health Organization, the International Exchange Service of the State Department, the Department of De¬ fense, and a few from such organizations as the Carnegie Foundation and the American Association of University Women. As in several years previous, more and more overseas physicians came here for training in the clinical specialties of pediatrics and obstetrics and many will return to teaching positions in medical schools in their respective homelands. Seven physicians on the faculty of medicine in Indonesia came for further training in pediatrics and obstetrics, part of an overall plan to upgrade medical education in that country. Thailand has continued its pattern of requesting 2 or more years for training physicians who will teach the clinical specialties, and the International Cooperation Administration has supported this pattern. Twenty-three persons came to study child and youth welfare. Of these, 4 studied group work with children and youth; 3, juvenile de¬ linquency ; 1, child guidance ; and 15, the general area of child welfare. Three persons studied in the field of medical social work. In addition to the long-term trainees and observers, interviews and short observation visits were arranged for 152 short-term visitors from 55 countries. Among the 152 were top-ranking Government offi¬ cials; members of Parliament; judges; teachers in universities, high schools, and grade schools; health educators; nutritionists; labor leaders; directors of insurance programs; doctors; nurses; social workers, etc., all of whom had major interest in some general field, but a minor interest in children. INFORMATION FOR PARENTS AND THOSE WORKING WITH CHILDREN In 1959, 37 new and revised publications were issued, and 9 more were undergoing, or ready for, printing, as compared to 32 issued and 13 ready to go at the end of fiscal year 1958. The number of printed pages produced in 1959, however, totaled 2,180, as compared to 1,864 in 1958 — the highest total of published pages since 1927. Besides important additions to its list of technical publications, the Bureau issued three new publications for parents which proved in¬ stantly popular — Tour Gifted Child, The Mentally Retarded Child at Home , and Accidents and Children . A publication highlight was the issuance of the 40,000,000th copy of Infant Care and its presentation to “typical” American parents by President Eisenhower at the White House. A promotional effort for Children resulted in the addition of 4,000 new paid subscribers to that interdisciplinary journal, giving it the Social Security Administration 55 highest paid circulation of any Department of Health, Education, and Welfare periodical. Federal Credit Unions Several noteworthy events during and immediately after the close of the fiscal year helped to strengthen the Federal credit union program and provided additional opportunities for service to the members. Midway through the fiscal year, total assets of federally chartered credit unions passed the $2 billion level for the first time and active membership exceeded 5 million. June 26 marked the 25th anniversary of the Federal Credit Union Act, passed by Congress in 1934. Early in July the Bureau paid the final installment of a long-term debt (nearly 5 years ahead of sched¬ ule) , thereby becoming completely self-sustaining and self-financing. Continued growth provided further opportunities for rendering service to additional thousands of American families. This service takes the form of timely loans at reasonable rates of interest for prov¬ ident and productive purposes; financial counseling by many credit union officials to the members ; and further encouragement to save for the proverbial “rainy day.” Credit unions enjoy certain inherent advantages which enable them to fulfill their mission of lending financial assistance and rounding out the financial education of the members. The cohesiveness of shareholder groups and the convenient location of credit union offices at places of employment present opportunities for service that might otherwise be lacking. Since credit unions are organized for the pur¬ pose of mutual assistance to the members, they can and should develop an esprit de corps that helps to sustain confidence in times of stress. Credit unions resist inflationary forces. The members’ savings (shares) in credit unions have always exceeded members’ borrowings from credit unions. When the Federal Credit Union Act was passed a quarter of century ago, there were about 2,350 credit unions in the United States that had been chartered under State laws since the passage of the first State credit union law in Massachusetts in 1909. Today there are more than 9,300 active Federal credit unions alone, or about one-half the total number of active credit unions in the United States. Assets of the federally chartered groups totaled approximately $2,150 million on June 30, 1959, and active membership approached the 5.5 million mark. During fiscal year 1959, total assets increased 15 percent, member¬ ship rose 7 percent, and loans outstanding to members moved up from $1,320 million on June 30, 1958, to $1,460 million a year later, an in¬ crease of 11 percent. According to Federal Reserve Board estimates, 56 Department of Health , Education , and Welfare , 1959 Federal credit unions held 3.7 percent of the consumer installment credit outstanding at the end of June 1958 ; a year later, their share of the total had moved up to almost 4 percent as installment credit held by Federal credit unions increased 14 percent in contrast to a rise of 8.5 percent for installment credit as a whole. The Bureau of Federal Credit Unions is the supervisory body charged with the responsibility of administering the Federal Credit Union Act. The Bureau receives no appropriation from the Congress, and is now completely self-supporting from fees paid by the credit unions chartered under the Federal act. To aid the Bureau in con¬ verting from a partially tax-supported to a completely self-sustaining basis, the Congress authorized a $250,000 loan in 1953. Repayment of the loan, together with interest totaling $30,070, was completed in July 1959, nearly 5 years ahead of the July 1, 1964, due date specified in the act which authorized the loan. As the credit union program moves forward, looming ever larger in the Nation’s economy, the Bureau’s responsibilities increase with each passing year. The credit unions are faced with new and big¬ ger problems as they continue to grow, and the Bureau’s task of supervising and examining an increasing number of larger groups becomes more complex. By way of illustration, the past few years have witnessed a trend toward machine bookkeeping and other elec¬ tronic devices in the larger credit unions as their volume of business expands. The examination program of the Bureau, which repre¬ sents a major phase of its operations, must cope with this develop¬ ment, and at the same time must provide simpler yet equally effective examination procedures for the small credit union. Staff development is receiving increasing attention as the training needs of the examiners and other Bureau staff are geared to the growth and ever-changing requirements of a dynamic program. J ust as the credit union must constantly be alert for ways to improve and expand the services to members, so must the Bureau move for¬ ward in its efforts to improve and expand its services to the credit unions. A well-informed, knowledgeable supervisory staff obviously contributes to this end. A broadened and continuing training pro¬ gram was emphasized during the past fiscal year when the Bureau created and filled a new position of Employee Development Officer. The 25th Anniversary week was highlighted by a week of confer¬ ences in Washington of the Bureau’s regional representatives and associate regional representatives, and publication in the June 1959 issue of the Social Security Bulletin of a commemorative article entitled “Federal Credit Unions: Twenty-five Years of Self-Help Security.” As part of the 25th Anniversary celebration and with the coopera¬ tion of the Voice of America, the story of credit unions in the United Social Security Administration 57 States was broadcast throughout the world in English and to Europe and to the Far East in 14 other languages — Russian, Ukrainian, Mandarin Chinese, Cantonese Chinese, Hungarian, Indonesian, Greek, Serbo-Croat, Italian, Persian, Bulgarian, Polish, Czech, and Armenian. At the conclusion of the first quarter century of the Federal credit union program, there is every indication that it is entering a new era of maturity. The ideals of the early credit union leaders are firmly embedded in the program as it moves forward with increasing vigor and with a new appreciation of the social significance of credit unions as part of the American way of life. Today’s credit union leaders are giving increasing attention to the field of family finan¬ cial counseling as an area of emphasis toward expansion of services of a social nature. Perhaps even broader in its application is the increased thought given to providing credit union services to low income groups. Financial gains must not obscure the basic purposes so cogently expressed in the motto of credit unions everywhere : “Not for Profit, Not for Charity — But for Service.” Table 1. — Social Security Administration: Funds available and obligations incurred, fiscal years 1959 and 1958 1 [In thousands; data as of June 30, 1959] Item Funds available * Obligations incurred 1959 1958 1959 1958 Total _ $2,181,882 $1, 960, 587 $2, 180,039 $1,937,598 Grants to States: Public assistance— . . . . Old-age assistance _ 1,957,960 » 1,767, 173 1,957,098 1, 132, 194 47, 619 626, 546 150, 739 44, 728 16, 494 16, 401 11, 833 178, 213 610 170, 087 2, 142 2, 165 150 3,059 1, 745, 173 1,052,708 44, 192 525, 318 122, 955 40, 722 16,336 14, 847 9, 539 151, 703 504 144, 449 1,974 2, 045 Aid t.n t.hfi blind _ _ _ Aid to dependent children _ Aid to the permanently and totally disabled.. Maternal and child health and welfare services . Maternal and child health services . . Services for crippled children _ _ - Child welfare services - - Administrative expenses:4 . . Office of the Commissioner * _ ... .. .. Bureau of Old-Age and Survivors Insurance Bureau of Public Assistance _ Children’s Bureau 7 - - White House Conference on Children and Youth _ _ _ 45,000 16, 500 16, 500 12,000 178, 922 596 170,614 2, 164 2, 172 150 3,226 41. 500 16. 500 15,000 10,000 151, 910 S41 144, 692 1,982 2,048 Bureau of Federal Credit Unions . 2, 647 2,731 1 Funds available and obligations reported by administrative agencies. 2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, recoveries, and fee collections for services rendered. 3 Excludes $3.4 million transferred to other DHEW appropriations accounts pursuant to P.L. 85-472 for meeting portion of increase pay in 1958. 4 Funds made available and obligations incurred for salaries, printing and binding, com¬ munications, traveling expenses, and all other objects of expenditure. 5 Appropriations by Congress from general revenues accounted for approximately 56 percent of the administrative expenses of the Office of the Commissioner in 1958 and 1959 ; balance from old-age and survivors insurance trust fund. 6 Administrative costs of the old-age, survivors, and disability insurance program which involved benefit payments of $8,043,000,000 in 1958 and $9,388,000,000, in 1959. Does not include construction costs of new buildings as follows : Funds available: 1959, $8,979,461 ; 1958, $30,140,163. Obligations incurred: 1959, $1,345,587 ; 1958, $22,370,702. 7 Includes expenses for investigating and reporting on matters pertaining to the welfare of children authorized by the act of 1912, as well as expenses for administration of grants to States. 530344—60 - 5 58 Department of Health , Education , and Welfare , 1959 Table 2. — Financing social insurance under the Social Security Act: Contribu¬ tions collected and trust fund operations, fiscal years 1957—59 [In millions; independently rounded] Item 1959 (pre¬ liminary) 1958 1957 Contributions collected under— Federal Insurance Contributions Act 12 _ . _ $8, 459 $8, 193 $6, 877 Federal Unemployment Tax Act1 2 3 4 5 _ _ _ _ 324 336 330 State unemployment insurance laws 45 _ _ 1,675 1,500 1, 537 Old-age and survivors insurance trust fund : Receipts, total _ 8, 109 7, 824 7, 100 Net appropriations and deposits _ ... ... . _ _ 7, 565 7, 267 6, 540 Interest and profits on investments 6 _ . . 543 557 561 Expenditures, total _ ... _ _ . _ . _ 9, 379 8, 041 6, 665 Monthly benefits and lump-sum payments 7 _ 8 9, 174 7,875 6,515 Administration _ _ .. _ 206 166 150 Assets, end of year _ _ _ - _ - . _ _ Disability insurance trust fund: 21, 542 22, 813 23, 029 Receipts, total. . . _ ... .... _ 928 942 338 Net appropriations and deposits. _ _ 895 926 337 Interest _ _ 33 16 1 Expenditures, total _ _ _. .. 360 180 1 Monthly benefits. .. _ _ _ .. _ 339 168 Administration _ _ 21 12 1 Assets, end of year _ ... . _ .. _ 1, 666 1,099 337 State accounts in unemployment trust fund: Receipts, total - 2, 126 1,794 1, 790 Deposits8. . . . . . _ _ _ _ 1, 946 1, 575 1, 578 Interest _ . _ _ _ 179 220 212 Withdrawals for benefit payments _ 2, 797 2,926 1, 514 Assets, end of year _ _ _ 6, 688 7,360 8,492 1 Contributions on earnings up to and including $4,200 a year in 1957 and 1958, and $4,800 a year beginning Jan. 1, 1959. Contribution rate paid by employers and employees: 2 percent each; 2J4 percent each begin¬ ning Jan. 1, 1957; 2 Yi percent each beginning Jan. 1, 1959, Contribution rate paid by self-employed: 3 per¬ cent; SH percent beginning Jan. 1, 1957; 33A percent beginning Jan. 1, 1959. Includes deposits by States under voluntary agreements for coverage of State and local employees. Includes deductions to adjust for reimbursements to general funds of the Treasury of the estimated amount of employee taxes subject to refund on wages in excess of wage base. 2 Includes old-age and survivors insurance and, beginning Jan. 1, 1957, disability insurance contributions. 3 Prior to 1957 tax could be paid in quarterly installments by employers of 8 or more; beginning Jan. 31, 1957, tax payable annually on preceding year’s wages by employers of 4 or more. Rate is 3 percent on first $3,000 a year of wages paid to each employee by subject employer. Because of credit offset of up to 90 per¬ cent of amount assessed that is permitted for contributions paid under State unemployment insurance laws (or for full contribution if reduced by State experience rating provisions), effective rate is 0.3 percent of such wages. 4 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 5 Contributions and deposits by States usually differ slightly, because of time lag in making deposits. Deposits in the State accounts also include loans from the Federal unemployment account of the unemploy¬ ment trust fund and the distribution of Federal tax collections among the States under the Employment Security Administrative Financing Act of 1954. 8 For 1957 and 1958 includes interest transferred from the railroad retirement account under the financial interchange provisions of the Railroad Retirement Act, as amended in 1951 and 1956. 7 Represents checks issued. 8 Includes payment of $124 million to railroad retirement account under financial interchange (see footnote 6). Source: Compiled from Final Statement of Receipts and Expenditures of the United States Government, other Treasury reports, and State agency reports. Social Security Administration 59 Table 3. — Old-age, survivors, and disability insurance: Estimated number of families and beneficiaries receiving benefits and average monthly benefit in current-payment status, by family group, end of June 1959 and 1958 [In thousands, except for average benefit; data corrected to December 1959] June 30, 1959 June 30, 1958 Family classification of beneficiaries Number of families Number of . benefi¬ ciaries Average monthly amount per family Number of families Number of benefi¬ ciaries Average monthly amount per family 9, 728. 5 13, 181.4 8, 797. 1 11,905.3 7, 295. 6 9.636.6 5.153.6 6, 638. 5 4, 662. 0 8, 785. 1 5, 153. 6 $68. 30 4, 662. 0 $62. 00 Male _ _ _ 2, 700. 6 2, 700. 6 2, 453. 0 3,956.2 1.2 77. 30 2, 500. 6 2, 500. 6 2, 161.4 3, 670. 4 69. 80 2, 453. 0 58.30 2, 161.4 1,835.2 .8 53.00 1, 978. 1 .6 120. 60 110. 20 113.70 1.6 105. 10 Worker and aged dependent husband.. 14.7 33.5 29.4 78.4 104. 70 119. 70 13.7 29.1 27.4 69.4 93.20 106. 70 Worker, wife aged 65 or over, and 1 or more children _ _ - - -- 14.7 47.9 152. 70 8.0 26.2 139. 00 Worker, young wife, and 1 or more children _ _ _ _ _ 100.3 369.6 148. 20 89.6 327.8 128. 30 Worker, husband, and 1 or more children. . _ _ _ _ _ .1 .3 135.00 .1 .3 129. 00 Survivor families. . _ _ _ 2, 157. 7 1,311.5 1.7 3, 183. 6 1,311.5 1,958.2 1, 165. 4 1.5 2, 919. 8 1, 165. 4 1.5 Aged widow _ _ 56. 20 51.60 Aged dependent widower 1.7 53.20 48. 30 Widowed mother only 1 2 . _ 1.1 1. 1 57. 20 1.2 1.2 50. 30 Widowed mother and 1 child _ _ 154.2 308.4 129. 00 145. 1 290.2 116. 20 Widowed mother and 2 children 107.9 323.7 166. 50 101.8 305.4 149. 50 Widowed mother and 3 or more chil¬ dren . _ 102.7 494.0 177.50 96.5 459.6 148. 10 Divorced wife and 1 or more children _ .3 .8 161.60 .3 .8 137. 40 Aged widow and 1 or more children.. . Widower and 1 or more children. .. 8.6 0 276.5 17.8 0 276.5 113. 00 94.30 5.8 0 258.0 11.9 0 258.0 105. 50 94. 00 1 child only _ . _ _ 56. 40 51. 20 2 children. _ _ _ _ 104.9 209.8 97. 00 99.4 198.8 88. 10 3 children. _ _ _ 35.1 105.3 125. 00 34.2 102.6 113.80 4 or more children. _ 22.2 98.8 150. 00 21.3 95.0 123. 60 1 aged dependent parent 28.5 28. 5 58. 60 26.0 26.0 52. 70 2 aged dependent parents . . . 1.7 3.4 110. 40 1.7 3.4 98. 40 1 or 2 aged dependent parents and 1 or more other survivors _ _ .8 2.3 190. 00 0 0 0 Disabled worker families 3 _ 275.2 361.2 200.4 200.4 74. 40 Worker only.. . _ _ 235.6 235.6 87.70 200.4 200.4 74. 40 Male 179.0 179.0 91.40 158.8 158.8 75. 50 Female. ... . _ _ . 56.6 56.6 75.80 41.6 41.6 70. 10 Worker and aged wife 12.7 25.4 130. 00 Worker and aged dependent husband. Worker and 1 or more children . . . 1 .2 104. 00 6.4 18.6 158. 00 Worker, wife aged 65 or over, and 1 or more children . . . _ .2 .6 200. 00 Worker, young wife, and 1 or more children 20.2 80.8 188. 00 1 Benefits to children were being withheld. 2 Less than 50. 3 Benefits to disabled workers aged 50-64 began July 1957, and benefits to their dependents began Septem¬ ber 1958. Table 4. — Old-age , survivors, and disability insurance: Number and amount of monthly benefits in current-payment status at end of June 1959 and amount of benefit payments in fiscal year 1959 , by State 1 [In thousands; data corrected to Dec. 9, 1959] 60 Department of Health, Education, and Welfare, 1959 S iisRsISIll SssSsSsS! of to of co «o cf io -T of t-f oo of co co to" of ,-T tjT eo co oo rf SI Benefit payments in fiscal year 1959 co < O Lump-sum death payments $149, 625 §"i?iI3i!! islSlslIS ISSilllEl *H t^fof COof oVofrfcf rf ofufcdcf-Tco Monthly benefits $8,899,522 HSlslsSI IS1ISISSI §!S3s8§§! SSSgGgggS Total $9,388, 378 gglSSlill !§gllg§33 8S83SSSS3 2”»gS8353S SgSSgSSSS SSg|||g|S Monthly benefits in current-payment status, June 30, 1959 A Monthly amount $27, 141 |»SSg||S§ l§SS|g3|| |Sg|§3|gS ef rf Number 361.2 CDhOJCOOHWNW _ _ _ _ Fiscal year 13, 181. 4 12, 820. 2 361.2 11,905.3 11,704.9 10, 342. 1 10, 342. 1 Number (OASI) _ _ _ _ _ Number (DI) _ 200. 4 Old-age (retired-worker) _ _ . ... . ... _ _ _ 7, 295. 6 275.2 6, 638. 5 200. 4 5, 832. 3 Disability (disabled-worker). . .. .. _ Wife’s or husband’s (OASI and DI) _ 2, 141.8 2, 108. 5 33.2 1, 947. 4 1,947.4 1,719.0 Wife’s or husband’s (OASI) 1,719.0 Wife’s or husband’s (DI).. . . . . Child’s (OASI and DI)1 2. _ _ _ 1, 747. 7 1, 694. 8 52.8 1,571.9 1,571.9 1, 427. 4 1, 427. 4 Child’s (OASI)2 1 Child’s (DI)2.. _ _ 1, 322. 0 366.5 1, 172. 8 344.9 1, 020. 5 314.9 Mother’s _ _ _ . ... _ Parent’s _ _ _ . ... . ... _ _ _ 32.7 29.4 28.1 Total monthly amount (OASI and DI). _ $805, 545 $778, 404 $659, 684 $644, 773 $554, 637 $554, 637 Total monthly amount (OASI) Total monthly amount (DI)__ . .. ... .. .. . $27, 141 $14, 911 $436, 244 $14,911 $67,821 Old-age (retired-worker). . _ _ $526, 701 $24, 324 $81,295 $80, 096 $1, 199 $373, 230 Wife’s or husband’s (OASI and DI) _ . . . $58, 749 $58, 749 Wife’s or husband’s (OASI) _ $67, 821 Wife’s or husband’s (DI) Child’s (OASI and DI)2 _ _ $76, 209 $74, 591 $1,618 $74, 359 $61,471 $54, 283 $54. 283 Child’s (OASI)2... $61,471 Child’s (DI)2 Widow’s or widower’s _ _ _ _ . .. $60, 457 $51,707 Mother’s _ _ _ _ _ . ... .. . $20, 760 $17, 241 $15, 224 Parent’s _ _ _ _ _ _ _ $1,896 $72. 19 $1, 538 $1,445 $63. 99 Average monthly amount: Old-age (retired-worker) .... $65. 71 Disability (disabled-worker) _ $88. 40 $74. 42 Wife’s or husband’s (OASI and DI).. $37. 96 $34. 83 $34. 18 Wife’s or husband’s (OASI) $37. 99 $34. 83 $34. 18 Wife’s or husband’s (DI) _ _ $36. 09 Child’s (OASI and DI)2.. $43. 61 $39. 11 $38. 03 Child’s (OASI)2 _ _ _ _ $44. 01 $39. 11 $38. 03 Child’s (DI)2... $30. 62 Widow’s or widower’s _ . . _ .. $56. 25 $51. 55 $50. 67 Mother’s _ $56. 65 $49. 99 $48. 35 Parent’s _ _ ... _ _ . $58. 02 $52. 34 $51.38 Benefit payments during period: Monthly benefits (OASI and DI) _ _ . . . $9, 238, 753 $8, 899, 522 $7, 900, 638 $6, 391, 690 $6, 391,690 Monthly benefits (OASI) . . . . $7, 732, 218 Monthly benefits (DI) _ _ _ _ _ _ $339, 231 $168, 420 Old-age (retired-worker).. _ _ . ._ $6, 041,417 $5, 245, 777 $4, 340, 271 Disability (disabled-worker) _ _ _ _ _ $311, 105 $168, 420 Supplementary (OASI and DI) _ ... $1,007, 142 $860, 488 $860, 488 $679, 289 $679, 289 Supplementary (OASI) $979, 016 $28, 126 $1, 879, 089 Supplementary (DI) _ Survivor _ _ ... . .. . . $1, 625, 953 $1, 372, 130 $122, 891 74, 140 Lump-sum death payments _ ._ . _ . . . $149, 625 $142, 714 Insured workers (midpoint of period — Jan. I):3 4 77, 310 76, 210 75, 310 Fully insured _ ------ . .... . _ 75, 810 73, 860 280 4 4, 052 Currently but not fully insured.. _ . . _ . Estimated number of employers reporting taxable wages, 1st quarter of fiscal year _ _ . _ _ _ ...... 1,500 4 4, 090 900 4 4, 060 Calendar year Estimated number of workers with taxable earnings _ Estimated amount of taxable earnings _ _ (!) (5 *) (*) 70, 000 $181, 000, 000 $2, 590 70, 500 $181,300, 000 $2, 570 Average taxable earnings 9-. . . ... _ _ _ 1 Benefits under the old-age and survivors insurance (OASI) parts of the old-age, survivors, and disa¬ bility insurance program are payable from the OASI trust fund to old-age insurance (retired-worker) bene¬ ficiaries and their dependents and to survivors of deceased workers. Benefits under the disability insurance (DI) part of the program are payable from the DI trust fund to disability insurance (disabled-worker) beneficiaries and their dependents. 2 Includes benefits payable to disabled persons aged 18 or over — dependent children of disabled, deceased, or retired workers— whose disability began before age 18. 3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from : (1) provisions that coordinate the old-age, survivors, and disability insurance and railroad retirement pro¬ grams and (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported or more than 1 account number. 4 Excludes agricultural employers. 5 Not available. 8 Rounded to nearest $10. Table 7. — Special types of public assistance under plans approved by the Social Security Administration: Number of recipients and average payment , June 1959, and total payments to recipients, by program and State, fiscal year 1959 [Includes vendor payments for medical care and cases receiving only such payments; data corrected to Oct. 16, 1959] 64 Department of Health, Education, and Welfare, 1959 Aid to the permanently and totally disabled Payments to recipients Total, fiscal jcai viu thou¬ sands) $188,844 212, 209 244, 664 i i issagssi ai£s ; ;ssss V | !«%*%*<» «n«o“ © £ I jrjTeooJVH Aver¬ age pay¬ ment, June $59. 10 60. 69 63. 37 33. 31 36. 62 86.80 65.80 134. 95 64. 52 74. 63 60. 19 51. 95 71.81 69. 58 71. 52 81. 79 44.11 53. 77 70. 89 lifjy 283, 910 312, 585 339, 233 s i ilsfslss gsSg i islll | j 0%H Aid to the blind Payments to recipients Total, fiscal year (in thou¬ sands) $80,610 85, 397 89,066 HN rH ‘g‘ a""' Old-age assistance Payments to recipients Total, fiscal 1 $1, 724, 289 1,798,374 1,858,004 SIIIsSSIss SIIllSsllS Average payment, June $58. 66 61.38 64.76 45. 02 60. 57 57. 12 48. 66 83. 86 98. 01 110. 17 49. 02 64. 32 53.83 47. 46 58. 45 64. 06 69. 66 59. 67 72.58 77. 32 43. 27 66. 13 65. 04 Number of recipients, June 2, 503, 790 2, 460, 299 2, 419, 959 sIlllSSssI sllsiSsIsS |-‘SS3‘3'3'-rrfS S'-rt'‘RS'g‘a‘B‘2‘3 Stato Fiscal year: 1957 . . 1958. . . 1959 _ Alabama.. . — Alaska _ . Arizona _ Arkansas.. _ _ California _ Colorado _ Connecticut Delaware - _ District of Columbia _ Florida _ Georgia _ Hawaii.. . . Idaho _ Illinois _ Indiana _ Iowa _ Kansas Kentucky _ Louisiana _ Maine _ Social Security Administration 65 lllssigg rfcoeorH-cfo^r-r E SIfISSiils "SggiSSSKs ggs (OHOffiHVooo’HiN eor-T 65.08 116. 06 85. 85 61.20 29. 95 57. 94 70. 76 70.32 2 82£888£858 8828888288 882 S3 883 58888 800' 8228388858 888 5,412 10, 025 4, 226 2,215 ,8774 15, 458 1,430 1, 570 s sglllllsSS glilSSSsli 1S1 COdV t-VT OOOV «T JH NNWNU5N OO t-VT SSSSSSS3SS !S3i*I§8!S -ISlSS^gs =ss cSrtwfcftS «0 < c m sliilli slls eo«oVeo ««o j-T-T ® S'S’S 9^ 3 PLh O 2 CD 00 CD NOOTftH^iH»OODCO^ (N CO CO ih -rO'r) g,® fl © S >-3 NOOCCCOCONOONtJH lO^iON^OOOOOCvO RSSSSSSSSS SSSBSSSRSS SSI IsS gSlISlIISI SISlIlills ;^®Vs££s§"s“°r © T> 03 , fl . 33 c3 03 2 a >.’s-g •3 © 'fl < fl 111 sss I ; IlilSISs Issl i llei eo i im’^nh <-T co tfl cT . In'mn T3.Q ◄ gSI 33 S !=3ifS§33! i”sSlSSsl§ t>T t-T i-T rnVT r-T^T 2^2 S §25 = 222 (NCOvO pl SsSilllISS ISIlSiellS sis O '7n ISSSsSSlIS llslllsSIS % “Sfssr -g 3 iSI 1S1 ISSISISsIS SlSsliills s-s's2S2~-'s s-»BSSS3sa U II \di Hi « imm Social Security Administration 67 OHIOHCCOOH^ CO ^^T^(N005^^000 NNWOCJ^HOiNN >0 05^ s' 5'^ssiesss^^55^ ssigsg's'gs^s sss' li§gisii 5 IIIIrsIIEI sisgSSIlsgS HI ^rte^o»Vr0o'ortd‘N|esr 0 0)ON®00N®OH WNM Stg§gS38S£8 ESS SflssIS!l!§ lisisglslg SlSHg8“si g§s V COCO CO of 00 03 0 Ol CD 1-4 00 r-l CO * 03 CO 00 CO CO g$i;S3£KgpigS? 3£s'g2g$gs'S$ K33 siiissiisi sssssisssi ggissssssi sss S“8^£®*$5"soVref 2SS S‘eo‘s"gfS‘fe-®“ ^"SST5-^ ®'gj g}^ (M 05 CO CC M U3 iO tJUO h 00 O O 00 C2W^cj'>O>O«-Ttr ^•ON^'WCO T^r CO 00 issssssm sisi§sssi§ mmmmm sis »-«i^V5g-rfs'cC rfsfVgfgW rfg- o-oo-r IlsSiSHII S§lslilSiS llsisSISSI 1SI 2SSSSfS»3^' c335S»WSS‘» ®S'-‘Sg‘»’t 29 88“ i! III! Is Ilf SB figg © v io r-» co co *o ^ ci oo c* O c3 .so Q a I-s Igfl c i § s o w < a lO £ OHH fo CO »o" co Referrals Cases During fiscal year Remain¬ ing at end of year 3 During fiscal year Remain¬ ing at end of year 8 Total Accepted for services Not ac¬ cepted for services a Total active load (re¬ ceiving services) Closed from active load Reha¬ bilitated After rehabili¬ tation plan ini¬ tiated * Before rehabili¬ tation plan ini¬ tiated 8 United States, total _ 373, 024 121, 559 128, 630 122, 835 280, 384 80, 739 9,494 19,040 171, 111 Alabama _ _ . 7,555 3,079 614 3. 862 8,515 2,363 238 417 5,497 Alaska _ _ '578 ' 147 171 260 349 45 16 35 253 Arizona: General _ 1, 802 733 620 449 1, 318 458 72 71 717 Blind _ 121 62 20 39 158 26 6 8 118 Arkansas . . _. 7, 589 2,517 3, 482 1,590 5, 062 2,169 234 147 2,512 California _ 27, 049 6,371 16, 319 4,359 13, 496 1, 790 617 2,144 8,945 Colorado: General _ 2,823 1, 164 778 881 2,404 823 185 83 1, 313 Blind _ 397 43 49 305 162 33 4 5 120 Connecticut: General _ 2, 299 1, 479 318 502 3,975 906 273 311 2,485 Blind _ 184 95 55 34 197 72 12 0 113 Delaware: General _ 1,315 582 463 270 1,270 500 19 71 680 Blind _ _ 50 26 21 3 51 18 10 4 19 District of Columbia... . 3, 649 792 2,175 682 1, 731 324 70 140 1,197 Florida: General _ _ 14, 284 4,306 5, 619 4, 359 8,558 2, 760 370 517 4, 911 Blind... . . 3, 987 405 2, 296 1, 286 1.041 271 80 41 649 Georgia _ 20, 888 6,309 6,129 8, 450 12, 351 5,628 312 473 5, 938 Guam . . 222 55 33 134 55 0 0 5 50 Hawaii: General _ 1,156 256 463 437 596 189 37 10 360 Blind _ 27 12 5 10 78 16 8 0 54 Idaho: General _ 1, 855 424 752 679 872 256 29 22 565 Blind _ 39 23 14 2 49 13 4 1 31 Illinois _ 13, 703 6,090 4,245 3, 368 13, 779 3, 793 256 1,290 8,440 Indiana: General _ 2,656 1, 258 652 746 3,878 1, 187 109 177 2. 405 Blind _ _ 193 74 53 66 246 45 30 27 144 Iowa: General _ 5,598 1, 546 1, 948 2, 104 3, 792 1, 176 169 235 2,212 Blind . . 439 52 236 151 151 26 10 16 99 Kansas: General... . 3,926 1, 336 1,247 1, 343 2,839 904 104 193 1,638 Blind _ 353 104 87 162 249 66 8 17 158 Kentucky . . 6,829 1, 883 2,570 2, 376 3,954 1,240 111 339 2, 264 Louisiana: General _ . 5,006 2,782 1, 270 954 7,239 1, 771 189 572 4,707 Blind _ _ 798 175 145 478 582 110 6 10 456 Maine: General. . 1,840 537 637 666 1, 311 333 61 130 787 Blind _ 169 72 66 31 161 46 9 31 75 Maryland . . 5,189 2,329 1, 209 1, 651 5, 397 1, 342 93 420 3,542 Massachusetts: General _ . 5,811 2, 048 1, 335 2,428 4, 562 1, 359 125 213 2, 865 Blind _ 360 120 29 211 362 61 16 11 274 Michigan: General _ 9, 625 3,680 2,359 3, 586 9,520 2,644 435 226 6,215 Blind _ 385 207 102 76 446 83 39 58 266 Minnesota: General _ 6,128 1, 495 1, 874 2,759 4,791 1, 173 180 128 3, 310 Blind _ 850 120 390 340 426 82 22 24 298 Mississippi: General . . 3, 510 1, 807 779 924 3,240 1, 250 70 150 1, 770 Blind. . . 856 350 352 154 908 288 29 20 571 Missouri: General _ _ 7, 397 2,177 2,664 2,556 4,477 1, 511 197 256 2,513 Blind _ 889 195 403 291 570 163 19 24 364 Montana: General . . . 1,916 577 693 646 1, 345 404 10 34 897 Blind _ 384 16 295 73 62 19 2 4 37 Nebraska: General . . 1, 644 699 333 612 2, 278 623 81 96 1,478 Blind _ 208 74 89 45 | 162 62 4 1 95 Office of Vocational Rehabilitation 239 Table 1. — Number of referrals and cases, by agency, fiscal year 1959 — Con. Referrals Cases During fiscal year During fiscal year Agency > Remain¬ ing at Total Closed from active load Remain¬ ing at end of year 6 Total Accepted for services Not ac¬ cepted for services ? end of year1 2 3 active load (re¬ ceiving services) Reha¬ bilitated After rehabili¬ tation plan ini¬ tiated 4 Before rehabili¬ tation plan ini¬ tiated 5 6 Nevada: General . 1,087 135 802 150 267 89 22 9 147 Blind _ 42 17 11 14 46 11 1 3 31 New Hampshire: General _ 964 340 83 541 806 170 80 28 528 Blind _ 38 17 13 8 74 10 6 4 54 New Jersey: General . 6,118 988 2,102 2,416 1,600 4, 501 1,316 212 457 2,516 Blind _ 221 342 425 554 200 33 24 297 New Mexico: General - 1,365 272 614 479 542 275 12 10 245 Blind _ 218 38 65 115 96 30 6 3 57 New York: General . . 26, 151 8,688 8, 364 9,099 16,975 5,278 594 995 10, 108 Blind _ 1,067 432 216 419 859 226 53 69 511 North Carolina: General _ ... 11, 186 5,811 3, 907 1,468 13, 073 4,369 451 623 7,630 Blind _ 1,327 530 506 291 1,538 397 40 136 965 North Dakota _ 1,742 439 493 810 1,083 309 24 34 716 Ohio: General . 6,580 2,217 1,565 2,798 4, 779 1,508 135 187 2, 949 Blind _ _ 545 253 134 158 767 130 39 50 548 Oklahoma _ 4,609 2, 841 922 846 7,846 1,560 171 926 5, 189 Oregon: General . . 6,936 1, 057 3,197 2,682 2,672 629 113 230 1,700 Blind - 233 51 71 111 158 39 4 6 109 Pennsylvania: General . . 24, 827 9, 062 7,409 1,216 8,356 20, 277 5,878 1,047 1,593 11, 759 Blind . — . 2, 279 445 618 1,103 239 52 92 720 Puerto Rico . . 7,394 1,723 1,436 4,235 4, 472 970 59 267 3,176 Rhode Island: General . ... 1,918 858 433 627 1,992 633 81 6 1, 272 Blind _ 103 75 6 22 233 44 18 13 158 South Carolina: General _ 5,918 1,931 2,384 1,603 4,916 1,502 107 254 3, 053 Blind _ 349 136 150 63 297 94 4 18 181 South Dakota: General _ 1,197 353 185 659 965 237 20 52 656 Blind... . 324 38 159 127 103 22 4 2 75 Tennessee: General . . 11, 465 3,414 4, 029 4,022 6, 766 2,302 203 306 3, 955 Blind . . 1, 300 309 460 531 839 245 16 42 536 Texas: General _ 11, 881 3,489 2,875 5, 517 10, 259 2,219 149 683 7,208 Blind _ 834 341 216 277 796 354 20 15 407 Utah _ 1,621 607 263 751 1, 520 432 43 20 1,025 Vermont: General _ 1,289 340 443 506 856 210 73 65 508 Blind _ 61 28 21 12 76 19 9 5 43 Virginia: General . 16, 416 4,089 8,153 4,174 8, 458 3, 072 156 775 4,455 Blind _ 500 139 154 207 284 95 22 8 159 Virgin islands . 137 53 6 78 84 23 2 6 53 Washington: General . 4,043 1,634 1,316 1,093 4,103 960 171 447 2, 525 Blind _ 211 72 88 51 196 50 7 11 128 West Virginia - 15, 460 4,401 4,112 6,947 10, 388 2,665 136 1,279 6,308 Wisconsin: General _ ... 6,821 1,585 2,616 2, 620 5, 079 230 1,276 92 61 3, 650 Blind _ 157 108 26 23 67 10 11 142 Wyoming . . 792 185 295 312 441 164 17 8 252 1 In States with 2 agencies, the State division of vocational rehabilitation 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. 4 Closed after rehabilitation plan was initiated; received rehabilitation service but never reached the point of employment because of personal factors, illness, aggravated disability, etc. 5 Closed prior to initiation of rehabilitation plan because of indifference of individual, increase in degree of disability, loss of contact, etc. 6 In process of rehabilitation on June 30, 1959. 240 Department of Health , Education , and Welfare , 1959 Table 2. — Vocational rehabilitation grants, 1959 , Sfafe divisions of vocational rehabilitation Total . . Alabama _ Alaska _ _ Arizona . . . Arkansas . . California . . Colorado . Connecticut _ Delaware . Florida . . Georgia . - . Hawaii . . . Idaho - - Illinois . . Indiana _ Iowa _ _ Kansas . . . Kentucky . . Louisiana . Maine . Maryland . . Massachusetts - Michigan.. . . Minnesota . Mississippi . Missouri _ Montana - - Nebraska _ _ Nevada _ New Hampshire _ New Jersey _ New Mexico _ New York _ North Carolina _ North Dakota _ Ohio _ _ Oklahoma . — Oregon _ _ — Pennsylvania . Rhode Island _ South Carolina _ South Dakota _ Tennessee _ Texas _ Utah _ _ Vermont . . Virginia _ Washington . . West Virginia - Wisconsin . . Wyoming _ Guam _ Puerto Rico . . Virgin Islands _ District of Columbia. State or Territory Support grants Extension and improvement grants . ; Total $40, 545, 007 $949, 466 $41, 494, 473 1, 531, 192 1,875 1,533,067 104, 771 5, 000 109, 771 335, 352 9,687 345, 039 1, 177, 621 15, 076 1, 192, 697 2, 628, 598 118, 712 2, 747, 310 261, 702 13, 700 275,402 312, 088 15, 363 327, 451 141, 234 141, 234 1, 303, 435 1, 303, 435 2, 222, 889 30,007 2,252,896 146, 128 3,000 149, 128 159, 392 159, 392 1, 743, 698 80,000 1,823,698 463, 632 28, 740 492, 372 670, 606 21, 619 692, 225 409, 541 9, 565 419, 106 457, 750 25, 923 483, 673 1, 008, 063 1,008,063 230, 487 8, 041 238,528 526, 783 526, 783 668, 207 33, 192 701,399 1, 174, 858 66, 536 1, 241,394 815, 797 22, 515 838, 312 528, 291 528, 291 658, 809 13, 891 672, 700 164, 572 5, 679 170, 251 285,808 8,679 294, 487 37, 311 37, 311 90, 794 3, 600 94, 394 847, 847 35, 169 883, 016 112, 793 112, 793 2, 942, 975 125, 178 3, 068, 153 1, 388, 957 2,738 1, 391, 695 287, 058 5,491 292, 549 632, 626 24, 967 657, 593 1, 047, 343 19, 416 1, 066, 759 539, 009 12, 445 551, 454 3, 158, 663 66, 015 3, 224, 678 215, 654 7, 350 223, 004 664, 029 9, 000 673, 029 196, 245 4,786 201, 031 1, 414, 268 1, 414, 268 1, 361, 629 26, 745 1, 388, 374 213, 154 7,256 220, 410 153, 330 5,000 158, 330 1, 091, 699 1, 091, 699 711, 072 15, 160 726, 232 1, 134, 578 16, 850 1, 151, 428 1, 194, 453 25, 500 1,219, 953 109, 989 20, 565 595, 910 109, 989 20, 565 595, 910 15, 778 235, 974 15, 774 235, 978 Office of Vocational Rehabilitation 241 Table 3. — Vocational rehabilitation grants , 1959 , State commissions or agencies for the blind Total. Arizona . Colorado _ Connecticut Delaware. „ Florida _ Hawaii . Idaho . State or Territory Support Extension grants and improve¬ ment grants Total $4, 954, 016 $81, 415 $5, 035, 431 57, 920 71, 996 37, 880 36, 963 427, 000 27, 863 14, 621 566 3, 840 5,000 2,000 57, 920 72, 562 41, 720 41, 963 427, 000 29, 863 14, 621 Indiana . . Iowa. . . Kansas . . Louisiana _ Maine _ Massachusetts. 57,033 _ 61, 774 2, 248 125, 785 4, 189 154,819 . 68,647 _ 155, 330 4, 378 57, 033 64, 022 129, 974 154, 819 68, 647 159, 708 Michigan.. Minnesota. Mississippi. Missouri... Montana.. Nebraska.. 114, 955 123, 865 266, 898 216,357 47, 158 77,242 5, 749 3, 702 114, 955 129,614 266, 898 216, 357 47,158 80, 944 Nevada _ New Hampshire. New Jersey _ New Mexico . New York _ North Carolina.. Ohio . 4, 715 31, 200 192, 136 48, 707 392, 302 443, 421 262, 629 5,000 1,665 5, 250 16,721 9,715 31, 200 193, 801 48, 707 397, 552 443, 421 279, 350 Oregon. . Pennsylvania.. Rhode Island.. South Carolina. South Dakota. . Tennessee _ 77, 960 378, 862 45, 164 58, 424 52, 500 265, 812 1,200 77, 960 378, 862 45, 164 58, 424 53, 700 265, 812 Texas . Vermont.... Virginia _ Washington Wisconsin.. 288, 846 30, 786 79, 235 65, 907 91, 304 16, 907 3, 000 305, 753 30, 786 79, 235 65, 907 94,304 Saint Elizabeths Hospital The care of the patients in line with modern and progressive standards has continued. During the year three of the key medical personnel, namely, the Assistant Superintendent, one of the Clini¬ cal Directors, and one of the Chiefs of Service retired after 30 years’ service to accept more remunerative positions with State governments. Institutional psychiatry is becoming a more highly competitive field, with the States offering more than the Federal Gov¬ ernment; the result has been a lack of success in recruiting to fill the vacant positions. Indeed, there are now 10 vacancies for staff phy¬ sician. Had it not been for the devotion of the medical staff, the ward personnel, and the other employees of the hospital, it would have been impossible to mainfain anywhere nearly adequate care of the patients. As it is, the general health of the patients has continued good and a reasonable degree of success has been achieved in main¬ taining the high standards of care to which the hospital is dedicated. The so-called tranquilizing drugs have continued to prove their usefulness as palliatives rather than as cures, but their use has re¬ sulted in a steadily increasing number of patients who have been able to leave the hospital, at least for a time. Further progress can be noted in the development of so-called open wards and in patient self-government. Every effort is made to achieve an atmosphere of permissiveness and friendly interest, and although some patients occasionally take advantage of this the results on the whole have been beneficial. The load of aged and infirm patients continues to increase, thus throwing additional responsibili¬ ties on an already overworked staff and ward personnel. Electro¬ shock has been used sparingly, and no lobotomies have been performed. During the year, 1,607 patients were admitted and 1,513 discharged. Of the latter, 1,034 were released to the community or to other insti- 243 244 Department of Health, Education, and Welfare, 1959 tutions, that is, 64.3 percent of the admissions. It appears that some stability of discharges and admissions is being achieved. During the 3-year period just closed as compared with the preceding 3-year period, there was an increase of 18.9 percent of admissions and an increase of 22.4 percent of discharges. During the year the patients on the rolls increased from 7,466 to 7,511, whereas those in the hospital decreased by 65, that is, from an average of 6,965 to 6,899. On the other hand, the readmission rate, that is, the rate of patients admitted who have previously been cared for in this or similar hospitals, has continued to rise, amounting to 31.3 percent for the year just closed. Of the admissions, 94, or 5.8 percent, were under 21 years of age. The writ of habeas corpus, that “palladium of our liberties,” con¬ tinues to be utilized by a certain segment of our patients. During the year the hospital was ordered to show cause in 72 cases and to produce the patient under a writ of habeas corpus in 61 cases or a total of 133, by far the largest number yet. That a considerable number of these proceedings was frivolous is suggested by the fact that only three patients were discharged on habeas corpus. This right of the patient is duly recognized despite the fact that an inordinate amount of the physicians’ time is demanded in preparing answers to writs and to testifying in court. The courts are showing an increasing amount of interest in the mental state of persons charged with crime and the admission rate in this group continues to rise — 154 as compared with 145 last year. Of these, 41 as against 21 last year were admitted after acquittal by reason of insanity. Twelve men were admitted under the so-called Miller (sexual psychopath) Act. It has been necessary during this year to maintain a waiting list for prisoner patients, much to the regret of the hospital. Fortunately, the courts have in general been quite understanding of the difficulties of space under which the hos¬ pital works. It is expected that the new maximum security building, the John Howard Pavilion, will be ready for use early in the fall and from that time on a waiting list should be unnecessary. Various other agencies of government, notably the Health Department, the Public Welfare Department, and the Rehabilitation Division of the District, and the Veterans Administration have all been most coopera¬ tive. F urther plans for even closer cooperation are being worked out. As in previous years the hospital had the pleasure and the inspira¬ tion of being visited by numerous persons from other countries, as well as by many in the United States. Indeed, no less than 23 foreign countries were represented among our visitors this year. An active program in education has been carried on and even further developed during the year, not only in the field of psychiatry but in those of psychology, social work, general medicine, surgery, pathology, occupa¬ tional therapy, nursing, and clinical pastoral work. The three local Saint Elizabeths Hospital 245 medical schools, as usual, have utilized the facilities of the hospital for the training of their students, and inservice training in a number of fields has been carried on. The hospital continues to be the only public mental hospital in the country which is approved for rotating internship. During the year full accreditation was received from the Joint Commission on Accreditation of Hospitals. Mention was made in last year’s report of the Joint National Insti¬ tute of Mental Health-Saint Elizabeths Hospital Research Project. This project is now well under way, and the enthusiasm of the par¬ ticipants, both from the Institute and the hospital, continues un¬ abated. A number of significant projects, both clinical and labora¬ tory, are being carried on. Division of Clinical Services CLINICAL BRANCHES The general care and treatment of the patients is carried on by three clinical branches, each of them subdivided into services. A Medical and Surgical Branch is charged with the acute medical and surgical treatment of all patients and emergency attention to employees. Shortage of professional staff continues to be the single most pressing problem in operating the hospital. The present standards of salaries are insufficient to compete with what is now being offered by many of the States, so that recruiting has become almost impossible. The increased alertness of the patients brought about by the so-called tranquilizers has laid much greater responsibility upon the ward and medical personnel with the result that the shortages which existed have become even more noticeable and pressing. General crowding of the hospital in spite of the slight drop in the population is con¬ siderable, averaging about 7 y2 percent, but there are areas in which the crowding is considerably greater and in some areas the patients are cared for under substandard circumstances. The program of replacement is underway but is inevitably slow. All the buildings erected since 1944 have been replacements rather than additions. During the year, through agreement with the District of Columbia Health Department, arrangements were made for a representative of the Health Department to be present at the hospital during the week to grant permits for the admission of voluntary patients. This has removed one of the obstacles to the use of the voluntary admis¬ sion law, and it has been much appreciated by the families and the patients themselves. The general therapeutic program has continued on the wards. Open wards, greater freedom of patients, and more self-government have been developed. Group therapy has been much used, together with a moderate amount of individual psychotherapy to the extent permitted by the time available to the physicians. In 246 Department of Health, Education, and Welfare, 1959 addition to the recreational therapy facilities offered by the hospital, various volunteer groups have been most faithful in visiting the wards and providing entertainment for the patients. The increasing co¬ operation with the various community and official agencies has already been noted. MEDICAL AND SURGICAL BRANCH The work of this Branch continues to be unusually varied and of high efficiency. The Medical and Surgical Building itself, now over 30 years old, is approaching obsolescence, and a study is being planned looking toward replacement. There were 1,986 admissions to this Branch during the year and 88,812 hospital days, together with 56,476 clinical visits. The efficiency of the pharmacy has been greatly im¬ proved and the personnel expanded. The same may be said of the dental division. During the year the hospital has been very fortunate in obtaining for the Medical and Surgical Branch, as well as for the laboratory, a very considerable amount of surplus property in excellent condition. Work is underway looking to an exploration of a more effective employee health program and also to expanding the research program. With the increasing use in medicine of radioisotopes, a radiation officer has been appointed. NURSING BRANCH In spite of the general shortage of graduate nurses and indeed a general shortage of ward personnel, the Branch has done excellent work in the care of patients. An active program of inservice training is carried on, and 14 schools of nursing affiliate with the hospital. In addition, a number of Navy Hospital corpsmen are trained by the Nursing Branch. It is a matter of regret that space does not permit elaboration of the fine work done by this important, nay essential, Branch. PSYCHOTHERAPY BRANCH This Branch provides services to certain selected patients in the field of individual and group psychotherapy, psychodrama, and dance and art therapy. It is of interest to note that the coming year will mark 20 years of psychodrama at Saint Elizabeths Hospital. The hospital was the first public mental hospital in the United States to take up this very important and significant form of group psychotherapy. The psychodramatist has been in considerable demand in the field of public relations and of training various groups outside of the hospital. PSYCHOLOGY BRANCH Four projects are underway. During the year one doctor’s thesis and two master’s theses were undertaken by students in the Branch. A very active teaching and research program is carried on. An Saint Elizabeths Hospital 247 increase of 10 percent in the tests given to patients was noted during the year. RECREATIONAL THERAPY RRANCH This Branch conducts a very active program, providing ward parties and entertainments both on the wards and in the Bed Cross Building and Hitchcock Hall. The Commanding Officer of the Bolling Air Force Base has continued the arrangement to have patients taken to the swimming pool during the summer season several days a week. This has been greatly appreciated by the patients, particularly as the hospital does not yet have a swimming pool. Many dances have been arranged for the patients and a chorus as well as choirs have been conducted by a member of the staff of the Branch. Bands, orchestras, and sports have likewise been arranged. VOLUNTEER SERVICES BRANCH This Branch accomplishes much for the benefit of the hospital. During the year, 188 volunteers contributed well over 12,000 hours of service, including groups with an average of individuals over 500 per month. In addition, many community organizations have been brought into contact with the hospital and many gifts have resulted. The number of groups is too large to permit naming them all. They have been of various kinds : church, community service, and the Amer¬ ican Red Cross. They have been most generous, and the hospital is deeply appreciative of what they have done. OCCUPATIONAL THERAPY BRANCH To this Branch, too, the services of volunteers have been invaluable, particularly in connection with the educational activities in the re¬ habilitation program. No less than 243 patients have benefited by the educational activities. During the year, six affiliate students were trained in the Branch. SOCIAL SERVICE BRANCH This Branch has been most helpful in the rehabilitation of patients and their return to the community. Nine hundred and ninety-seven patients were served by the Branch during the year. Close relations have been maintained with the Veterans Administration, the Office of Vocational Rehabilitation, and the District of Columbia Village. It is of some interest to note that since 1952, 116 patients have been sent from the hospital to the District of Columbia Village, of whom only IT have been returned to the hospital. Fifty-five patients were re¬ ferred to public assistance. One of the great needs of the District of Columbia is a greater number of available boarding homes, particu¬ larly for the older patients. The Branch also has had general super¬ vision of the school program under which two full-time instructors 248 Department of Health , Education , and Welfare , 1959 from the Board of Education have been providing instruction for the teenage patients. CHAPLAIN SERVICES BRANCH This Branch under Catholic, Protestant, and Jewish chaplains car¬ ries out religious ministry to the patients, both in the chapel and on the wards. New patients are visited, and such other patients as re¬ quest the services of the chaplains. Training is carried out both for Catholic and Protestant clergy and theological students. The various community organizations have been most helpful to the chaplains, as has the Volunteer Branch. Through a gift of Mrs. Howard Chandler Bobbins, three fellowships in advanced clinical pastoral training for Protestant clergy were established. The director of Protestant chap¬ lain activities served as the Chairman of the Mental Health Week Committee. During this week probably at least 8,000 persons visited the hospital, and much was done to promote community understanding of mental illness. MEDICAL RECORDS BRANCH This Branch is continuing its development, and steps are underway to reorganize the filing system for hospital records. LIBRARY SERVICES The Medical Library provides library service for the medical staff. A large part of the time is devoted to interlibrary loans, the checking of references, and the indexing of the 215 journals to which the hos¬ pital subscribes. The total number of books is 19,478, with the addi¬ tion of 18,000 pamphlets. It is a matter of keen regret that most of the libraries with which the hospital deals, even though they too are public organizations, are curtailing their services, increasing the amount of “redtape” involved, and making it more difficult to use them for interlibrary loans. The Veterans Administration is a nota¬ ble exception, and particular thanks are due to them for their very generous and helpful cooperation. The Medical Library is badly crowded, and it is the hope of the hospital that the proposed wings of the Administration Building which will add very considerable library space may be authorized in the near future. The Patients’ Circulat¬ ing Library now has over 61,000 volumes and circulated approximately 2,800 books to the various wards in addition to making books available to the many patients who visit the Circulating Library. Many classes, such as those in typewriting, stenography, and French, are carried on. During the year, through the helpful cooperation of the Department, a considerable modernization of the bookbinding activi¬ ties was brought about. Saint Elizabeths Hospital 249 LABORATORY BRANCH This extremely active and efficient Branch has been increasing its activities substantially. Tests performed were up 13 percent over last year. The autopsy rate was 46 percent; that is, 218 autopsies were performed. Much new equipment, most of it surplus property, has been installed. Division of Administration As last year, space does not permit mention of the various activities of this Division, such as financial, personnel, construction, grounds, and laundry, which are carried on efficiently. Substantial progress is still being made in developing new methods of property control and of billing. The Division has been very active in securing sur¬ plus property, which has been greatly appreciated and which has promoted the efficiency of the Hospital. The grounds have been maintained in excellent condition and several contracts, such as that for the construction of the maximum security building, have been supervised. A methods unit has been organized, and two management analysts have been employed. Needs of the Hospital The need of new buildings for replacement and also for reduction of the overcrowding continues to be pressing. Nor should it be over¬ looked that the administrative activities have multiplied greatly with the increase of Government “redtape” and that wings for the en¬ largement of the Administration Building are very seriously needed. Most pressing of all, in addition to more personnel, is the revision of the salary scale, particularly for professional people. The States have marched ahead of the Federal Government in this field for several years, with the result that the Federal Government is far behind the procession in a competitive way. This is especially true of psychiatrists and pathologists. Proposals are being made to the Civil Service Commission, and it is hoped that some remedy may be found for the very serious shortages which now exist. 530344-60- 17 250 Department of Health , Education , and Welfare , 1959 Table 1. — Movement of patient population, fiscal year 1959 Total Male Female White Colored Total White Colored Total Total number under care and treatment, fiscal year 1959 _ 9, 070 2, 557 1,928 4, 485 2, 675 1,910 4, 585 Remaining on rolls. June 30, 1958... .. 7, 463 2, 128 1, 549 3, 677 2, 185 1, 601 3, 786 Admitted during year _ 1, 607 429 379 808 490 309 799 Total discharged or died _ _ 1,513 442 334 776 470 267 737 Discharged _ 1,034 298 251 549 293 192 485 Discharged as— Recovered- _ _ 44 13 13 26 12 6 18 Social recovery.. _ ..... 389 72 77 149 111 129 240 Improved . ...... ... 439 145 122 267 129 43 172 Unimproved _ .. _ 148 61 32 93 42 13 55 Worse _ 0 0 0 0 0 0 0 No mental disorder _ _ 14 7 7 14 0 0 0 Unknown _ _ ... ... . . 0 0 0 0 0 0 0 Died _ _ _ 479 144 83 227 177 75 252 Remaining on rolls, June 30, 1959.. . . 7,557 2,115 1, 594 3, 709 2,205 1,643 3, 848 Change in color and sex _ 0 -1 +5 +4 0 -4 -4 On visit or elopement.. _ _ _ 577 91 85 176 198 203 401 In hospital, June 30, 1959 _ 6, 980 2,023 1,514 3. 537 2. 007 1, 436 3, 443 Table 2. — Consolidated statement of movement of patients , by classification, fiscal year 1959 Saint Elizabeths Hospital 251 spuBisj mgiTA | 05 00 11 o> 3 1 CM || 00 O CO 138 2 8DIAJ8g miB8H Oqqnj 05 0 CO (N II t-~ Tt* "IH CO 05 CM 1 sjuapTsaonou *o*a CO CO II CM || CO CM II CM 8 253 -32 -j-273 241 30 pjBno jsboq to ° jj ° o o |j >o o *o o auoz jeubo too jj ° oo |j too CO O atresin treipBUBO to rH ]l (N ■° 1, i-H ^ II 50 O II 10 1C l-H *o saniOH iBUOTjBjq jo rvBaong coo || o o o jj CO o CO o aoiAjag uoijezqBinjeN pira noij'BjSimini 0*0 jj o O O || CM ° CM O nonBsnadnioo .saa^ojdmg; jo nsaang ^ H II O II OO |j 0*0 CM O jCmay ioo II o « IP o o »o o 1 205 0 IBjojqng 1,418 243 472 50 422 1,189 4-260 1,449 75 jaqjO coco |j | O •>*« jj eo • © j o