1957 HEALTH, EDUCATION, AND WELFARE annual report For sale by the Superintendent of Documents, U. 8. Government Printing Office ashington 25, D. C. - Price 75 cents U. S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1957 Marion B. Fotsom, Secretary JoHN A. Perkins, Under Secretary OFFICE OF THE SECRETARY Exvuiot Len RicHarpson .. . Assistant Secretary for Program Analysis. Epwarp Foss Witson .. . . Assistant Secretary for Federal-State Relations. Aims C. McGuinness .. . . Special Assistant for Health and Medical Affairs. JoHN R. MacKenzize. ... . Legislative Liaison Officer. Wiuuis D. Grapison, JR.. . . Assistant to the Secretary. CHARLES F. BARRETT. . .. . Assistant to the Secretary. PaRKE M. Banta ..... . General Counsel. Rurus E. Miues, Jr. .. . . Director of Administration. Cuester B. Lunp .... . . Duirector of Field Administration. Harvey A. BusoH .... .. .. Director of Publications and Reports. FREDERICK H. Scumipt. . . . Director of Security. SOCIAL SECURITY ADMINISTRATION CHARLES I. ScHOTTLAND .. . Commissioner of Social Security. Wiuuram L. Mircuety . .. . Deputy Commissioner of Social Security. Victor Curistaau.. . . Director, Bureau of Old-Age and Survivors Insurance. Jay L. Ronsy. .. . . . Director, Bureau of Public Assistance. J. DEANE GaNnNon. .. . Director, Bureau of Federal Credit Unions. KATHERINE B. OETTINGER. Chief, Children’s Bureau. PUBLIC HEALTH SERVICE Leroy E. Burney... . . . Surgeon General. W. Patmer Dwarine. ... . Deputy Surgeon General. JoHN W. Cronin... . Chief, Bureau of Medical Services. CHARLES E. BuRBRIDGE . . Superintendent, Freedmen’s Hospital. O1is L. ANDERSON. .. . Chief, Bureau of State Services. JamEsS A. SHANNON. . . . Director, National Institutes of Health. OFFICE OF EDUCATION LAWRENCE G. DertHick . . . Commissioner of Education. WayngE O. Reep. ..... . Deputy Commissioner of Education. ii FOOD AND DRUG, ADMINISTRATION GErorGE P. LARRICK . . Joun LL. Harvey. .... Commissioner of Food and Drugs. Deputy Commissioner of Food and Drugs. OFFICE OF VOCATIONAL REHABILITATION Mary E. Switzer . EK. Emory FEREBEE Director of Vocational Rehabilitation. Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL WINFRED OVERHOLSER .... App1son M. Duvau Superintendent. Assistant Superintendent. FEDERALLY AIDED CORPORATIONS Preise DAViS... « sw se Lronarp M. Evstap..... Morpecal W. JOHNSON... . Superintendent, American Printing House for the Blind. President, Gallaudet College. President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN. JosEPH B. O’CoNNoR. . EpMUND W. BAxtTER . Ricuarp H. Lyte. . MELVILLE H. HoscH.. . JAMES W. Doarn JAMES H. BonD .: .. ALBERT H. ROSENTHAL . Fay W. Hunter... Region I, Boston, Mass. Region II, New York, N. Y. Region III, Charlottesville, Va. Region IV, Atlanta, Ga. Region V, Chicago, Ill. Region VI, Kansas City, Mo. Region VII, Dallas, Tex. Region VIII, Denver, Colo. Region IX, San Francisco, Calif. lil AWE wn i Ol 6 ist nw) AH Avi ‘anal bo teleds yy! Nan Naa Sgt bain rg st Wnt to ' } n Py it i ; oh : ‘ if ‘ 4 © 4 ¥ Ya s \ 4 Li A i La | n \ i , hs raat H aly = j t f ae i eri wee i. , Bunbes, ] i % Letter of Transmittal DEPARTMENT OF HeEaAttH, EpucaTION, AND WELFARE, Washington, D.C., December 1, 1957. Dear Mr. Presipent: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1957. Respectfully, Secretary. THe PRESIDENT, Tue Wuite Hovss, Washington, D.C. IIVMVH VuSVIV eseroyouy pe yon \ Al } \ \ | x ewe yg \ | Ds wo\ ov x SGNV1SI NISYIA “O31 OLUINd ‘avo 2 AWD sesuey ¥\ ES TUNOSSIN \ 1aauaq ~ Oay yo | as 05 “cov y01s0S | VLONYV } —— .%L0%VG_ HLnos ’ V.LOSANNIW \ i) SOIIJJQ pue Saijepunog jeuoisey JUVITIM ONY ‘NOLWONGI ‘HLIVIH 40 LNIWLYYdI0 'S‘N Contents MME A YSINCNONE (0 oie ew ce a ee eee Beer security Adminisiration. ..... 1.6.22 ees MEME UH, SETVICE we ee ME OT hice esl a a oe os fo 0 Bodh ce ww 8 ws Pooaeana Drug Adminisiration ..... +. +s + 2,002 Oimee-o) ) ocational Rehabilitation ............. Pemeriizabeiis Hospital’... ee Es American Printing House for the Blind ........... eee sColicpe hh) 8 OIE PE PY) eee) bey RE IV CTSILY. . 6 a 2a. cafe ayo) Th etrey 6 ho bag ey lege ans A detailed listing of the contents of this report, by topic headings, will be found on pages 255-2630 4 y+ f eka) tad | } il +} i ean \ i ‘ i | ; } i A i 4 ! ea i ‘ atti h i ae ” v ” vw * ager { { i 4 " * Fo . - mu a me | ih Ni q i 9 me Fir rf Me yt ' * i pet , » ty % A 4 1 Ga wy A ‘i i oN eo ah) & Ya ee i 4 ” Y ie eke of f (Pi } ine * x, ’ \ i ; : | j woh y ‘ ° Wy ‘ { iy { py 1 4,44 , nay i 7 for, { f " TOM. Yi Ns Oe: l a } his ¥ \ ade OSE. The Secretary's Report Tue 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 1958 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. Kd- 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 EK. 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 1958 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 ae 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. Just 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 June 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 againstit. 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 recelving 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] Social Office of | American States, Territories, and Security Public Office of | Vocational | Printing possessions Total Adminis- Health Education | Rehabili- | House tration Service tation for the Blind Totalotc cs soos $1, 963, 870, 093 |$1, 594, 674, 421 |$130, 390, 272 |$204, 336, 577 |$34, 228,823 | $240, 000 ATAOMATT See eee 61, 212, 620 50, 593, 352 | 5, 087,664 | 4,440,916 | 1, 085, 431 5, 257 APO £6 14, 730, 449 10, 933, 758 | 1,217,585 | 2, 312, 158 265, 206 1, 742 FRANCS ee ee 28, 475, 397 23, 350, 788 | 2,052,286 | 2, 337, 833 729, 323 5, 167 Galitorniateseceese se see 214, 054, 627 171, 901, 675 6, 217,198 | 33,748,271 | 2,169, 849 17, 634 Colorado eee 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 Delawareo te ee 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 Higruin soot cect eee. 54, 651, 488 45, 333, 978 2, 859, 678 5,429,497 | 1, 122, 537 5, 798 Goorgiavses: .242seL3¢; - 62, 878, 000 50, 153, 923 4, 682, 198 6,118,713 | 1, 915, 986 7, 180 Tdaho. et ou Lda 7, 578, 030 5, 631, 177 1, 011, 929 867, 535 66, 277 1,112 Tino ee 69, 431, 797 59, 731, 222 3, 626, 024 4,521,467 | 1, 541, 428 11, 656 rican ee Sate 26, 066, 010 21, 315, 348 2, 335, 098 1, 928, 961 482, 487 4,116 TOWA te ee 27, 914, 403 24, 039, 713 2, 029, 583 1, 315, 854 525, 257 3, 996 Kansas t6 32.) by vee g 27, 879, 787 21, 074, 145 2, 259, 607 4, 198, 327 345, 275 2, 433 Keniithy 1-2 ee 41, 305, 703 36, 009, 394 2, 646, 689 2, 268, 184 377, 501 3, 935 Louisianas: 2272 24422 87, 156, 376 80, 694, 527 3, 658, 481 1, 827, 217 972, 095 4, 056 Niaitio See ee 10, 705, 880 8, 336, 552 1, 046, 970 1, 107, 971 214, S87 T-<-cancaee Maryland,£4...- cosas: 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 Miciinan. 7. 2e 0 eee 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 IMEISSISSIPles sense eee ee 31, 989, 934 26, 223, 936 3, 427, 081 1, 780, 390 554, 682 3, 845 Missouriscs 402 4) 4 bee 89, 295, 372 80, 276, 605 4, 587, 759 3, 717, 508 709, 234 4, 266 NiOntala. 2 tee ee 8, 551, 118 6, 566, 056 549, 931 1, 263, 528 170, 642 961 Nebraskalis susie Boe 14, 435, 117 10, 822, 056 1, 407, 112 1, 970, 096 234, 411 1, 442 Nevada soe ae 3, 258, 253 1, 856, 651 423, 909 944, 319 Od S14 Sees cee New Hampshire-------- 4, 594, 310 3, 273, 132 501, 224 732, 599 87; 355 ipeece eee New Jersey cece 2 2eoee 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 IN@ Wi Ones ere 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 38, 053, 848 1, 310, 422 11, 145 INogth} Dakota = 2.2 2 7, 489, 843 5, 649, 843 994, 019 577, 236 217, 964 781 Olio Sree anes Fee 68, 467, 207 57, 634, 310 8, 847, 831 6, 296, 978 677, 003 11, 085 Oldaioniaw. wea ses 63, 212, 680 51, 987, 194 3, 099, 316 7, 391, 471 732, 085 2, 614 Oreeon sues eee ee 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 tlarid’? 5o2>. Te * 9, 790, 308 7, 071, 312 1, 018, 815 1, 475, 735 224° AAG ooateeee 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, 457 148, 047 1, 262 ‘Tennessee: sees 42, 5038, 932 35, 035, 802 3, 302, 210 38, 293, 230 867, 523 5, 167 A RY: Kopel cy SON ged Shas bead! acl es 126, 575, 646 105, 403, 048 7, 777,958 | 12,348,662 | 1, 037, 236 8, 742 Utah ss SU said Avan 9, 735, 931 6, 833, 482 726, 911 1, 973, 903 200, 253 1, 382 Vermont canes eine oe 4, 610, 234 8, 601, 053 417, 125 330, 302 161; 754 |gapeseees Mirglivig. wit as 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 8, 815 West Virginia, 2.500 .0-. 28, 658, 846 24, 390, 627 2, 540, 362 938, 918 785, 664 3, 275 WisconsinigSs225 2. 8 26, 477, 413 21, 910, 172 2, 163, 733 1, 623, 066 774, 824 5, 618 Wyoming?) £0 SAW AL 3, 880, 686 2, 704, 242 404, 236 688, 791 85 4171 eee Alaska (i Vers eh ed 6, 201, 251 2, 191, 025 435, 641 8, 478, 734 05, S61 lo -cncntees SEA Wall eee ea eer 7, 777, 305 4, 046, 214 661, 207 2, 889, 362 180, 131 391 PUCTIO RICO ae anne eee 18, 550, 510 8, 307, 848 4, 302, 303 595, 964 341, 932 2, 463 Virgin Tslandso2e22 oo) 429, 631 355, 858 47, 091 20, 000 6, 682 tae cee Other possessions. ._____ 0431220" | Sane ese cue see 56, 060 287, 160: |2o2oe eee | eee 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 1434 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, Social Security Administration | eye 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, show 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 80, 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 380, 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 rss nnn eesti ht etn ae 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 18 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 economie 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 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- 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 benefits at the end of June 1957. Contributing also to the increase 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 _ inthe 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 18,000 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 eo a RO 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 114 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 a Ann SS lS TOs SRE ce NNR LEAT 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 38,500 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 3,587 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 January 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 een TI SS ach CER AEAE OL NAS EE 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 al] 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 380, 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 new 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. Benefits 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 TVA 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 insufii- 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? - 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 calre and cases receiving only medical care. 40 } Department of Health, 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 Rico ($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 Rico ($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 February. 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, 1957 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 214 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 te rN 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 Federal 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 i eee ence ia hanno canton 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 hdl a ee, conan In addition to the issuance of reports mentioned above, other publi- cations processed for distribution during the year included: Jdiness 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 Felated Data; and National Manual—E'mergency 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 48 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. AJ- 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 1985, 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, Bilication: 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 188,300, 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- hes with four children had a median money income of $4,860; 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 Role 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 Jwenile 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 and 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, Hawai, Puerto Rico, and the Virgin Islands receive Federal funds 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 casefinding, 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 Health, 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 ef 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 8 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 58 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 psychological 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 (282,000) 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 eroup, 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 Rico, 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 Se ee ee 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 1s 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’s 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 Welfare and Y outh 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. Joining 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 69 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, 18 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, 1957 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 Region 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 millien om June 80, 1957, a gain of 11 percent. Members’ savings (shares) im 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 establishedigroups. 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 * [In thousands; data as of June 30, 1957] Funds available 2 Obligations incurred Item ral 1957 1956 1957 1956 Totaly sect EVEL) SUNN stad SEP eee: See eel td $1, 741, 948 | $1, 578, 038 | $1, 751,994 | $1, 576, 272 Grants:to States si tase se esse RE eee See 1, 614,361 | 1,481,157 | 1, 624, 613 1, 479, 736 PublicmassistanGe: 4-2 he ae Se eee eee nee eee es 31,575,000 | 1,447,000 | 1, 586, 361 1, 446, 116 Old-age eye sda tyes BORE SESE 9 Serle 2 S22 os ees 38 “rs a 539 Aijd tosthe blind: 2 s3ae2 2: 2 See e sees eee e : 7, 618 ‘Aid to dependent children... __- 1 wine +1, 575, 000.) ; 1, 447,000) Saagiaig 395, 290 Aid to the permanently and totally disabled______- 108, 506 90, 669 Maternal and child health and welfare services_-_---- 39, 361 34, 157 38, 252 33, 620 Maternal and child health services-____- V5 st pet EB 16, 000 11, 928 15, 497 11, 922 Services for crippled children_.__________._-___-___- 15, 000 15, 000 14, 835 14, 803 Child welfare Servicesi22 k= wee a oe ee ae ee 8, 361 7, 229 7, 920 6, 895 Administrative expensesi4222_-2-s24a25s 2st ee ee ee 127, 587 96, 881 127, 381 96, 536 Office of thei Commissioner >see a ee 372 323 361 320 Bureau of Old-Age and Survivors Insurance 6__.__ __ 121, 500 91, 229 121, 412 91, 067 BureatorePublic Assistance. 222s 955 2 ne. ee eee 1, 748 1, 636 1, 729 1, 621 Children’s: Bureaus sas ae0 leas ee oee eee eee ees 1, 822 1, 740 1, 811 1731 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. 3 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. 6 For administration of the old-age and survivors insurance program, which involved 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 iIn millions] Item 1957 1956 1955 Contributions collected under— Wederal Insurance Contributions Act '2f0i00_ 22.222 2 $6, 877 $6, 442 $5, 087 Federal Unemployment Tax Act'sul 2. ee ee 330 325 280 State unemployment insurance laws 4 §_____________ ee ee ih eee 1, 329 1, 142 Old-age and survivors insurance trust fund: Ey IE a 22) Sg ec 7, 100 6, 937 5, 535 Netapproprations.and. deposits... 222-24 2n coe see ese Le 6, 540 6, 442 5, 087 Interest and profits on investments ®__.._---2-- ke 561 495 448 ICME IUUTeS weal 2! ed cel LI Nea 6, 665 5, 485 4, 436 Monthly benefits and lump-sum payments 7.___________________ 6, 515 5, 361 4, 333 BAOMEREIM GUHA UROMIEM panel gee ln oo nee A ke el ese es ne 150 124 103 RENO SOCOM Onl es ee gone ee ke Sk 23, 029 22, 593 21, 141 Disability insurance trust fund: LRSSOS OS UCU ee Se Se a a a 3355 [a il Ree el ed | ek ae INehappropmiahons and deposits... 2/25 2-.. 225222. ese sles SOT Uo as Ree ee Rs DAEDESSERDIST. sn 5 es ie li i ae i Pp, me LEE oa: ares ee See: mxpenqivures (administration) 22... 2-2 s25 ec eee TRE ee DUAR ATEN Oe es te aS 2 DSSS, GGT CLERC 2 Se Saale ils ar) eR a Bo PONG sae ee A IRs By FSI AT State accounts in unemployment trust fund: LESEEB DUBS, (KOUTEU Lz, Se sm cc pe le i a ee ce 1, 796 1, 520 1,333 uo cE AE eR DR OR ee 1, 578 1, 333 1, 146 HOWIFETR OSU. 2S ee RES Ie a ft a Ca ee 212 187 187 Watndraywais tor benefit payments... +... eel 1, 514 1, 287 1, 760 ANSSEURE GING sO Ayia aa a m5) gh a 8, 492 8, 216 7, 983 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, 24% per- cent beginning Jan. 1, 1957. Corresponding rates for the self-employed: 3 percent and 338 percent. In- cludes 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 ot 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 4or 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 0.8 percent of such wages. 4 Contributions plus penalties and interest collected from employers and contributions from employees, reported by State agencies. 4 5 Contributions and deposits by States usually differ slightly, primarily because of time lag in making eposits. 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 Receipts 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 Num- | Average Num- Average Family classification of beneficiaries Num- | berof | monthly | Num- | ber of | monthly ber of | benefi- | amount | ber of | benefi- | amount families | ciaries per families | ciaries per family family TOCA Te Bites eS SR Pee alg Beer on TESS lS 10; 3420s a= 2 eee 6, 160. 2ulS, S74 NOs eee ee Retired sworkermiaint lies sees = es ae eee HEPES TAOS I || ee 4, 731. 9 \ Oda ae ee ee WiOrkeriOn ya one ee ee ee 4,091.9 | 4,091.9 $59.90 | 3, 460.3 | 3, 460.3 $60. 00 Aloe See} pene splot SNPS ee eee 2, 271.8 | 2,271.8 67.70 | 2,148.4 | 2, 148.4 65. 60 Ihemales 2-2 aes an OO re ee ee ae 1, 820.1 | 1,820.1 52.30 | 1,311.8 | 1,311.8 50. 70 Woorkerand aged wiles sess eee 1, 630.2 | 3, 260. 4 107. 80 | 1, 182.6 | 2, 365.2 104. 80 Wiorkerandsyoung wile eee ees .5 1.0 101. 10 «3 ~6 113. 30 Worker and aged dependent husband---_-_-_-- 12.8 25.6 92. 80 10. 7 21.4 88. 20 Worker and 1 or more children________-____- Dies 54. 4 104. 40 16.6 42.7 101. 00 Worker, wife aged 65 or over, and 1 or more childrenees: < se ape sas Soe resend eh Le an 3.6 135. 90 led 4.0 132. 30 Worker, young wife, and 1 or more children_ 74.3 273.0 129. 30 60. 1 220. 1 121. 10 SULVAVOT families se. = BOO Fe. Rs Sk a 15749260|52;.63250 tsa. Saas s 1, 428.34; 2,260 steers oe oe A ved widOWwit tars sages: oe te he 1,019.0 | 1,019.0 50. 70 746. 3 746. 3 49. 00 Aged dependent widower_-_-_-__-------------- 1.4 4 47. 60 Veli 11 48. 20 Widowed mother only !_______-_---------_-- 1.9 1.9 59. 90 8 Rice 51. 20 Widowed mother and 1 child_____--____--_- 132. 9 265. 8 112. 20 128. 4 256. 8 108. 50 Widowed mother and 2 children____________ 92.5 277.5 144. 60 85.7 257. 2 137. 80 Widowed mother and 3 or more children____ 87.3 413.5 142. 20 82. 4 389. 8 136. 40 Divorced wife and 1 or more children_______ ai # 136. 50 .3 7 135. 70 CHT OWA Ye oe sca ae ng oe 238. 2 238. 2 49. 80 217.0 217.0 48. 50 DiCNT ATOM Sieh sed Nae et eee Paces eee ees, & 94.8 189. 5 85. 60 90. 0 179.9 83. 80 SCO GT CNE aes eon wien famine 2 ee eee 34. 0 102. 1 109. 00 31.8 95.3 105. 20 4-Or OTe CHUGKEW wezeyee ew a a nen hei 21.0 94. 3 116. 70 20.2 89.3 112. 20 1 aged dependent parent_____.___----------- 24. 6 24.6 51. 60 22.8 22.8 50. 50 2 aged dependent parents____-_-__--__---_-- 1.8 3.6 98. 30 15 2.9 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, and taxable earnings, by State, for specified periods, 1954, 1956, and 1957 [In thousands, except for average taxable earnings; data corrected to Nov. 21, 1957] Monthly bene- Calendar year 1954 fits.in current- Benefit payments fiscal Em- | payment status, year 1957 1 ployers | end of fiscal report- Amount of taxable year 1957 1 ing tax-| Work- earnings 4 State able Jers with wages, | taxable Lump-| July- | earn- Average Num- | Amount} Total | Monthly} sum Sep- | ings 3 Total per ber benefits | pay- | tember worker ments | 1956 2 Motals 2) 32 10, 342.1) $554, 637/$6, 514, 580/$6, 391, 689/$122, 891) 4,070} 59, 700/$133, 800, 000} $2, 240 Adabamae ..=._-. 12 152.9 6, 583 76, 600 75, 021 1, 579 59 880} 1,539,000) 1,740 PAT AS eee | 788 4.9 238 2, 854 2, 807 47 3 70 128,000} 1,920 Arizonass.. 22-2. 49. 2 2, 544 29, 688 29, 064 624 22 320 585,000) 1,820 AmRansase .- 220005) 102. 0 4, 390 49, 296 48, 512 784 34 490 768,000) 1, 570 Califormia_-_...2-. 22 808.7} 45,001} 583, 981 524,418} 9, 563 338} 4,940] 11, 437,000) 2,320 Colorado. -..---.-- 85.9 4, 510 52, 795 51, 971 824 39 560} 1,040,000} 1,860 Connecticut -_____- 166.9} 10,125} 121,544); 119,162) 2,382 65| 1,070} 2,634,000} 2,450 Delaware_________- 23. 5 1, 292 15, 338 15, 003 335 12 180 383, 000 2, 150 District of Columbia 31.2 1, 967 23, 597 23, 055 542 30 480 941, 000 1, 950 Monidae 2... 295.0} 15,884) 183,065} 180,341} 2,724 108} 1,310} 2,108,000) 1,600 Georeiat 2 o.s 160. 1 6, 912 80, 381 78,404} 1,977 7a -1,,210) - 2,022,000) 1,670 awa! 22S IP), it 1, 074 12, 561 12, 415 146 11 170 355,000} 2,050 JIG ay0e So ee ees ee 37.0 1, 839 20, 907 20, 576 331 14 210 358, 000 1, 720 Alin giseae see. 609.2} 34,939) 414,387) 405,343) 9,044 236] 4,140] 9,727,000) 2,350 indianaeces 2 300.2} 16,196; 188,509) 184,973) 3, 536 96} 1,750} 3,851,000) 2,200 TOwiee es Fe) Wie s T 9,170; 102, 713 101,144; 1, 569 69 900} 1,781,000} 1,990 IGANSAS HES. 2 130. 6 6, 624 73, 865 72,612} 1,253 50 720| 1,368,000} 1,890 Kentucky -_-______- 179. 4 8, 200 93, 306 91, 672 1, 634 57 830 1, 508, 000 1, 820 AouIsianan 22... 119. 5 5, 491 64, 539 63,015) 1, 524 61 860} 1,626,000} 1,880 IVEaiNe! =e) ao 2 2 79. 4 4, 035 48, 839 47, 906 933 26 380 652,000} 1, 730 Maryland .......-2 140. 8 7, 486 89, 208 87, 149 2, 059 69 1, 010 2, 046, 000 2, 020 Massachusetts. ____ 397.6 23, 054 278, 953 274, 116 4, 837 127 2, 130 4, 565, 000 2, 140 IWeiehigan: 2.48 441.1} 25,735} 301,814) 296,003} 5,811 159} 2,960) 7,117,000} 2,400 Minnesota________- 199.9} 10,684); 121,467) 119,514) 1,953 73} 1,050} 2,092,000) 1,990 Mississippi-_--__-_- 90. 2 3, 612 40, 025 39, 234 791 34 500 779,000} 1, 540 JAM ESS%5} 013 Cee 283.1 14,980} 171,428} 168,506} 2,922 103} 1,620) 3,318,000} 2,040 Montana. 2-2 -L 2. 39. 0 2, 039 23, 052 22, 642 410 16 220 410, 000 1, 820 Nebraska_______-_- 87.1 4, 428 48, 508 47, 808 700 35 480 861,000} 1,800 INIGVad ae cy 10.3 570 6, 750 6, 586 164 7 120 185,000} 1, 540 New Hampshire-__- 48.5 2, 609 31, 522 30, 916 606 iy 270 504,000] 41,840 New Jersey_.-_---- 389.4} 23, 181 274,414] 268,828) 5, 586 151} 2,340) 5,363,000} 2,300 New Mexico__-__-_- 28.8 1, 264 14, 616 14, 256 360 17 220 338, 000 1, 540 New York________- 1,116.0} 64,350} 768,691} 753,148] 15, 543 502} 7,550) 17,238,000} 2, 280 North Carolina____ 185. 0 8, 124 92, 204 90, 242 1, 962 86 1, 380 2, 261, 000 1, 630 North Dakota_-_-__- 28. 2 1, 318 13, 622 13, 452 170 13 150 216, 000 1, 420 OMOs eee see ae 583.5] 33,240) 394,827} 387,317) 7, 510 205} 3,760} 8,808,000} 2,340 Oklahoma. _-_____-- 119.8 5, 762 66, 004 64, 927 1, 077 51 770 1, 374, 000 1,770 Oreos]... = 126. 2 6, 928 81, 948 80, 754; 1,194 49 670} 1,463,000} 2,190 Pennsylvania______ 789.4) 44,664] 537,455} 527,316) 10,139 255) 4,530} 10,092,000) 2, 230, Puerto Rico. ___-_- 48.3 1, 449 15, 913 15, 713 200 16 350 301, 000 860) Rhode Island ____-_- 67.3 3, 840 46, 326 45, 450 876 21 380 771,000} 2,010) South Carolina--_- 91.7 3, 877 44, 848 43, 721 ob 2 7: 44 630} 1,056,000} 1,680) South Dakota-_-__- Sie 1, 814 19, 304 19, 069 235 16 180 286,000} 1, 630) Tennessee _-_-_----__- 169. 8 7, 467 84, 730 82,994! 1, 736 70} 1,040} 1,804,000) 1,740) pDe@xcswee as 9 2 380.5; 18,059} 205,927) 201,554) 4,373 216} 2,940) 5,648,000} 1,920) Wishaw eo. . 39. 2 2, 058 23, 786 23, 371 415 16 310 568,000] 1, 840) IMerINOMt=-.. =. 29. 0 1, 476 17; 555 17, 248 307 1 160 314,000} 1, 960) Virgin Islands___-__ 0.6 19 226 217 9g} (5) 10 5, 000 450) Warciniansess uo. 178.7 8, 367 97, 793 95,750} 2,048 82} 1,210} 2,180,000) 1,810) Washington .______ 183.4; 10,185) 120,904) 118,954) 1,950 66 930} 2,038,000} 2, 180) West Virginia______ 134.0 6, 541 77, 760 (ovaay: 0) a 740) 37 560} 1,081,000) 1, 930) Wisconsin. -_______- 259.5) 14,264; 165,353) 162,610) 2,743 90} 1,400) 3,231,000) 2,310) WivOminge 22-3. 15.2 804 9, 272 9, 101 171 9 130 222, 000 1, 660) oreign 6s 2. 62.7 3, 374 39, 610 39, 269 Pals Se ees 50 126,000) 2, 580) SM ESTE REG Occ ke ae a Pa mea caer es ed |e re |e 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 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. 5 Fewer than 500 employers. 6 Benefit data relate to persons in foreign countries receiving old-age and survivors insurance benefits. Employment and earnings data relate to citizens of the United States employed by American employers. ? 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 i 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 (end of period) Numberes chi 22 5 SRE venir pe eG ek Pio Pe co 10, 242. 1 8, 374. 5 7, 563. 4 Oldsdee. 54s. sire. rst erage Et ne 5, 832. 3 4,731.9 4, 214.8 Wafe’sior husband's. 2 708i... seem | Basses Cor seyee te 1, 719.0 1,255. 0 1, 131.3 Ohild’s 1... ce beaded 2 OA Sa 1, 427.4 1, 316.7 1, 220.9 Widow’s0r widowers. -- = 0 Bee eA eae 1, 020.5 747.8 689. § Mother’s2 ae Peett yids ae ee 314.9 297.3 281. 2 Parent:S2 22828 Sealed to cee es ey ee 28.1 25e7 25. 6 Notalkmonthlyiamount. 22. wy bse Pee eee $554, 637 $439, 424 $384, 025 QOld-A2022:-soscsewsd ics eooes eseesbrebeee ee ESE $373, 230 $296, 976 $257, 230 Wifeisionhusband’ size... et _ a ea $58, 749 $41, 968 $37, 011 CHild’ Sy Ber NR se 1 ee $54, 283 $48, 662 $43, 730 Widowstorswidowerist..... 282. A | Ee ee $51, 707 $36, 648 $32, 150 IVE Ot erzaths hain: eS eR $15, 224 $13, 876 $12, 677 Parentiser Vek Gi ewehs baat AE re hin SF 2 ee $1, 445 $1, 293 $1, 226 Average monthly amount: ld -aremth waste JOT Aw oO TOR? IRR $63. 99 $62. 76 $61. 03 W.ife’sorihtisband’soe@t 22) 882s BR Le eo Lee $34. 18 $33. 44 $32. 72 CHI’ s ia bbe SRE Ae EE seer FURR Ie $38. 08 $36. 96 $35. 82 W.idow/Storsawidower's! £2 atl. . = eee See eS = $50. 67 $49. 01 $46. 61 IVMLOtherse i eeek et a Fe eet: : e $48, 35 $46. 67 $45. 08 Parentises ee os OSE RES ee RS 2 ee BS ee $51. 38 $50. 31 $47. 86 Benefit payments during period: Monthlyibenefits: . 85.5. _. 2a)... AES Re A © $6, 391, 689 $5, 245, 476 $4, 232, 609 Old-aremih ARR ele pees 8 2 AON 2 5 a ct ae eT 2” TEE $4, 340, 270 $3, 531, 824 $2, 802, 967 Supplementaky® 220b? we 5 = ee a ee $679, 289 $531, 831 $428, 847 SUPVIVOTEL 208 fw PO ce Be ee ee es ee $1, 372, 130 $1, 181, 821 $1, 000, 795 Taimp-sumpagmants(ghc 08 REA $122, 891 $115, 337 $100, 539 Insured workers (midpoint of period—Jan. 1): 2.______________ 72, 500 70, 900 70, 700 Billy:insaredavnt. this Soe seen iru ER Eat eS 72, 200 70, 100 70, 300 Gurrentlyibutinot fullymnsuredi:_- =. 10 Ae ee ee ee 300 800 400 Estimated number of employers reporting taxable wages, !st quarteriofifiscalty cartes... i. ee ee ae 3 4,070 2 3, 910 87715 Calendar year Estimated number of workers with taxable earnings. _________ (4) 68, 000 66, 000 Estimated amount of taxable earnings___.__._..______-______- (4) $170, 000, 000 | $158, 000, 000 Average taxabléeamingsrs: J. - to. eee ee ee a (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. 5 Rounded to nearest $10. 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Poe Tae eas JUOULIO A. £08 € ETOAS A the AGS tee oe OE es. yen 86 ‘£8 COOL sb bene oR ee “SBXO,L, 826 ‘ST OGnes stew Se gossouud J, 098 ‘€ EECA penis meet) sce eae Hie oe aS og ejoyeq yyNog 69F ‘ZT SLO 0. ap). ee ee euUIfOLBO YN, ELIE L909. = is E> een ee pues] opoyry P82 ‘T CIEEG FER ad | coeds Genes ee ees ody OJON g 998 ‘0% COR GRSLA [TTS eeer roo oe Sas erueA[Asuue g 88¢ ‘1 02k. ll) ee eee u03010 LOP ‘OF SHE TGOR [TP FSSEES Tp ree ee ane eumloyel{o ZSP ‘OF COTO; go | TTP TERaET SS etpen eee ogo LES CORE ps [TT a ee Seg se eres e1O¥VC YWON 6&P ‘9T Geetope [Pafssterecscakecses BUTTOIVO YON 820 ‘SF jee wab., [pi iseseassssresoscrge YOK MON £0 ‘F LOFOTs 4 |i RESIST -OOTXOTA, MON €29 ‘8 GPICOP) ..- [TE T2e ak eres PPE aeraser Aosiof MON LES ‘Z GEST on 77 Tapani = eR EEE allysduey, MON 99T ‘T Cpe PP Ste sh ser Sse BpBAON, OOF 1S “Ti ECPOTS "| Taeeeosaer as serearsesssss BYySeIqON gous -|SISSB TR1OL e5e-PIO 01039 1 $0181G 09 SJUVIS [BIOPOT penunu0e)—7¢6] 41ak wasyf ‘a1n1g pup wpis01d Xq ‘spunf jv1apagy Worf JUu2d1ad pud sainzipuadxa 10707 pun $a]D1¢ 07 $]UDIG posapay :U0IWDAWSIUMIUpY £}14NIag 1D190G ay? Aq paaosddy sunjd sapun aoun}zs1ssp anqnd fo sad4} ymaadg—) 21q¥ I, Social Security Administration $1 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 + ; {In thousands] Maternaland| Crippled Child State child health children’s welfare services services services VEE LTIGXG! (SESCUAO}SE 2 hare RR MR ode a eect are a $14, 913.1 $14, 835. 0 $7, 920. 2 JSORISOTIDD os os SO ne ee 493. 5 520. 4 242.1 AB Sih 1 > a 5 oe lela ae Se RE ek en 122. 4 177.9 43.9 LESTE 5, yl aie Sc Roc elec en a em A BIPAD HAL Jol ee nego acehenay shag 81.2 CC TUSS AGL 8 2 or eco i aE ie pe el tcp naa ae lg 241.0 307. 2 174. 3 DEW AND ae car sk eer Pn U6 Neon 8 napa age Bea 794.6 694. 0 228. 8 SOG ai Omer ree ee ee 265. 4 167.0 91.0 CHYER XS CS oe IE a ere eee 203. 5 217.0 79. 2 Benth Meee eee ts ec te te ke 108. 5 92.8 47.6 ucmCHOMmCOnmMbits fo Lo ee Le 215. 6 151.0 33. 4 TMVQIROG: kt a a a eg penn SO pa 374. 3 367. 4 161.8 Oe ee ee 444.0 546. 4 255. 0 ev urs ee erm ch ee ee A eee ee ee 152.4 V5300 51.6 MGIB R) oo) a 2 eS ee me em a eR Thies 105. 3 34.1 JUSROT) ou oe Se oe RIS Il eee eae tea alia, ad ee ed 407.3 453. 5 236. 4 archi) De eraemet aee (wi UN hiro eee re ee 290. 8 193. 0 111.9 ROTA oe oe dal SR et I sae ale ee oe 202. 3 316. 5 170. 6 Scribe ne Ree ta a ae eee Sn ee ee 166. 6 172. 4 128. 4 tot Sah alll a eet di pele na ieee oedema NC 340. 7 520.1 253. 0 HADIEU ST ESRC a a. Tu ct 5 we cella el a ea sh a 362. 3 Byatal 199.0 IMATE, oo SS EU EE ee ee ee 1 Ea agent | 115. 6 78.0 INET BING Je. 2 ot ne ie aes a win a aR A 371.5 300. 6 118. 4 BYISIOS AC USC LUOmeEEIM nS ee erm ee eee 468. 4 23len 90. 9 SES EEE ee ee ae ee 461.0 459. 7 263. 3 Witte ae ee oe See SPN N SUNN GI IRESE Beret) BS ook. ts 299.5 308. 1 192. 5 ee ee ee ee eS, 7 ee a ee 390. 3 326. 6 226. 5 ESEQ WIN ne tL ee, a ere et pea ei 313.6 220.8 194. 5 IV ORE OT D GE Sa cn NE SE ee ee ree ato (Wea 167.0 Ged ISG, SEEDS) SE et oe ea a ee 110.3 LDA edt 58.8 INN ENO Pe, ee nach RS sy 95. 6 91.8 28. 9 SS. PRR SS Sg UR 92.5 97.3 56. 0 cc ell IR a gg ae 196. 6 222. 4 97.0 INT MGSO oS aI Cs bor a ee ed 149. 7 162.8 83. 7 Seeman ta Fe ee ae 664. 7 o27. 1 257.2 Tides) (ORTR ON CMV. SS an 2S SII ee eee ee eee ne 616. 7 577.3 367. 2 NIGER sinter sete er ee Oe LOS? 106. 1 64.8 CO Tit I ee iy ee ee 509. 9 486. 9 287. 0 COGENT CLIT. Ln sae | C1 eee RY elie Pa ae 203. 7 324. 7 149. 8 reenter tere sa ee SS ee So eee 143.0 156. 3 81.0 Rene rere ees ts eee veh ee Lie ee I Pr 623. 1 620. 0 367. 1 TEUIIOND, USCA ce 2 a cpa Sl aces (ae a ee ee 374.1 430.1 23186 pumomisinnee es aime Oat t so heh LL AGE. eel Ne AL 110.0 108. 4 45.5 BOtrs@oTOniMnts = senbon sah 9 TR it east ERA es 341. 6 381. 4 217.4 PO HeD Ones a ere eee FURY yet) ERT. 8 hy FR Ba 89. 9 79.1 81.6 FEC icaccOmeneee ence shes eae ee ath ae ee 453. 7 480.5 247.1 Pic eeereer oe ee Ng oe OS ee ee 595. 3 652. 3 389. 1 (LIOR. 3 as te Sale ie SR Oa, SN A ee 159. 3 180.1 56. 3 WAG) SEDO 2 age a a re ae 100.3 97.3 58. 5 Darin clangseme amee hi ss NS [ORO TE ee TU ee Ae ey 86.8 86. 7 34. 7 “YCEIEG VGN eS. cs se oper lc eae eee ene 427.5 407.6 249.1 errr err emeemeer ee ets as ke) Rs OW) Te A a ee ee Qs 4. 164. 8 129. 2 ere urea Stee EU et URE CE by ese 220. 7 210. 9 189. 2 \AiSeorasih i, Soo Wes ee ogee aA ae: ene Sea) Oe lee Pe re es) a 193. 0 318. 3 199. 0 a eT EDI 2) a 83.7 86.9 Bonl 1 Based on checks issued less refunds. 82 Department of Health, Education, and Welfare, 1957 Table 9.—Federal credit unions: Number of members, amount of assets, amount of shares, and amount of loans outstanding, Dec. 31, 1935-56 7+ Number of Year operating Number of Assets Shares Loans out- Federal members standing credit unions 1935 ae cee hee eee ee 772 119, 420 $2, 372, 100 $2, 228, 400 $1, 834, 200 OSG sete Ce ee Sees eee 1, 751 309, 700 9, 158, 100 8, 510, 900 7, 343, 800 LOS ere re re ee eee eee 2, 313 483, 920 19, 264, 700 17, 649, 700 15, 695, 300 O38 vee EL Ai ange eg 2, 760 632, 050 29, 629, 000 26, 876, 100 23, 830, 100 1930 5052 SE ee eae. eee 3, 182 850, 770 47, 810, 600 43, 326, 900 37, 673, 000 NOAQE 2 Rare. af mew. Se es ees 3, 756 1, 127, 940 72, 530, 200 65, 805, 800 55, 818, 300 LOAN Oe eee oe one 2a ere 4, 228 1, 408, 880 | 106, 052, 400 97, 208, 900 69, 484, 700 QA 2S Se SUR et poems 28 oo eee 4, 145 1, 356, 940 | 119, 591,400 | 109, 822, 200 43, 052, 500 AGA RR eee cee EAR gee foe ere ere 3, 938 1, 311, 620 | 127,329, 200 | 117, 339, 100 35, 376, 200 OA AN Cd See ee Eaten ee ere ee ee 3, 815 1, 306,000 | 144, 365,400 | 133, 677, 400 34, 438, 400 HO4 ber 2 22 Sot Be eee oe 3, 757 1, 216,625 | 153, 103,120 | 140, 613, 962 35, 155, 414 GAG pa ae ee 3h eee se) cee eee 3, 761 1, 302,132 | 173,166,459 | 159, 718, 040 56, 800, 937 104 fale © ee Ae aes ee 3, 845 1, 445,915 | 210,375,571 | 192, 410, 048 91, 372, 197 19480 cS Sach pens Pe eee 4, 058 1, 628, 339 | 258, 411, 736 | 235, 008, 368 137, 642, 327 1949 m8 cath oki Jk eee oe 4, 495 1, 819,606 | 316, 362, 504 | 285, 000, 934 186, 218, 022 OL fe @ ea as eae in Sep rhe eae age) ee 4, 984 2, 126,823 | 405, 834,976 | 361, 924, 778 268, 735, 838 JOGNe tee 2 Bee ee i eo 5, 398 2, 463, 898 | 504, 714,580 | 457, 402, 124 299, 755, 775 HO52s 13. 22.2 Ree oh ee oe 5, 925 2, 853, 241 | 662, 408, 869 | 597, 374, 117 415, 062, 315 VOSS% 2. 2 2k. Se eee 6, 578 3, 255, 422 | 854, 232,007 | 767, 571, 092 573, 973, 529 LOGAN 2k Ne eS: ee 7, 227 3, 598, 790 |1, 033, 179,042 | 931, 407, 456 681, 970, 336 OG bee. so ho eee eee 7, 806 4, 032, 220 |1, 267, 427, 045 |1, 135, 164, 876 863, 042, 049 1O5G2 Fo acta fe eee oe ee See ee 8, 350 4, 502, 210 |1, 529, 201, 927 |1, 366, 258,073 | 1, 049, 188, 549 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, 1956, and Dec. 31, 1955 Assets and liabilities Number of operating Federal credit niONS ss <. £3 oe ee ee. ee, Savings and loanishares: 8-2 = ee. ee Loans to other credit unions_____________ ame ard) Dui dine see. a hee eee Otheriassetss 2.2 Hes. .o 2 sso Cb a eee aoe INotesspayable-2 285... "2-22 4 Re ee Accounts payable and other liabilities___ Shares 2s eee tee eee een ee Regular reserve: 2... 5h ee Special reserve for delinquent loans___-__- Otherireservesi225 2 ee a A 1 Included in ‘‘other assets.’’ Amount Percentage distribution Dec. 31, 1956 | Dec. 31, 1955 | Change dur-|} Dec. 31, | Dee. 31, ing year 1956 1955 8, 350 7, 806 544) . 2 ve 2s eee $1, 529, 201, 927|$1, 267, 427, 045} $261, 774, 882 100. 0 100. 0 1, 049, 188, 549) 863, 042,049) 186, 146, 500 68. 6 68. 1 118, 900, 595 105, 361, 383 13, 539, 212 Ufa - 8.3 88, 009, 631 83, 896, 302 4, 113, 329 5.8 6.6 228, 565, 099] 181, 956, 756 46, 608, 343 14.9 14.4 31, 647, 416 24, 019, 882 7, 627, 534 2.1 1.9 3, 449, 730 lo 2) Me 9, 440, 907 9, 150, 673 3, 739, 964 6 AT 1, 529, 201, 927) 1, 267, 427, 045 261, 774, 882 100. 0 100. 0 34, 572, 441 29, 098, 259 5, 474, 182 2.3 2u3 4, 344, 517 3, 642, 212 702, 305 .3 an 1, 366, 258, 073} 1, 135, 164,876] 231, 093, 197 89.3 89.5 49, 668, 568 39, 042, 931 10, 625, 637 3.2 3.1 3, 469, 216 2, 468, 400 1, 000, 816 7 22 6920884 S22 eae eee 692, 884 Pa bl ieaie ee ae 70, 196, 228 58, 010, 367 12, 185, 861 4.6 4.6 2 Reserve for contingencies and special reserve for losses. Public Health Service Health of The Nation STEADY ADVANCES in health continued to be made during the past year. There was a nationwide expansion of medical research, and this research yielded significant new knowledge about health and disease. In applying the new knowledge, State and local health agencies broadened their programs and turned increasing attention to new and emerging health problems. There was an increase in health facilities of various kinds, and inroads were made into the stubborn problem of shortages of health personnel. And the health record of the American people showed new gains over old foes. During the year, new programs were begun or established programs were expanded within the Service, as a result of legislation enacted by Congress at the close of fiscal year 1956 and the start of fiscal year 1957. Among the most important legislative measures were: a new program of Federal matching grants to aid in the construction and renovation of medical research facilities; a program of trainee- ships for professional nurses to qualify them for supervisory and teaching positions, and for various types of professional public health personnel; a 2-year extension of the local-State-Federal program of hospital and medical facilities construction; authorization of Fed- eral grants for special studies of care and institutional services for the mentally ill; extension and strengthening of the State-Federal water pollution control program; authorization for the Public Health Service to conduct a continuing survey of sickness and disability in the United States; and the creation within the Public Health Service of a National Library of Medicine. Considerable time and energy during the year was devoted to planning and organizing these new programs and to putting them into 33 $4 Department of Health, Education, and Welfare, 1957 operation. In addition, there was a significant increase in research and research training, and an intensification of effort against some of today’s important health problems, such as accident prevention, chronic disease control and health of the aging, and radiological health. Finally, the year was marked by the appearance of a new strain of influenza and the planning and adoption of preparatory measures to minimize an anticipated epidemic in the United States. HEALTH RECORD The indices by which national health is measured showed that the health of the American people remained at a high level. The general death rate for 19561 was 9.4 per 1,000 population—the ninth con- secutive year that the death rate has been below 10 per 1,000. Both the infant and the maternal death rates, which have declined steadily since the end of World War II, continued to drop. The infant mortality rate was 26.0 deaths per 1,000 live births in 1956, compared with 26.4 in 1955. Since 1946 this death rate has dropped by 23 percent. The maternal mortality rate was 3.8 maternal deaths per 10,000 live births, compared with 4.7 in 1955. There has been a 76 percent decline in the maternal death rate since 1946. The average length of life for the entire population—69.5 years— remained unchanged in 1955, the latest year for which there are published life tables for the United States. The average life expec- tancy was 67.3 years for white males, 73.6 for white females, 61.2 for nonwhite males, and 65.9 for nonwhite females. The decade since 1946 has been marked by reductions in mortality from such communicable diseases as tuberculosis, syphilis, and in- fluenza and pneumonia. The tuberculosis death rate was 8.3 per 100,000 population in 1956, compared with 9.1 in 1955 and 36.4 in 1946. The principal diseases of childhood—scarlet fever and strep- tococcal sore throat, diphtheria, whooping cough, and measles—which caused about 10 deaths per 100,000 population under 15 years of age in 1945, were responsible for about 2 deaths per 100,000 in 1956. In the same period, death rates have also decreased for suicide, homicide, and accidents. No definite trend has been apparent for motor-vehicle accidents; the death rate was 23.9 per 100,000 popula- tion in 1946 and 24.3 in 1956. For all other accidents, however, the death rate dropped from 45.9 in 1946 to 32.1 in 1956, the lowest on record. In 1956, decreases were reported in the number of cases of sev- eral reportable diseases, including infectious hepatitis, poliomyelitis, meningococcal infections, diphtheria, whooping cough, and typhoid fever. Malaria continued to decline. Small increases were reported 1 All vital statistics are given for the calendar year. Public Health Service 85 in the number of cases of Salmonella infections, measles, and strep- tococcal infections, and larger increases for encephalitis and psitta- cosis, due largely to several outbreaks of these diseases. The chronic diseases continued to take the heaviest toll of lives. Together, diseases of the heart and blood vessels and cancer accounted for more than 70 percent of all deaths in 1956. The death rate for the major heart and blood vessel diseases was 513.3 per 100,000 pop- ulation in 1956, compared with 345.2 in 1900. The 1956 death rate for cancer was 146.6, the highest yet in its climb from 64.0 in 1900. BIRTHS, MARRIAGES, AND DIVORCES The Nation’s birthrate has remained at a high level since the end of World War II. About 4,220,000 live births occurred in 1956, for a birthrate of 25.2 per 1,000 population. In 1955, there were 4,104,000 live births, and a birthrate of 25.0. Since there were 9.4 deaths per 1,000 people in 1956—or a total of about 1,600,000 deaths—the rate of natural population increase was 15.6 persons per 1,000 population, the second highest total in the last 25 years. The number of marriages increased slightly in 1956. There were 1,569,000 marriages, for a rate of 9.4 per 1,000 population, com- pared with 1,531,000 marriages and a rate of 9.3 in 1955. Provisional figures for 1956 indicate that the number of divorces was about the same as in 1955, when there were 377,000 divorces, for a rate of 2.5 per 1,000 population. INFLUENZA Asian influenza, caused by a new strain of influenza virus, made its appearance in the United States in 1957. Believed to have started in Northern China, the disease first became known in the Western Hemisphere following a mid-April epidemic in Hong Kong. Within a few months, millions of cases were reported from the Western Pacific and the Far East, and the disease soon spread over most of the world. The first confirmed cases in the United States occurred aboard a naval vessel in Newport, Rhode Island, in June and localized outbreaks were reported during the summer, normally a season of low influenza incidence in this country. Shortly after the outbreak in the Far East, the new virus strain was isolated by U. S. Army medical teams and shipped to this coun- try for study. Scientists at both Army and Public Health Service laboratories confirmed the report that this was a new strain of the Type A influenza virus. On May 22, the Public Health Service supplied samples of the strain to the six pharmaceutical manufacturers licensed to produce influenza vaccine. All six immediately began to produce experi- mental vaccines against the Asian virus strain, and on June 7, the 86 Department of Health, Education, and Welfare, 1957 first experimental lot was submitted to the Public Health Service’s Division of Biologics Standards for testing. From these tests, it was determined that the new single-strain vaccine would give sub- stantial protection against Asian influenza, and the manufacturers began working on large-scale production. They set a production goal of at least 60 million cubic centimeters of the vaccine by Feb- ruary 1958. Asian influenza was characterized by a high attack rate—in the Far East, the attack rate was approximately 20 percent—and a low case death rate. Health experts believed that an epidemic was prob- able in the United States with the coming of cold weather in the fall and winter. This was based on the past epidemiology of influenza, the wide sweep of the disease through Asia, the fact that it had been “seeded” in the United States, and that the people of this country had little or no immunity against the new virus strain. Because even a mild form of the illness could disrupt community life, the Public Health Service began to develop preparatory measures to reduce the incidence of the disease and to minimize the impact of an epidemic. On June 10, the Surgeon General established and met with an advisory committee on influenza, including representation from the American Medical Association and the Association of State and Territorial Health Officers. The group recommended that: (1) the Nation’s health workers, and the population generally, should be alerted to the threat of a possible influenza epidemic; (2) epidemio- logical and diagnostic laboratory forces should be strengthened to develop more information about the disease and its spread; (3) the influenza vaccine should be recommended for military and civilian uses aS soon as supplies became available; and (4) emergency medi- cal and health measures should be planned to provide medical care in the event of large-scale epidemics. These measures were put into effect immediately. In cooperation with professional and voluntary health groups, the Public Health Service undertook a program of public information and education to alert people to the probability of an epidemic and to encourage maximum use of the vaccine. The vaccine manufacturers agreed to distribute the vaccine to each State, according to its population, to assure an equitable share of the early, scarce supply. It was recommended, too, that first consideration in vaccination programs be given to those performing essential community services, including those who care for the sick, and those with chronic disease or other debilitating illness. Communities across the Nation began estab- lishing advisory groups to carry out these recommendations. The Public Health Service made plans to strengthen its resources for influenza research, for epidemic intelligence, and for laboratory Public Health Service 37 identification of the virus. Diagnostic materials were sent to more than 100 viral laboratories throughout the Nation, and physicians and health officials were alerted to cooperate with these laboratories in identifying cases. An Influenza Surveillance Unit was set up within the Service’s Communicable Disease Center to help trace the source, location, and extent of outbreaks of the disease. Finally, the Nation’s medical and hospital organizations made plans to mobilize personnel, resources, and facilities to take care of the emergency medical care needs in epidemic situations. For the first time in history, therefore, public health and medical officials in this country were in the position of being ahead of an impending epidemic of influenza. Considerable planning and prepar- atory work, including the development of a new vaccine, was done before a single case of Asian influenza occurred in the United States. This was the result of a vast cooperative effort among the Nationt’s official health agencies, professional and voluntary organizations, Civic groups, industry, and the public. It was a dramatic example of modern public health in action. POLIOMYELITIS In 1956 there was a dramatic reduction in poliomyelitis incidence in the United States. In 1955, 28,985 cases of poliomyelitis were re- ported in this country. After the first full year of use of the new poliomyelitis vaccine, the number of cases decreased by more than 50 percent. The total number reported from 1956 was 12,146. The reduction in paralytic poliomyelitis was also striking, from 7,886 cases in 1955 to 5,241 cases in 1956. In August 1955, Congress enacted the Poliomyelitis Vaccination Assistance Act, which authorized the Public Health Service to make grants to the States to purchase the vaccine and administer vaccina- tion programs. This Act was extended in February 1956 to June 30, 1957. Under the Act, $53.6 million was appropriated to buy vaccine and to get children and pregnant women inoculated. The States used over 99 percent of this fund, and about 29 million people benefited. About 91 million cubic centimeters of vaccine were produced during the year, and by the start of the 1958 fiscal year there appeared to be enough vaccine available to protect almost the entire population under 40 years of age. The Public Health Service, in cooperation with the American Medical Association, the National Foundation for Infantile Paralysis, and State health officials, undertook a cam- paign of public information and promotion to urge vaccination of as many people as possible during the fall and winter months. 38 Department of Health, Education, and Welfare, 1957 Funds and Personnel There was a total of $682.5 million available to the Public Health Service in 1957 (see table 1, page 150). Of this amount, about $534 million was in appropriations and authorizations. The balance was made up of reimbursements for services rendered to other agencies and in unobligated balances from previous years. | About one-third of the total amount available was devoted to medical research, chiefly through research and training grants to medical, dental, and research institutions. Another third was allo- cated to the States in the form of grants for public health pro- grams, and for the construction of hospital and medical facilities and of sewage treatment plants. The remainder supported the opera- tion of Public Health Service hospitals, foreign and interstate quar- antine, and other direct Service activities. There were 23,354 full-time employees in the Public Health Service at the close of fiscal year 1957 (see table 2, page 153). This number included 1,422 members of the regular Commissioned Corps of the Service, 1,759 members of the Reserve Corps on active duty, 175 officers of the Commissioned Reserve on temporary training duty, and 19,998 full-time Civil Service employees. National Library of Medicine The National Library of Medicine Act (P. L. 941, 84th Congress) was signed into law by the President on August 3, 1956. In accord- ance with this law, the Armed Forces Medical Library—its person- nel, equipment, collections, records, and funds—was transferred from the Department of Defense to the Public Health Service’s National Library of Medicine. The new Library continued the 120-year tradition of the Armed Forces Medical Library. It is one of the three largest research li- braries operated by the Federal Government, and one of the largest research libraries in a special subject in the world. The Library’s holdings exceed one million pieces—books, journals, theses, pamphlets, prints, and films. Material of clinical and research importance is received from every country in the world. Each year the Library acquires almost 100,000 monographs and journal pieces. Each month its loan service places over 10,000 items in the hands of medical re- search workers throughout the country. During fiscal year 1957, the National Library of Medicine acquired about 12,000 books, 73,000 serial pieces, and 1,200 new serial titles. It purchased 525 rare and old items for its History of Medicine Di- vision. Almost 28,000 titles were catalogued, and about 2,000 pictures and portraits were added to the Library’s art collection. Over Public Health Service 89 125,000 volumes were circulated to users of the Library, and some 9,000 reference questions were answered and 435 bibliographies com- piled. Almost 16,000 major entries were prepared for the 1956 volume of the National Library of Medicine Catalogue; and 111,000 items were published in its Current List of Medical Literature, from 1,500 journal titles. More than 1,100,000 pages were filmed in re- sponse to 69,000 photoduplcation orders. BOARD OF REGENTS In February 1951, the President appoimted a Board of Regents to advise and make recommendations to the Surgeon General on policy matters affecting the National Library of Medicine, includ- ing selection of the site of a new library building, which was author- ized by the legislation. ‘The 17-member Board includes the Surgeons General of the Public Health Service, Army, Navy, and Air Force, the Chief Medical Director of the Veterans Administration, the As- sistant Director for Biological and Medical Sciences of the National Science Foundation, and the Librarian of Congress as ex officio mem- bers; and ten appointed members from leaders in medicine and re- lated fields. The Board of Regents held three meetings during the year. At its first meeting, the Board elected Dr. Worth B. Daniels as Chairman and Dr. Champ Lyons as Vice Chairman. Dr. Frank B. Rogers, Director of the National Library of Medicine, was appointed Secre- tary to the Board. At its second meeting, on April 29, 1957, the Board unanimously recommended a site for the new hbrary build- ing on the grounds of the National Institutes of Health in Bethesda, Maryland. After hearing additional reports on the planning for the new building at its third meeting on June 7, 1957, the Board reaffirmed its decision on the site. Other matters brought before the Board were the Library’s policies regarding interlibrary loans and the distribution of publications. In order to modernize its loan policy and improve lending services, the Library reexamined the bases for both loans and photocopying. With the approval of the Board of Regents, a unified system of inter- library loans and photoduplication was adopted. The Board also approved adjustments in the distribution pattern of the Library’s publications, so that agencies of the Federal Government would be served on a more equitable basis. NEW BUILDING Active planning for the new Library building was resumed in August 1956. A contract was later negotiated with an architectural firm for a preliminary study of Library requirements. In June 1957, 448006—58——_7 90 Department of Health, Education, and Welfare, 1957 ee a ee a second contract was let for architectural services calling for de- sign of the building and preparation of working drawings and specifications. Public Health Methods The Division of Public Health Methods continued to provide staff assistance to the Surgeon General and to conduct research in the fields of public health administration, organization, needs, and re- sources. The new National Health Survey program was organized, and the publication of Public Health Reports continued. ANALYSIS OF ILLNESS AND DISABILITY A continuing national health survey was authorized by legislation enacted a year ago. Under this program comprehensive statistics on health and illness are being compiled for the general population. This represents the first large-scale collection of such data since 1936. By the end of the first year, the basic household interview phase of the program had progressed through a 2-month “dry run” collection of data in the field. The gathering of data for tabulation began in July 1957. Another phase of the program will consist of medical examinations of a sample of the population. Several methodological studies are already under way. The sampling, field work, and sta- tistical processing of results from the household survey are being con- ducted for the Public Health Service by the Bureau of the Census. A 16-month survey of Indian health, conducted by the Division in cooperation with other units of the Public Health Service, was completed during the year. The published report, “Health Services for American Indians,” is a compendium of information and data on Indian health needs and resources, on Federal programs, and on requirements for a comprehensive health program for the Indian population. While a wide variation exists among Indian commu- nities in different areas of the country, conditions urgently requiring attention include: tuberculosis, other communicable diseases for which- specific control measures are recognized, and accidents. The report recommended : improvement and extension of medical services outside hospitals; establishment of more field health units; expansion of pre- ventive services; additional dental services; more preventive health services for infants and children; and mental health services. Morbidity studies were conducted during the year on the following subjects: influenza and pneumonia mortality trends in relation to epidemics of these diseases; long-term trends in illness and medical care; and illness and availability for work. At the Division’s office in Hagerstown, the reliability of chronic illness data obtained in household surveys was evaluated in a special study. Public Health Service 91 Since 1951, the Division has been serving as a clearinghouse on current morbidity statistics projects. A fourth listing of the Clear- inghouse’s “Sources of Morbidity Data” was published during the year. EDUCATION FOR HEALTH PROFESSIONS A cost analysis study of Emory University’s School of Medicine has been completed. This study was made to develop concepts and methods of cost analysis applicable to the problems of medical schools. Part II of the manual, “Cost Analysis for Collegiate Pro- grams in Nursing,” developed jointly with the Division of Nursing Resources, has also been completed. At the request of the House Committee on Interstate and Foreign Commerce, the Division assisted with the preparation of a 479-page report on medical and other health professions schools. The docu- ment, published under the title “Medical School Inquiry,” includes data on the capacity of medical schools, their graduates, physician requirements, and the financial aspects of medical education. STUDIES OF HEALTH SERVICES “Prevention of Chronic Illness’—Volume I of the series, Chronic Iliness in the United States, published as the findings of the Com- mission on Chronic Il]ness—was edited and certain chapters written in the Division for the Commission. A document, “Guide for Com- munity Surveys—Assessing Chronic Illness in Your Community,” is being developed as a manual for organizing studies to measure chronic illness and to inventory a community’s resources for medical care, rehabilitation, and other services. A report on social service departments in hospitals in the United States, surveyed in cooperation with the American Hospital Associa- tion and the National Association of Social Workers, has been com- pleted and published. The study presents the current patterns of organization and staffing of social service departments, summarizes the professional training, and analyzes activities reported by the departments. CONSULTATIVE SERVICES In the fields illustrated above, the Division of Public Health Methods gives consultation to governmental, voluntary, and profes- sional organizations, advising on methods of evaluating and formu- lating programs. During the past year, assistance was provided: on a proposed reorganization of the Ministry of Health of Colombia, South America; to the Smithsonian Institution in its plan for a Hall of Health exhibit; to the Bureau of the Budget and the Veterans’ 92 Department of Health, Education, and Welfare, 1957 ee ee Administration on a projection of hospital bed requirements; to the Office of Defense Mobilization in the development of a policy for mobilization of professional health manpower; to the University of North Carolina, which is planning a study of factors in the choice of health careers; and on other subjects. National Institutes of Health Increased appropriations in fiscal year 1957 for the research pro- grams administered by the National Institutes of Health for fiscal year 1957 brought opportunities for expansion of medical research throughout the United States. Three-quarters of the funds were awarded as grants to non-Federal institutions, supporting research projects, training activities, and construction of research facilities. The Institutes of Allergy and Infectious Diseases, Mental Health, and Dental Research received the largest relative increases. Dollar increases were largest in the programs of the Heart, Mental Health, and Cancer Institutes and in the Institute of Neurological Diseases and Blindness. The availability of additional funds led to a greater volume of grant applications, to the awarding of more research grants and fel- lowships to scientific investigators, and to a doubling of the training grant expenditures over 1956 levels. An important byproduct of the increase in funds over the past few years has been the stabilization of support for scientists working on long-term research projects. In 1957 support for NIH grantees con- tinued for an average of 3.2 years, as compared with 2.5 years in 1955 and 1.8 years in 1951. More than half of the past year’s 8,000 applications, however, proposed new rather than continued projects. The number of research fellows rose from 1,400 to 2,100, and over 4,000 persons were trained under the training grant and traineeship programs. The first senior research fellowships were awarded in fiscal 1957, beginning a five-year program to foster additional re-— search in the basic science departments of schools of medicine, den- tistry, and public health. Training was strengthened in the preclinical and physical sciences. New training programs were inaugurated to overcome the shortage of statisticians trained in epidemiology and biometry and to experiment with methods of research instruction for medical students during their undergraduate years. A program to develop training in dental research was initiated in dental schools. Under Title V of the Health Amendments Act of 1956 (Public Law 911), grants were authorized for projects to evaluate treat- ment and care of the mentally ill in all types of institutions. ee ee ee ee ee Public Health Service 93 Other new legislation—the Health Research Facilities Act of 1956 (Public Law 835)—authorized a 3-year program of grants to build and equip laboratories and other facilities for medical research throughout the country. A supplemental appropriation authorized the planning and construction of urgently needed laboratory and office facilities at the NIH site in Bethesda, Md. Special emphasis was given during 1957 to the expansion of the cancer chemotherapy program and to the development and expan- sion of psychopharmacologic treatment methods. The Cancer Chem- otherapy National Service Center completed its second year of opera- tion as a national headquarters in the voluntary, cooperative search for a chemical cure for cancer. Establishment of the Psycho- pharmacology Service Center during the year stimulated research on drugs that affect psychological function. Guidelines were pro- vided in the fall of 1956 by a national conference on the evaluation of pharmacotherapy in mental illness. Another development of special significance was the establishment of the Center for Aging Research. Administered by the National Heart Institute, the Center was created to stimulate and coordinate cardiovascular, psychological, and related studies on gerontology conducted at NIH and other institutions. These various developments are discussed further in sections con- cerning the individual NIH programs. The National Institutes of Health comprises seven Institutes and Five Divisions—the Clinical Center, the Division of Biologics Standards, the Division of Research Grants, the Division of Research Services and the Division of Busi- ness Operations. Clinical Center The clinical research programs of NIH achieved a gratifying de- gree of maturity and professional acceptance. The physical plant was brought to the stage where maximum utilization was possible. The Clinical Center departments that provide hospital care and diag- nostic services for all research patients were functioning with full effectiveness despite continued shortages in technical personnel. The most important physical changes initiated during the year were the completion of the residential facility for disturbed children, activation of a child nursing unit, and plans for a new surgical re- search wing. Maximum available bed capacity was attained in 1957, marking an increase in available beds from 443 in July 1956 to 516 in July 1957. No further expansion of bed capacity is contemplated. Inpatient admissions totaled 2,598, as compared with 2,095 in 1956. Visits of patients as ambulatory followup or outpatient research sub- 94. Department of Health, Education, and Welfare, 1957 oe EE eee jects totaled 21,348 as against 18,575 in 1956. Although patients con- tinued to come from all sections of the United States, approximately 75 percent were referred from the District of Columbia, Maryland, and Virginia. Division of Biologics Standards The importance of biologics control in the development of preven- tive medicine has been emphasized by the expanding range of diseases to which biological products are applicable, particularly in the field of virology. Two new vaccines have been under intensive study by the Division of Biologics Standards—the adenovirus vaccine and the Asian influenza vaccine. After months of testing, standards relating to the safety, purity, and potency of the adenovirus vaccine—a biological product designed to prevent infections due to adenoviruses—were drawn up by DBS scientists and given preliminary approval by the Surgeons General of the Army, Navy, and Public Health Service. With confirmation that the influenza epidemic in the Far East this spring was due to a hitherto unknown virus strain, the Division pro- cured samples for the six licensed manufacturers so that production of a vaccine to combat the new strain (Asian, type A) could be stud- ied. As data became available, suitable potency tests were developed in DBS laboratories; reference vaccines correlating data from labora- tory, clinical, and field investigations were established; and specifi- cations for the manufacture of vaccine containing the new strain were provided for the guidance of the pharmaceutical industry. A new potency test for poliomyelitis vaccine was developed by scientists in DBS and industry. The test employs chicks instead of monkeys. It has been approved by the Technical Committee on Poliomyelitis Vaccine and is being used concurrently with present monkey potency tests on a trial basis. Over 97.5 million cubic centi- meters of poliomyelitis vaccine were released during 1957. More than 100 licensed blood banks throughout the country are collaborating in a study initiated by the Division to determine the causes of error in labeling blood for transfusion, and thus to reduce eventually the number of such errors. Division of Research Grants The Division of Research Grants, in addition to coordinating NIH grants and fellowships, initiated several new programs and expanded its support of research and research training in the basic sciences. The Health Research Facilities Act of 1956 (Public Law 835) estab- a Public Health Service 95 lished the National Advisory Council on Health Research Facilities and authorized $30 million annually for construction grants to re- search institutions on a matching basis. Among other new programs initiated during the year were a Senior Research Fellowship Program, to help relieve the acute shortage of teachers and investigators in the preclinical sciences; a Postsophomore Fellowship Program, to provide research opportuni- ties to medical students; and an Experimental Training Grant Pro- gram, to permit experimentation with research training in medical schools. The Division also intensified the coordination of research and training in epidemiology, biometry, and public health. Progress was achieved in biophysics, biophysical chemistry, experi- mental pathology, and other areas of Division-sponsored grantee research. A major practical finding is that edathamil calcium disodium increases the urinary output of accumulated lead, providing a new therapeutic agent for lead poisoning in children. Of funda- mental importance is the discovery of a new type of ribonucleic acid. Ribonucleic compounds represent the bedrock of all known mecha- nisms for transmitting individual traits from one generation to another. Central Services The Division of Business Operations furnishes NIH scientists with auxiliary management services. During the year, the Division developed and carried through a program of decentralizing authority to the individual Institutes. Paperwork and multiple-level reviews have been reduced, and thus action has been speeded. The Division of Research Services provides scientific, technical, and engineering support for the Institutes. Major emphasis in 1957 was given to planning and designing additional construction author- ized by Congress. This includes special facilities for the production and care of germ-free animals, a surgical wing for the Clinical Center, a permanent office building, and laboratories for the Division of Biologics Standards and for the National Institute of Dental Research. During the year, the Division established a program for translating and disseminating selected research papers and abstracts from Soviet periodicals devoted to the medical and_ biological sciences. Institute of Allergy and Infectious Diseases This Institute conducts research and training in the field of allergic and infectious diseases. Allergies alone affect some 17 million per- 96 Department of Health, Education, and Welfare, 1957 sons in the United States. Acute respiratory diseases—to cite a single category of infections—are by far the most prevalent of all illnesses. Although spectacular gains have been made against some com- municable diseases, remaining problems are numerous and important. The increase in the average life span has created new problems, one of which is how to prevent illness and disability in the added years. The control of allergic and infectious disease is a significant aspect of this problem. | Research to develop more potent and less toxic protective vaccines has shown notable progress at the Institute’s Rocky Mountain Laboratory, Hamilton, Mont. Working with various types of micro- organisms, the scientists have found that the cell wall, when separa- ted from the inner protoplasm of the cell, can be purified chemically ; this not only leaves a concentrate that contains the elements which confer immunity but removes toxic substances responsible for some side reactions. These techniques open new opportunities for 1m- proving vaccines, including possibly one for tuberculosis. Institute scientists extended their work with the adenoviruses, a group of viruses originally isolated from diseased adenoidal tissue. The adenoviruses have been shown to be almost as important a cause of eye infection as of respiratory disease. Continuing studies in- dicate that these infections are particularly prevalent among pre- school] children. Since a vaccine against certain types of adenovi- ruses in military recruits has been shown to reduce illness, the in- vestigators are studying the advisability of developing an adenovirus vaccine for specific use in young children. Institute clinicans made the first direct measurement of the rate at which humans produce antibodies against disease. This was done by transplanting lymph nodes—tissues involved in manufacture of protective antibodies—to a patient suffermg from hypogamma- globulinemia, a rare disease characterized by extremely low levels of antibody production. ; About 250 million people throughout the world have malaria and about 244 million die from it each year. Recent cooperative studies with the World Health Organization have shown that malaria can be prevented by administering antimalarial drugs in the same manner as iodine in salt. A dietary salt-drug blend may be useful in areas where spraying is not a practical means of controlling the carrier mosquito. GRANT-SUPPORTED RESEARCH It has long been evident to scientists that factors other than spe- cific immunity are involved in susceptibility or resistance to infec- tious diseases. Scientists from the University of California, with Public Healih Service 97 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 1s 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 ee er eS ee 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 mocu- 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 NIH has collaborated with the Veterans’ Adminis- tration on a followup study of more than 200,000 World War I vet- erans. Information compiled from replhes 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 383,000 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 ylelding 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 Research. ‘There were 265 dental research proj- ects under way with the aid of grant funds in 1957, a fivefold in- OO a 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- very. 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 1956 (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. Family 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 hyperaggressive 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- 108 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, mn 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 1s 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 B,» 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 has 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 Rh factor. _ 2 11, 669, 801 Tuberculosis: .control. 2-22 sses cee ee ee eee 4, 485, 949 Mental health) aetivitiesics__.gioclscee uri ee ee 3, 949, 845 Cancer, ;control.2 - aot ey A we Leste Lan ee 2, 235, 318 Heart disease control... ee 1, 987, 983 Medical facilities survey and planning__-_--____. 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II@ T&T ee oe ge erie XO, be Aetgeld LC taeaecene SPL ‘T nl 918 Pr 6¢ Ly 06 Tee T2T 88 ee ee GE POSSE, Sr lent aati (tea alittle ZO Z e) LI ¢ cI a6 18 &I j — BAOHVC YNOG ao ------ =~ CI 699 ‘T Or 1¢¢ $e oF 1g €9 L¥Z a4 +6 —_ BUTpoIeD YYNOS oh ahs’ ot fetacain nen eras 228 earner sats Me 1Z 91 IT 9% eg GZ Oe ee ele DOSE CP OC ae eee eer sews 00¢ ‘I CZ 10% % og SII iba! 99z €89 822 LG 1 eyueapAsuued i On ae a 9¢ C08 g ZOPF 2G 91 61 ze 821 g Sheu ao gk > Seagal Office of Education Introduction Fiscau 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 1051. . 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 m 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 IT, 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 Se EE TL SS TR TSE TS SS ST SE SS ESET PT PETS EEE 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 38, 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 SUSE RRE 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 Nt a ee 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 Accounting 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, (8) 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 $1314 billion was spent to provide schoolhousing for an enrollment increase of 714 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 new 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 what 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. , g , ee ee we eS ee ee = wh eee aS Se ee 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 illteracy 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 Welfare, 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 ait 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 RW 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 sacl MANS 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 eheayies 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. i ee ee Chocolates, sugarssandirelated productsaes cess sa= = seen 22 St ee re = Dairy products: iButter anGechurninoricresyiises en eee ee eee ee ee ee 15 1°) Sc2d. ee @heese-andiotheridainy products sees 2a ee eee 5 6. |i. See Hegsand eos Productss=. see ene ee een ee eee ee ee 8 2; || 25 Se ees Riavorsyspices: and comaiments = 52 eae ee ee ee 3] Oy | Rae Mritsiand truit products tes ee seen a eee ee a eS 27 1) | ee Sere Meat products:andspoulinyae aot ee ee ee ee ee 21 3 1 Nits and mut Products! ee eae see eee ee ee eee ee (2: "| eee 522 | Se ee Oils, fats, and. oleomargaring #2. we we ee es ee 10.) ee 1 Seafood 2 2S 7 Pr ee ae a ee ee ee Be a ee ee 108 13 3 Vegetablesiand veretableproducisen sameeren eee 72 6 1 Miscellaneousdoods (mixed lots) Somer aes een ee ee 11 Dl eee ie eg ae Wiarehoused! f00dS2:2 & 5 se sate See eck ee ee eee ee er 109 9 1 Food-forspecialidietary uses) tase) ee eee 24 |. LA eel ee See Violative.serving of oleomangarinG ss =e = ae ee eo 1 | ee Pood adjuncts22220 4 2 AO eh oa ST A Ee ee pa eee Pk 2 EAL be 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 were 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 3314 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. if 200 Department of Health, Edeeuiorn. and Welfare, 1957 che NER eee ncaa Saas AMOR SALSA 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. (8) 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 30 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 toa 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 (8) 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 Health, 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 pan owad misrepresented by collateral literature; and a distributor of “vim and vigor” proprietary remedies with promotion especially de- signed for the aging. Ten seizures were ae 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. a a ee | i | 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 B,, 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 Al] 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 Law 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 804 (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. 8, 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 a ay Wwavisiaien bith oy ree 7 ey"t rt m Pe ‘ : : — ogy he oS ete ane dig hy fi nl is | es, a bere pate ee bee) arms A ree) ; f , ; r : Te | t me | F, 5 ' : ! ‘ \ i ae ’ f ’ “ , 1 5 i ae t fa { wil ne | y i \ [ r * y ; © jal LZ.) ih . ais 4 .' } 7 : ‘ f . r OR * p ih, Po d Siso BAY 7 } iti bh l ‘ om A : geen v4 eects : ' - im ” » ee : ; , ? i Mag j [ { ‘ nl # +7 n } f ty : V4 ’ : ‘ ’ i ’ 2 s on ; we ON i } . | 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 * 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 383 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 Se ee Oh | a a 217 Office of Vocational Rehabilitation “OL /sisoinauaqn | 61 Aseuow|nd sajes pue jedl19|9 491 pasa y | BdIAJAS ; ES Hb ranastn 3 —“%hp (e}abeuew } 482 , aa, SoA RLS SS ine ‘]EUOISSAJOIIWAS | juawaredu | rag = __ ‘[euolssajold = deIpPsJed “92 tho ‘e pal |P1s!Wwes aunynoby oe pue pails “21 % \ wl gS SaAIMaSNOH % fll Jau0 IV ‘S JO OM uoneindwy Ajwe4 SNOILVdN000 YZOLVIN SHILITAVSId LG6IT svah ywosy ‘auinsoj9 40 dnoub youoyndns00 solnu fiq pun a0unjda00n 40 fginqnvsip fo sadhy fiq ‘squnppqnyas [0 2Ua040g SdNOUYD IWNOILVdNDSO YOFVW AGNV SIILMIGVsSid——"L HeYD 15 448006—58 218 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 publi 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 unemployed 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, 24 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 a es ee — ie’ 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 Ee ne Te Office of Vocational Rehabilitation 223 ES Sa le 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 erant 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- clalty 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 OVE 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- : 4 A Z 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 nh bl SS SARE AT Ta 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 who 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 ag 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 148 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 ae) eae SOP ae ee 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. ‘ r - pe a Office of Vocational Rehabilitation Table 1.—Number of referrals and cases, by agency, fiscal year 1957 Agency ! United States, wotals oo... -- 181000 Wein eee District of Columbia_-____-- Florida: KWentucky—...2.--2. Louisiana: Maryland_-_-_____-- Massachusetts: See footnotes at end of table. Referrals During fiscal year Re- Not ac- | maining cepted | at end for of year 3 serv- ices 2 101, 656 | 114, 244 920 | 3, 831 69 419 587 675 41 28 2,044 | 1,226 10,252 | 5,021 647 748 16 147 586 623 94 35 487 198 16 7 1, 581 444 2,977 | 2, 718 1,623 | 1, 199 5,231 | 7,828 526 215 11 9 630 633 2 17 4,678 | 4,243 524 631 85 65 1,438 | 2,350 45 824} 1, 555 65 180 2,557 | 1, 906 1,110 | 1,144 142 368 1,106 | 1,055 69 1,153 | 1, 700 1,082 | 1,413 35 166 2,017 | 3, 688 84 83 1,929 | 2, 580 277 271 934 801 357 141 1,203 | 1,613 232 279 582 692 236 106 168 412 56 67 235 Cases During fiscal year Closed from active load Re- maining After Before | at end Reha- |rehabili-|rehabili-| of year 6 bili- tation | tation tated plan plan initi- initi- ———_— ———<— | ————— | KrF | —oe (Ke _ | ___ ____*" 70, 940 7,230 | 15,833 | 144, 589 ——q— | eq— | — me |) um] ———_~ |__| ___ _____ 2, 070 181 262 4, 934 7 3 179 413 45 45 692 26 14 5 73 1, 501 120 129 2, 015 1, 567 507 | 1,078 5, 554 653 181 84 1, 089 43 oer 118 966 287 167 2, 336 50 18 1 9 485 7 52 669 17 9 2 29 340 156 159 851 1, 854 251 517 3, 566 260 42 22 528 5, 326 258 713 5, 578 202 41 11 356 13 3 2 59 165 24 14 396 8 4 0 22 4, 207 320 | 1,615 7, 407 1, 138 88 349 2, 536 43 14 35 163 1, 065 122 200 2, 323 12 0 5 576 60 118 1, 339 49 10 2 129 871 64 380 1, 812 1, 602 87 349 4,119 110 12 19 402 228 25 100 784 19 7 59 1, 218 142 440 2, 833 965 76 184 2, 176 62 5 12 248 3, 255 384 125 5, 457 100 41 42 219 967 141 119 3, 161 78 13 20 270 912 58 250 1, 530 272 42 33 558 1, 297 56 126 1, 989 123 18 14 349 400 15 30 731 21 2 2 29 615 43 33 1, 361 57 2 2 80 236 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 Closed from active load Agency ! Re- Total }|- 20 2 eee ee Ac- Not ac- |maining| active maining cepted | cepted | at end load After Before | atend Total for for of year 3} (re- Reha- |rehabili-| rehabili-| of year 6 serv- sery- ceiving bili- tation | tation ices ices 2 serv- tated plan plan ices) initi- initi- ated 4 ated 5 Ee | ee ee ee ey ee ee Nevadark ee 519 75 329 115 189 54 13 4 118 New Hampshire: General]_--_-___ 583 267 173 143 530 103 53 17 357 IBlindsscee east 48 27 11 10 84 15 6 12 51 New Jersey: eneral..-- 3-4 5, 159 1, 4385 1, 839 1, 885 2, 992 781 146 moeey 1, 748 Blinds ese 736 102 137 497 410 96 14 29 New Mexico: General. .2 02-2 1, 430 294 662 474 604 285 26 10 283 Blindheges ese 183 32 26 125 91 18 13 2 58 New York General_...-_-- 18, 013 6, 1382 6, 681 5,200 | 138, 496 4, 485 498 1, 220 7, 293 IBMNIdea ee eee 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 Blinds ss ease 1, 326 507 520 299 1, 478 368 25 95 990 ie Dakota_-_.-= 1, 498 417 336 745 938 274 14 17 633 te) General o.22 25 5, 821 1, 726 1, 556 2, 539 3, 780 1, 250 85 213 AL DBY: IBlindess. a 2k. 472 199 ah Be 162 662 128 43 30 461 pe hed ue eee 5, 088 2, 501 1, 590 997 7, 038 1, 396 101 713 4, 828 regon General______-- 5, 538 1, 044 1, 905 2, 589 2, 718 650 97 314 1, 657 Blinds ss ook 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 Blingtaecenes ee 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 Biind ese 44 41 0 3 188 28 Ri 6 151 South Carolina General_._____- 6, 233 1, 936 1, 413 2, 884 4, 822 1, 529 66 222 3, 005 Blin gskpe Se 389 Loi 151 81 284 94 7 25 158 South Dakota: Generale. .2. 892 200 169 523 825 171 4 37 613 1 liraal ales Sok Se 194 30 84 80 67 17 1 0 49 Tennessee: General______-_- 6, 252 2, 47 1, 487 2, 289 4, 994 2, 028 129 208 2, 629 Blind ere ese 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! 22a 1, 099 Suk 488 240 810 334 19 a1 436 Utah ae 8 ae 1, 165 466 233 466 1, 197 347 ou 15 800 Vermont General 1, 009 269 244 496 662 171 29 45 417 Blind mee. es. 60 30 20 10 70 19 4 a 40 Virginia: General______-- 12, 793 3, 510 5, 307 3, 976 7, 369 2, 271 109 797 4,192 Blind soos se 539 138 191 210 258 80 18 10 150 Virgin Islands_-~-___ 37 3 0 34 3 0 0 0 3 Washington: General________ 4, 827 1, 397 1, 849 1, 581 3, 538 1, 007 145 259 2, ae Blind ses 215 70 86 59 163 37 Qe 13 104 West Virginia______ 12, 879 3, 061 8, 274 6, 544 8, 335 2,171 71 663 5, 480 Wisconsin: General... --. 5, 567 1, 690 1, 612 2, 265 4,796 Bil 173 76 3, 170 Blind ooo 158 67 43 48 178 57 9 6 106 Wyoming: 2 2 1, 265 202 555 508 499 201 24 13 261 1In 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, ete. 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, ete. _ 5 Closed prior to initiation of rehabilitation plan because of indifference of individual, probable increase in degree of disability, loss of contact, ete. 6 In process of rehabilitation on June 30, 1957. b a br { Office of Vocational Rehabilitation 237 Table 2.—Vocational rehabilitation grants, 1957, State divisions of vocational rehabilitation Extension State or Territory : Support and im- Expansion Total grants provement grants } grants (a oo 9 ah Pee i gg eee a eae $30, 466, 162 $1, 043, 793 $887, 220 $32, 397, 175 pe eel a ae 1, 271, 534 26, 885 20, 022 1, 318, 441 ga Fg eal ae 246, 190 8, 689 5, 855 260, 734 i ea en ae a ae eel 866, 735 15, 862 5, 892 888, 489 Bie le lng le a ad 2, 071, 732 115, 541 79, 239 2, 266, 512 ee peal le al ge 213, 665 8, 091 16, 581 } 238, 337 aman ebiCiiteses see se oe ack Se ee 322, 827 15, 895 13, 390 352, 112 LOD BLS SWHREIND, = saga hee le 145, 000 5, 000 3, 648 153, 648 LPB pt eg a le ti 783, 558 30, 606 22, 493 836, 657 CAVE TS BLD ec cai ee li fn el lle aaa ede reed 1, 883, 882 82, 104 23, 528 1, 939, 514 [DEL De nother fs SS SE Sef i a le ye (Oot ial etme ese pies 2, 858 76, 754 Co AVEUOUG 3 yea i ca i a eel ae ae 1, 516, 896 36, 120 55, 420 1, 608, 436 OCU D a a De ee A lle ppg eae et 414, 551 24, 980 14, 960 454, 491 (ae a aa SE CE Readable Se 530, 257 21, 993 14, 850 567, 100 Es 1s arene reer rt Sei ox wee ie rs 261, 967 14, 072 9, 842 285, 881 tea Cue\2eea seme emer n e Ye ae 358, 306 26, 642 13, 376 398, 324 8) ote aap pet A a gl QOORSS 7H Peaeee eee 12, 000 912, 537 GOL EV LIES 2 ee pala aligned ea al ed el 181, 748 8, 024 3, 964 193, 736 gs Oc SS ie eee meee 389; 062 |2cc2esecc=2-=: 17, 025 406, 087 eee CIMISC TLS eee ooo Sees = eos 532, 013 43, 872 33, 399 609, 284 SS eae ce cee ea 1, 124, 720 64, 155 55, 362 1, 244, 237 Bese EEO SOU ee es ne eee ee Se Lae 641, 854 22, 428 3, 200 667, 482 Oe ae ee Se $49 945 A coe dees ee 10, 085 352, 330 Reem eee sec eee ree) eee 529, 522 18, 563 23, 255 571, 340 2 LE SIS Si i 143, 922 OV OLS wae ete e = 149, 534 IN SUIS I a 5 ee ee a 173, 073 7, 275 12, 598 192, 946 I DDG Gh. oaac TL | Gt | 698- |"""| 99. | 82 | O&L | 226 | T | eet ‘T | Ize 7 eH ee pozeredes 5 ee i a ke eae OPSOE |e ae le a Stag oe Tay oe ee. || Ut | ee | ot | cor‘t | Tt | sge‘t | org ‘r |--~2c61 ‘og eune 0 poygtmpy ~ GFL | LP | GCL | 8% | 2S | 8ZE | £6} TZ /F | 9 OL | WS | OT | 9T | 99] Ej z@ T | 88% | 988 ‘T | T | e8e | 2h | SOT | 9289 | 69 | 986° | e282 |---- 961 O€ 9UNL ‘S[[OI UO ~ Ei} ty | by Q On tay Gy te wn 1o ee) wn Ss] BSI SE) YS BIElzZ/ 2/2] 2 ieveyele] sea] € lg] s/s] 21 2 12) 2 | 2 Wish ah Xapt sl), Sees A Ee Gao esate) 2 dno io Q fm | © eB © Bi} @| B = oa] © 2 re) Q ® I © Sime, c/o PP AS se elele1e] SPeleyels! gl g)s | =e (s) eg) 2/2) © |e) s | = 3 0 as aS fe ae pa Fd ie! See eR chee |e tec) ena peel tial Ea sah © Bao Bae. Loaigs A ta Ra bal FB) eee toe) | ee eo" eo ae Ba cae El So ae Sale| & Ae a se S el ele |'¢ f-ahs SE (8 be |e. PES de | plaelc es oa lan ee yee hy a et SIE/2/8| & |e] "| El B8 se ea Baier = olin] @ 5B = wa @|s 3 P| a 5 = me a B ~ 5 st = ® 8 ale Se © |B /eB/es BE |e a r= eS See B| @ Bla" |s¢ & | 8 > a be & ss SZ ee 3 i) =) Mm io Oo © © n ct = st 3 wal se) .& 8 3 | sjuerjed e[q'es.mq UTeImO NV sjuer}ed 8[qesing MUTE LG6L 4naKX poasyf ‘uo1nasifisspj9 Xq ‘squaijnd fo yuawmaaowu fo qUaWaIDIS paypp1josu0)—"Z 93] qv J, 246 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 BO 19D (. 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 414 percent; re- corded educational tapes about 2 percent; and large-type books about 1714 percent. Approximately 2 percent was used for miscellaneous items. 247 a r €.B. Le « ei s i ' tr ig ¥ bs nf } ; ‘ a ki Fs ‘ ; x . ie oo Rede y j : % a i, : hy ) : q 5 , “* ff j ' J i H ' ‘ j i e * i i = 4 { f ; P. ‘ . ? ¢ 4 : t ; t 14 Z { ; ' 4 i f ’ . e } Has a , / ; rors i’ ( egy 8 ‘ £5 a x i i ; ‘ 4 4 r | F 4 b 4 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 a of. Columbia, and 7 foreign countries. 249) 448006—58——17 Ny ad 44 iby Wie rt) OO Ret Der ett ot p3o0veD Sf eee ; » “ t 7 4 . 4 m r] pe | ied iu x. rom ourien: To Derkien 1610; on t FRooo God Pe wide ed} eobivoigq iasontieqetl yrote yusqot | ol? Be fis ffi ti mrintdo OG gtd erty 4y*¥ RR ole atab rte "Ot loodog saitsoubol to Jocomtisqetl ssuherd ofl. teeb of) aay ee} nolisorbe odt ot seaolaih Lamores 29t OT B bres sorgob. a aF2! doow-wot a eretto base ,actiyeorl ‘cies dtiw stoshaias seqoab « otinpos of deiw odw etolsenvos Le tor }RooF Oo gaat agelion os si jaoraiiowse IetoT PNOSISE bash to . to toriei(. oft iinwall aint Gb mort -elmolirte Citar kK Bot Kinceno9 ngiotot VE PRE * Howard University Howarp Untversiry, 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 Og a 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 48 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 438 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. Aw 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, 13 9 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 Ce eee ee eS 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 Attaché 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 January 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, 2837; 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 19,828 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.” — Sg ee ene, Detailed Contents THE SECRETARY’S REPORT Page nn eerie. Peige Wier PT Pe Oe 2, ee ee Se) areal 3 TIER fe a ee ee eo ee Brit ae 4. ee ee tates... eed vile Ree vlivanerriatt by 5 TCP eg ieee vi Ree emia es 5 et ee eee ise abl tap bheteteowd Ao uy 9 OxLp-AGE, SURVIVORS, AND DIsABILITy INSURANCE________________-___- 11 Peri iomA NOR... tein bertilanO lo vitlidelievs. seacinea! oD 12 UEIIEREIE’ IST. DOIN. oe 2c ee Ls er rrOttt, ICE HABILITATION 225 co oerec seo PSOE e Soe boo Toles 14 Seecr it BANNING 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 eee rr YN 19572 <8 soee cc eo sese spe FOS OO CHO ROUAY 2 17 DL Te ee ee oe eee Wd DRO CHA TIONS = 0. ee ne he De oe en ee wa nena 18 eG eee MINISTRATION IN 1957... 2-2-2 ee eee 20 rem ROO OTTVITINS —§.. oo oo Be ee ew ee Se eee eee 22 OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE. ---_---- PR! epee roGRaAw Is LOING —.._. «45250 exec. en we meee eee 24 Menenemears-and Benefit Amountssy dws je erste’ eek Leloos sexless e 0-8 24 ne PIONS ia 5 ies P Dh. eo) ae goer Ey cee eed Sate Sent alloe eid 25 nr EErnIO AM TOVECCU. 2 tar eye dt oo bl i he be ci obs Sere KS 26 ate ow nee of the: Program oti viet oo eh Soe ce ea Bannd-snqe edn 27 Bre reeeesr ESO UrseMen tse enac ohees bead vaisun Sonne oe ees cut 22 27 Perth RING THE. PROGRAM..oo-2- 52 -2c-c2 hence ccecesl ese 28 LEGISLATIVE DEVELOPMENTS DURING THE YEAR.____-_---_______---_- 31 memeromsortne 1957, Amendments.___....._-."..---..-~..-.-------L-- 32 Combined Reporting for Social Security and Income-Tax Withholding EME en at ee ye a oe ae ae ey 35 256 Department of Health, Education, and Welfare, 1957 Page Coordination of the TVA Retirement System With Old-Age, Survivors, and: Disability Insutance.. 2 -o25.. 40.2. lee ole ee 36 Retirement System of Federal Home Loan Banks____---_-------------- 37 Simplification Study- 122 os oe ob eo ac oe ee 37 FINANCING THE ‘PROGRAM? g¥2i4 9074 3) fae ae Se eee 37 Old-Age and Survivors Insurance Benefits. ...-._._.--._----------------- 37 Disability Insurance Benefits. .ylios. 2 2. et SO 38 | PUBLIC (ASSISTANCE 2 02te Dae 20 ae SOARES Ee SRS ee 38 EFFECT OF THE 1956. AMENDMENTS. 2. 22 L221 te 38 TRENDS 1N CASELOADS AND EXPENDITURES- --_-___-_----------------- 39 Old-Age Assistance. £2222 ies sree Pea os ieee 40 Aid:to Dependent Children- (lun do cuieibos 22 nk oe See 40 Aid tothe Blindicns2ctecs oe bce Deke he ees ae oe ee 2 40 Aid te the Permanently and Totally Disabled__.__._.______-..-.-- Luce 41 General Assistance... 22 ou 28 2 Se oe ee oe i ee Se i 41 OASI Beneficiaries Receiving Supplementary Assistance Payments___-_-_- 41 PROGRAM AND ADMINISTRATIVE DEVELOPMENTS- -~_____-__--------- +4 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... -.... 3... ee 2 50 Defense Welfare Services 5° -- os ee ee 52 Services for Repatriated Americans. .:.- <=. .- 1. - ace eee ae ee 52 CHILDREN’S (BURA oe ee ee 53 Some Facts anp Figures ABout MOTHERS AND CHILDREN_____-_-_--- 54 CHILDREN: With SPaciat NeEps. 2h SCLC a oP eee 55 FEDERAL INTERDEPARTMENTAL CO) MITTEE ON CHILDREN AND YOUTH---- 56 PROGRAMS OF THE BUREAU o. (2222-0 Ji 5 UL Li 22 ee 56 Research. inyOhildi Lifél a 1 io Eat i 2 VIL SIS ee eee 56 Maternal and Child Health Services. -........--..-..1._ cee 58 €rippled Children’s Servicesa-s..202- 122.0 4-201. oe -e ie 60 Child, Welfare Services —.4 = 352 Gy nsehe se mene 0k ie < 63 guvenile Delinquency Serviceés...2 2.4... ae 68 International Cooperation 220-522 - - o 69 FEDERAL, CREDIT, UNIONS: 2. ce ee 70 RESEARCH AND DEVELOPMENT <... gnc2. _< os ee ek ee 141 umn reiiecring 2 8 ee eee EE a eal 142 Ree er oe itavion so ~~ 24 Ro OE et te te oh Be 142 ee ape aie ey Ge pe See SER ON aes USE = ve, Som 143 Meter cupply and Water Pollution Control___.___._---.--+--2-~-s--2. 143 InN O1ITCOS = 8 S00 LS ee ee 144 Meee keh DISEASH CENTER_.....-....-..-~-.. eee uss eoiesol 144 Bee tee a isaster Aid. re rrr re ee ee ELD LL OU 145 Representative Field and Laboratory Investigations____._--_---------- 145 RII AOU Sieh lero a henge ete eae 145 PERE y eI ISCASOG 9 SP mr a Soo SS a oon sen 145 | a mee wale tine ttre rs nt Pn es ee 145 | CS HDIISIr So ne ee ee cee oe ees oe CS 146 | NLS gE Eel desl ely aac lg py aap ah lyme nga 146 : ap aleietel loreatiagind deceit ph dekaglaesah iar tea 146 | ee rrr rrr re ee eee 147 | ee ere an Wart gira hedecrl esse jhe 147 emer ococcus:Diseasesios orn hiv srsatusi gels Ie ts es ess se 147 Ween nnorarory Ctivities..2. 22222242252 secsocec2ecs2c LLL Bh ee Se 147 U6 6) Co 8 1 till ini ea grein in pea 148 ee nena a net cost end densoconesbicsg2 see shes Sl 148 a icios OF DENTAL.PUBLIC. HBALTH....222L La 5_ S402 200 ee oe 148 een et. ee be Oe 8 eet 2 beh ol ese ceall bee 148 I Me Se etic cee nace ess eeu see tad 149 Piven Or INTERNATIONAL HEALTH... 2.022000 sss sslese sl ce lL 149 TaBLE 1.—Statement of appropriations, authorizations, obligations, and IO HVCATNLODS 222 ie ee pee a hee een 150 TapiE 2.—Commissioned officers and civil service personnel as of June 30, ee ato ais anes ewe ee ete ne ng eI. 153 TABLE 3.—Research grants and awards, fisca] year 1957__-___----------- 155 TABLE 4.—Payments to States, fiscal year 1957---_____--------------- 156 260 Department of Health, Education, and Welfare, 1957 OFFICE OF EDUCATION Page INTRODUCTIONS Sikes ACEO EE ee 159 Meo ttOUr as ne ere cme eae ee on eee etek ee he ee 161 ORGANIZATION AND ADMINISTRATION OF EDUCATION. ___-------------- 164 State School. Administration...2-..2.-222..-.2.4..- oe 164 Local School. Administration 22205 vay eee 165 Sehool Finance@s14 hee eee 165 Schoolhousing 2.0 et an eee i ea 166 SERVICES TO. LOCAL SCHOOLS_....---li_~----u. 24. ee 167 Klementary Education... 2.02002 S55 oo die ere Elm eee 167 Secondary, Hducationes fuse cel ee 168 AGuibsMdueation we a ee el 169 Exceptional Children oo oe eee oe 170 Audiovisual Education... 3000 eel ee ee ie! Radio- Pélevision Services....-- 2222S le 171 Guidance and Student Personnel. oo fl 172 WVocaTionaL EDUCATION... 2240-2} er 172 HiGHER. HDUCATION. oss e SP OLLIE BY Cee 175 Cost of Going to" Colleges ou see ee SS eee oe ka e ee Se e 175 Statewide Planning and Coordination of Higher Education_______-____- 176 College Student Retention and Withdrawal. -_-_.-22----222-.. -.--- 222 176 College and University Facilities Survey2222-222v 2-2-2 Tee ae 176 Survey of Organized Occupational Curriculums: 222... 22 2222222 177 College Stafiing Study -s2r2ee free ee v7 Institutional Financial Aid*to Students: 22. sc2veeces eee eee ee College Housing Programs: 2.2.02 lee EU See eee 178 Administration of ‘Grants... 1.2 en ci 178 INTERNATIONAL EDUCATION 222 Pew lel Veo kee ee eee 178 Research ‘and Studiesojil 0022 ol ell ile lel ae i ee 179 Far Wast:Oniteo 8! seccecstestaesbeoteeee james arses oe 179 Evaluation ‘of ‘Foreign Credentials_.....0...............432), 0 180 Educational, Clearinghouse >.) .2.0_ 2.2.4. .-L 4.3 180 International Conferences: 2.20). natu ee 180 Educational Materials Laboratory ........-......-...-...02 03a 181 eacher Iixchange Program. ..2 22.0100 001 o ll iol ol ee 181 Teacher Education Program i200 luo oll ee 182 Teehnical ‘Traming Program. 02 02.2020. Lk 182 Technical Cooperation Program l___ 1.2) 22 lol Lo ee ee 182 Nonprogram Visitors. ooo. ee eee eee ee ee 182 RESEARCH AND STATISTICAL SERVICES....uossi02_eLuuel 1.2 eee 183 Cobperative, Researchis ssi s2ue sucess bebe sues seer uses steel eee 183 Statistical, Services. 5 Se a ee ee a ae Se ee he 184 New Surveys_2.0- iu. cs252se4s 2 sete eee Et goer 184 ASSISTANCE TO SCHOOLS IN FEDERALLY AFFECTED, AREAS___________.- 186 LIBRARY, SERVICE ol ee ee Publiz Libraries Detailed Contents Serer oT Librarianship. <2 oval. deedows} sedceliatlud aiigecil ic Public School Libraries_____________-_ ge ea. ine tte DAs THE PRESIDENT’s COMMITTEE ON EpucaTION BEYOND THE HiGH ScHOOL. Masor PuBLICATIONS OrF THE PRESS IN FISCAL YEAR 1957 — eww ew we ew eee ee TasLe 1.—Enrollment in the continental United States, 1955-56 and eye i oe ee ee een te ee En TABLE 2.—Supply and demand for elementary and secondary public and eeeee eC OO! teachers, 1900-57... - 3-4-4 ene TasLE 3.—Grants to States: Office of Education, fiscal year 1957_______- FOOD AND DRUG ADMINISTRATION oe AND COSMETIC: ACT 22.1122. -eee ce cece encde css SOITAL. toeustorand-Wefense Activities... 220NS 22141. 902 Leb bide URI CSR TOU es 2G eb nee ee eed cee eeecce cetacean AUS RATIO O) emimivaenithcHezerdg.2 +o 2-een.ccs neha secede oO Mm BeEpe OOO -QlCANe a2 25 ose tet cs fe cee ae cee LOIS! Oh SMG TOLOUdON..--222nSUEIAL 1) AODRCM, SINSnom YItromel* PPPS DOC LION DCPViCe..< — a= 2cscacctsocce eK COOLIO LL ny Products of. Special Dietary. Significance. ...22U2.0 220 2 EL elle DPMMMUCG.ICOS 402250 S oh. cate enc tects se ece en DA BOVE DEGAS te Swe ee eee een cee e denn POMIY OF: MAGOUE Adulterated and Misbranded Drugs and Devices.________-_____-_-- ET rosie A a eh Be Tee tte fn ION a i ete tbe eT MICCS. la ry rer ee ea ge Leben hin Ue eros TOF. OTHER -ACTS..--ccccucceccsncteee nD SU UE AND Rew Oovurt INTERPRETATIONS: Jacoliwunion velww_besa-eullilabweldl ll Peevers in THE LAW AND REGULATIONS......2-----L.--.- i .-.5-- NE © Re i he fn 2 Re 2 Oe Bs ee NY ee 2 BEMENEEEL VEOTIGATIONG. 2022. 0-2 foe et ee bh me - KE i fon TATISTICN. 8 Ooo sca o ne thn ee eee ba ee ES TaBuLE 1.—Actions on foods during the fiscal year 1957_________------- TaBLE 2.—Number of samples on which criminal prosecutions and seizures were based and number of court actions instituted during the fiscal ee Neh bn we wn ee eek Hoenn eee PEO TABLE 3.—Import inspections and detentions during the fiscal year 1957_ OFFICE OF VOCATIONAL REHABILITATION RESEARCH-DEMONSTRATION PROJECTS AND INCREASED COMMUNITY IN- Treen Ane SHAPING REHABILITATION..._..._..__2-) 2 RESEARCH AND DEMONSTRATION PROJECTS COVER DIVERSE PROBLEMS SE ey es ee ee gn oe a ee oe ere oe 213 213 216 216 262 Department of Health, Education, and Welfare, 1957 Page Striking Results in Epilepsy, Cerebral Palsy ...-----_-----2------2.222 219 Studies, on. Many-Fronts_.....2-scteentccesee dct ee ee — 220 Community IntTEREST REFLECTED IN GrowTH OF REHABILITATION Fa CthiTits 95 os et ete eee oe im cies g ace po te 220 Federal Aid to Construction. o- ~. <.-4 e+ <2. ft eee a eS 221 FedéralAid to Facilitiésr. 2222 2 ee eee 221 New Aids’*for’ Center Planning? = - 222 eee 222 Sheltered" Workshops. 2= 24222222 ete 222 PRoGRAM OF TRAINING Is AUGMENTING SUPPLY OF PROFESSIONAL PER- gs SONNED. Wash Oe ae ee a 223 [: SERVICES TO BLIND PERSONS. 222. 22-222 2.255226 2 Sl eee 225 MENTAL ILUNESSI. A CCR LILI PACECA OLE Siel 44 2 Coe eee 227 PRoGRAM EXPENDITURES INDICATE GROWTH AND Activity THROUGHOUT woe NATION) KSIL1e Wn ee eck ete delete eee ee PEE ee ee 227 Stimulating Employment for the Handicapped-.----------------------- 228 New Programs Started__.-...---.2-----2 5-4 s-- ene oe = 229 Program’ Development. ....-..-.---+-+s=+-+-++-siseee ee 230 State Staff Improvement. _.....--2.--.-..-..----....2).) See 230 Cash Disability Benefits Broaden Program_...-_-.--ssiwsicel_deee ee 231 ; State-Federal Relationship..__...:.:...---2-.-s25242 -oo eee 232 ‘ Cooperation With Public ‘Assistance 5. . 22-2 Jessie pu So ee ee 232 Informational Activities-- 2 oe eee PEt ee 233 international Activities, ~~ oe os 2 2S Sole ee 233 TaBLE 1.—Number of referrals and cases, by agency, fiscal year 1957__-_ 2385 H TABLE 2.—Vocational rehabilitation grants, 1957, State divisions of voca- 3 tional rehabilitation.cwc MEpicatn SERVICES: = 27-2522 i.22i2t2l. +--+ ese 240 Cliiical- Branches: 24" 92 ee ae os etter erect se 240 Psychotherapy Branch... YS222cuiec lowell scl) echoed: shocl of: eae 241 Psychology Branchs22isusactur tesice be disien tuceelgeeee bo sed ae eee 242 Laboratory} Branch.jo:6 “bo sstizect 2owl mir 50002 10 -ededer 242 Nursing Branch. 0 2 ae ee an ere oor coos ee ee eee 242 Occupational. Therapy2ewit sedzb seedtuab's dom douheeces! Jeoger eee 242 Soeial Service. escutetoss. Baure pee oo ee ee os rn 243 Chaplain Services. Branch, aceer ce - se 5 ee eee eS ea ase- ee ee 243 TAbrary OTaAncl. . ee oe nee oc ce a ee ee ee esa ee 243 MDECIAL OELVICCS. oe ee ee a 243 VOICED BervViCes. 4. soa on bon ae oe eee ae en Breese 244 Medical “Records: Branch. £0 _ Sob eae ae ee ie eee 244 Division ‘Ors ADMINISTRATION. ooo. 222ccs2-2 sen sceue ase 244 Business’ Management Branch. oo +2. .<5cemq- 2 eee-e5ce. ese soe 244 Maintenance and Industrial Branch 2. ...-2. 2-202... lt Lee 244 Detailed Contents 263 Page memes LH OSPITAUS. 2002 So eC eS 245 TaBLE 1.—Movement of patient population, fiscal year 1957____________ 245 TaBLE 2.—Consolidated statement of movement of patients, by classifica- SIRE UO) ft ee i ie 246 AMERICAN PRINTING HOUSE FOR THE BLIND Services to Schools and Classes for the Blind________________________-- 247 GALLAUDET COLLEGE I i ee ee ee eek ae 249 ECR e gett ee ee 249 HOWARD UNIVERSITY ICU Ni G6 oo oe Se ee ee 251 S-oerapuical Distribution of Students___....2-.2___.._...-..-..- =. 252 I Mee a Oe ee 252 I eePOrCe tC) Ol. 2 ee ee ee a 252 as Say AE geese lg tl Me ne 252 IERIE. so ee ee ey 258 eA A mg ne 253 emeeeemmroreinn Countries... 2. - 50 26 seen. 254 U. S. GOVERNMENT PRINTING OFFICE: 1958 a | ‘iirc tee iaekaten Ui ani Ma | mite rt A oe ry ih goths ae caren Pate rN as i.e Sees Rp Rees att oom