U. S. DEPARTMENT OF 
HEALTH, EDUCATION, AND WELFARE 


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For sale by the Superintendent of Documents, U. S. Goverument Printing Office 
Washington 25, D.C. - Price 75 cents; (paper) 


U.S. DEPARTMENT OF 


HEALTH, EDUCATION, AND WELFARE 
As of June 30, 1958 


MARION B. Foisom, Secretary 
Vacancy, Under Secretary 
OFFICE OF THE SECRETARY 


ELLIOT LEE RICHARDSON ..... Assistant Secretary for Program Analysis. 


EDWARD Foss WILSON ...... Assistant Secretary for Federal-State Relations. 
AIMS C. MCGUINNESS...... Special Assistant for Health and Medical Affairs. 
JOHN R. MACKENZIE....... Legislative Liaison Officer. 

HoMER D. BABBIDGE........ Assistant to the Secretary. 

CHARLES EF’. BARRETT ....... Assistant to the Secretary. 

ROBERT Hi. HAMEIN SG aaa ss 6 Assistant to the Secretary. 

PARES Mi. ANE A CG wasn ie chsh ete General Counsel. 

Rurvus EH. MILeEs, JR...... . - Director of Administration. 

CHESTER BS UUND: 520s 25) Shes Director of Field Administration. 

HARVEY ‘A. BOSE. 2. corte os Director of Publications and Reports. 

FREDERICK H.SCHMIDT..... . Director of Security. 


SOCIAL SECURITY ADMINISTRATION 


CHARLES I. SCHOTTLAND ..... Commissioner of Social Security. 
WILLIAM L. MITCHELL ...... Deputy Commissioner of Social Security. 
ViIcTOR CHRISTGAU ...... Director, Bureau of Old-Age and Survivors 
Insurance. 
JAY) Ui, RONEY 2. 6S es Director, Bureau of Public Assistance. 
J. DEANE GANNON ...... Director, Bureau of Federal Credit Unions. 


KATHERINE B. OETTINGER . Chief, Children’s Bureau. 


PUBLIC HEALTH SERVICE 


Leroy E. BURNEY ......... Surgeon General. 

JOHN D. PORTERFIELD....... Deputy Surgeon General. 
JAMES Ve iOWRBY oiices et ets Chief, Bureau of Medical Services. 
CHARLES HE. BURBRIDGE . . . Superintendent, Freedmen’s Hospital. 
DAVID Do PRICR 2.050 28 3% Chief, Bureau of State Services. 
JAMES A. SHANNON..... Director, National Institutes of Health. 

OFFICE OF EDUCATION 
LAWRENCE G. DERTHICK ..... Commissioner of Education. 
WAYNE ©, RRED i 014 sceos a ts ers Deputy Commissioner of Education. 
FOOD AND DRUG ADMINISTRATION 
GEORGE P. LARRICK ........ Commissioner of Food and Drugs. 


JOHN Le FIARVOY 25/5 eVaietenece 6 Deputy Commissioner of Food and Drugs. 


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OFFICE OF VOCATIONAL REHABILITATION 


DUARY Mi. SWITZER... i... Director of Vocational Rehabilitation. 
Di PeMOnY FEREBERE ........ Deputy Director of Vocational Rehabilitation. 


SAINT ELIZABETHS HOSPITAL 


WINFRED OVERHOLSER...... Superintendent. 
AppDISON M. DuvaL........ Assistant Superintendent. 


FEDERALLY AIDED CORPORATIONS 


DerteePPAVIS =. kk ee Superintendent, American Printing House for 
the Blind. 

LEONARD M. ELSTAD........ President, Gallaudet College. 

MorpEcCAI W. JOHNSON ....... President, Howard University. 


REGIONAL DIRECTORS 


LAWRENCE J. BRESNAHAN .... Region I, Boston, Mass. 
JOSEPH B. O’CONNOR....... Region II, New York, N. Y. 
EDMUND W. BAXTER....... Region III, Charlottesville, Va. 
PerCreeeoe 1. LYLE wi. 2 6 ee ee Region IV, Atlanta, Ga. 
MELVILLE H. HoscH....... Region V, Chicago, Ill. 
WAMEGOSY. DOARN...... + Region VI, Kansas City, Mo. 
JAMES HSBOND 1.6... eee Region VII, Dallas, Tex. 
ALBERT H. ROSENTHAL ...... Region VIII, Denver, Colo. 


ee WV IUNTER . . ww te ee Region IX, San Francisco, Calif. 


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Letter of Transmittal 


DerparTMENT oF Heatru, Epucation, AnD WELFARE, 
Washington, D. C., December 1, 1958. 
Dear Mr. Prestoent: I have the honor to submit herewith the 


annual report of the Department of Health, Education, and Welfare 
for the fiscal year ending June 30, 1958. 


Respectfully, 
Secretary. 
THE PRESIDENT, 
Tue Wurre Hovss, 


Washington, D.C. 


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The Secretary’s Report 
Social Security Administration 
Public Health Service 
Office of Education 
Food and Drug Administration 

Office of Vocational Rehabilitation 
Saint Elizabeths Hospital 
American Printing House for the Blind 
Gallaudet College 
Howard University 


Contents 


A detailed listing of the contents of this report, by 
topic headings, will be found on pages 255=262. 


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The Secretary’ S 
Report 


A CHANGING ATTITUDE toward problems in social welfare is increas- 
ingly making its mark on our times. 

We are less and less inclined to accept as inevitable some of the 
age-old burdens of illness and ignorance and poverty which have 
limited man’s lot through the centuries. There is a growing determi- 
nation to uncover new hope for that which once seemed hopeless. 

We have often heard it said, for example, that the poor we will 
always have with us. But today, more and more, we are asking: is 
poverty really necessary? Or at least we are asking: can’t we further 
reduce, somewhat dramatically, the extent of poverty? 

Similarly, diseases such as cancer and mental illness and heart 
afflictions—once considered all but insoluble—are now under vigorous 
attack. 

This changing attitude arises in part from our increasing store of 
knowledge and our greater economic resources. Each new success 
against disease, ignorance, and poverty lifts our vision to the possi- 
bility of a further victory. We know now that much more is possible 
than man once would have dreamed. 

The rising tempo of advances against age-old social ills also arises 
in part, I believe, from a heightened sense of responsibility and concern 
for our fellow man, a growing sense of intolerance of preventable 
- human suffering. 

And it arises in part from a clearer understanding that continued 
advances in national prosperity, in national security, in our quest for 
world peace, rest in the final analysis on the development of human 
resources—on the physical energies, the knowledge and intelligence, 
the freedom from fear of want, of the American people. 


2 Department of Health, Education, and Welfare, 1958 


The progress we have made this past year against illness and igno- 
rance and poverty reflects this growing determination to break new 
ground in social welfare. 

The Department of Health, Education, and Welfare is the principal 
instrument of the Federal Government in this advance. But inter- 
woven throughout this report of the Department’s activities is strong 
evidence of another element in our national progress. This is a grow- 
ing disposition on the part of the American people to adapt to our 
complex modern society the old-fashioned habit of cooperation. 

In earlier times, among neighbors, families, towns, or movers on a 
westbound trail, cooperation often was something of a necessity for 
survival. In today’s increasingly complex society, cooperation be- 
comes more involved, but it is no less necessary and the benefits that 
stem from it are even more far-reaching. We have found that if our 
free society is to progress, Federal, State, and local governments 
must work more closely together, in cooperation with American in- 
dustry, private colleges and universities, voluntary organizations, and 
individuals. 

In our system of free private enterprise, as cooperation becomes more 
and more necessary to progress, we must never lose sight of the fact 
that the individual’s efforts on his own behalf are still paramount. The 
fundamental purpose of all our cooperative action is to enlarge the 
opportunities of the individual to better his own lot. 


Progress and Cooperation for Economic Security 


Few actions ever taken by the American people have made a greater 
contribution to economic security of more people, over a longer period 
of time, than the enactment of legislation creating the social security 
system. 

Over the years the system has become increasingly sound and strong, 
despite stresses of war, rapid economic changes, and an unpredicted 
and unprecedented growth in population. In recent years the growth 
of the old-age, survivors, and disability insurance program has been 
almost spectacular. Coverage has been broadened to include additional 
millions of people and now extends to nine-tenths of the work force. 
And the number of beneficiaries has increased almost 4 times in the 
past 8 years. 

At the end of the fiscal year, 11.9 million people were receiving bene- 
fits at an annual rate of $8 billion. Most of the beneficiaries (9.7 mil- 
lion, or 81 percent) were men and women who had reached the age of 
retirement. Of the remaining 2.2 million, almost 1.6 million were chil- 
dren, some 430,000 were mothers, and 200,000 were disabled workers 
aged 50 to 65. 


The Secretary’s Report 3 


For the fiscal year 1958 the average benefit for a retired worker and 
his wife was $109.90 a month. The average for a widowed mother and 
two children was $148.70. 

The relationship between the social security system and the Nation’s 
economy was emphasized anew during the middle months of the fiscal 
year when a downturn in business activity occurred. By April pay- 
ments under social security, public assistance, unemployment insur- 
ance, workmen’s compensation, veterans’ pensions and compensation, 
railroad and government employee retirement, and temporary disa- 
bility insurance, reached a new high rate of $24 billion annually. 
Thus, not only were millions of people protected in the recession period 
but purchasing power was bolstered, and the whole economy was 
strengthened. Social insurance, related payments, and public assist- 
ance at the end of the year accounted for 6.6 percent of the total per- 
sonal income in the United States, compared with 5.4 percent the pre- 
ceding year. This jump was due largely to the increased number of 
old-age, survivors, and disability insurance beneficiaries and to in- 
creased unemployment insurance payments. 

Under the 1956 amendments more than a half million women aged 
62 to 64, and more than 200,000 disabled men and women were receiv- 
ing benefits by the end of the fiscal year. 

To keep abreast of public needs, 26 additional district social security 
offices were opened during the year in agricultural communities and in 
areas where industrial expansion has created new population concen- 
trations. There are now 584 district offices. 

In October 1957, an Advisory Council on Social Security Financ- 
ing was appointed to review the status of the OASI Trust Fund and 
the recently established Disability Trust Fund, in relation to their 
long-term commitments. Composed of outstanding representatives of 
employers, employees, the self-employed, and the public, the Council 
will contribute knowledge and experience to assure that the social 
security system will continue to operate on a sound financial basis. 

A group of business consultants, appointed by the Secretary to sur- 
vey operations of the Bureau, made a number of recommendations for 
improved administration. The consultants generally praised the ef- 
ficiency of OASI operations and reported they were “well impressed 
with the way the Bureau personnel met and dealt with the public and 
with the impression of both efficiency and friendliness.” 

Soon after the close of the fiscal year, significant legislation was 
enacted. Among other provisions, old-age, survivors, and disability 
insurance benefits are increased and benefits provided for the depend- 
ents of disabled workers. The legislation raised the amount of total 
earnings that may be credited for benefit purposes, and provided for 
an increase in tax contribution rates and a stepped-up schedule for 
future tax increases. 


4 Department of Health, Education, and Welfare, 1958 
mtn cig aN a 


Progress and Cooperation for the Needy 


Today’s concept of social work is moving to a wider horizon where 
dependency is regarded more and more as a problem to be solved, and 
not merely a condition to be ameliorated. As this concept is applied 
more broadly and effectively, social work will move still closer to the 
ultimate objective—that of preventing dependency. This goal may 
never be attained in full for a whole society; but we can speed our 

_progress by improved services, and more joint planning and coordina- 
tion among both public and private agencies. 

_ A great deal of this teaming up to solve the problems of human 
want is already taking place, and gaining impetus all the time. Dur- 
ing the year efforts from many directions were made to learn more 
about dependency, and what causes it; about what kind of persons 
become dependent, and how they can be helped toward independence. 
In June 1958, 5.6 million needy persons were receiving monthly 
payments under Federal-State programs of public assistance. These 
included 2,460,000 persons 65 and over, 2,733,000 persons receiving 
aid to dependent children, 313,000 permanently and totally disabled 
persons, and 108,000 blind persons. ‘Total expenditures for public 
assistance from Federal, State, and local funds, including payments 
for medical care, were $2,911,000,000 during the year. Of this, 
$1,642,000,000 were Federal funds, representing 60 percent of the total 
budget of the Department. 

In addition, more than a million people in June 1958 were receiv- 
ing State or locally financed general assistance, a 71-percent increase 
over the previous year. Most of the increase came in the winter and 
spring, to include a number of unemployed men and women who had 
exhausted rights to unemployment insurance benefits. 

There was a steady decline in the number of people receiving old- 
age assistance, even though the population over 65 is increasing. In 
June 1950 about 226 of every thousand older persons were receiving 
public assistance. By the end of fiscal 1958 the figure was 162 per 
thousand—a decline of 28 percent. This decline reflects the progress 
of the social insurance system in providing greater economic secu- 
rity—as an earned benefit—for more and more older people. 

At the other end of the age scale, there was a substantial increase 
in need—among our children. In June 1958 nearly 2,733,000 persons 
received payments under the program of aid to dependent children— 
the largest number in any month since the beginning of the program, 
and 334,000 more than in June 1957, an increase of more than 12 per- 
cent. Children now represent the largest group of needy people in 

the Nation. 

The economic recession caused part of this increase—but a major 
long-term factor has been the increasing breakdown of the family 


The Secretary’s Report 5: 


unit. Most of these dependent children have been deprived of 
normal family life and normal support as a result of divorce, deser- 
tion, or unwed parenthood. 

In August 1958 amendments to the Social Security Act were en- 
acted to increase the amount of Federal funds available to States for 
public assistance, and to simplify State bookkeeping methods for 
claiming Federal funds. In addition, the legislation related part of 
the Federal share of funds to the financial abilities and needs of the 
States, and thus provides more assistance in low-income States where 
human needs are often greatest. These amendments became effective 
on October 1, 1958. 


Progress and Cooperation for Children 


The United States soon will cross a new population frontier. By 
1965 the number of children under 18 years of age is expected to 
reach 70 million—and we will have then more children than there 
were people in the country less than 60 years ago. Even now our 
59 million children represent one-third of the population. 

Every social resource in the Nation will be challenged to provide 
services when and where they are required, and to keep abreast of 
new needs of children in a world of change. 

Planning to meet future demands is a continuing need. An im- 
portant means of planning and communication is offered by the 
White House Conference on Children and Youth, which has been 
held every ten years since 1909. The President has called the sixth 
such conference for March 1960. In preparation, special commit- 
tees in each State will take stock of the problems of their young 
people. 

The Children’s Bureau during fiscal 1958 gave increasing attention 
to a number of problems of urgent nationwide concern. 

One of these pressing problems is that of juvenile delinquency. 
Preliminary data for 1957 indicate that more than a half million 
children appeared before courts on delinquency charges. Another 
urgent social problem rises from the increasing number of births out 
of wedlock—193,500 in 1956. About 77,000 of these unmarried 
mothers were under 20 years of age. The Children’s Bureau also 
intensified its activities in accident prevention, the chief cause of 
death to children and young people. 

Following the close of the fiscal year, new amendments to the Social 
Security Act authorized an increase of $5 million in future appro- 
priations for each of the three grant programs administered by the 
Children’s Bureau. For maternal and child health services, $21.5 
million is authorized; for crippled children’s services, $20 million; 
and for child welfare services, $17 million. 


6 Department of Health, Education, and Welfare, 1958 
ae NC RE AION Mb LA MOR OUTRO SOAR I 


As a major step forward, the new amendments authorized child 
welfare services for children in urban areas on the same basis as 
services for rural children. 


Progress and Cooperation for the Disabled 


The fiscal year 1958 brought further progress in our efforts to re- 
store the disabled—and particularly the severely disabled—to inde- 
pendent lives. 

During the year more than $50 million in Federal funds, granted 
through the Office of Vocational Rehabilitation, became available for | 
State rehabilitation programs for research and demonstration proj- 
ects, and for training grants to colleges and universities to increase 
the Nation’s supply of professional workers in rehabilitation. State 
legislatures increased their own expenditures for the precpaiees et 
to $25 million or 17 percent over 1957. 

For the third year in a row, a new record in the numbers of men 
and women rehabilitated was achieved this year. More than 74,000 
disabled people were rehabilitated into employment, and in addition, 
more than 18,000 others were prepared and available for employment 
at the end of the fiscal year. 

Increasingly, disabled men and women, all over the country, seek 
the services of rehabilitation agencies. Some are crippled by acci- 
dent or disease, some are blind or deaf, others suffer from chronic 
illness or mental impairment. They hear of this source of hope from 
their doctors, from hospitals, from health agencies, from public wel- 
fare offices, or from State employment offices. But there are far more 
disabled men and women who need help than present facilities—public 
and private—can accommodate. Every year, it has been estimated, 
some 250,000 persons come to need, and could profit by, vocational 
rehabilitation programs. 

During the past decade, almost 635,000 disabled people have been 
rehabilitated into successful employment. Taking their places on 
farms, in factories and shops, in homes, or as professional workers, 
these men and women are now active members of the American labor 
force. About two-thirds of those rehabilitated in 1958 had been un- 
-employed when their rehabilitation began—the others worked only 
part time, or in unsafe, low-paying jobs. Those working had earned 
altogether about $21.7 million a year, an average of only $1,000 per 
person. The entire group will earn, during a full year of employ- 
ment, an estimated $147.8 million. 

Nearly 15,000 men and women rehabilitated last year had been re- 
ceiving public assistance at a rate of about $14 million a year, which 
is $1 million more than the entire cost of their rehabilitation. Obvi- 
ously, this program pays for itself, in increasing the Nation’s produc- 


The Secretary’s Report v4 


tive potential, in tax revenues, and in relieving dependency upon 
public assistance. 

But even more important than these monetary considerations are 
intangible values inherent in rehabilitation. These values lie in the 
fostering of an atmosphere of healthy self-reliance and accomplish- 
ment for those who have overcome their handicaps—and for their 
families. 

An expanded research program—as varied as the needs of the dis- 
abled—was well under way during the year. Altogether, 177 research 
and demonstration projects, including special ones for the severely 
disabled, have been conducted since the beginning of the research 
program in 1955. More than 80 new research programs were begun 
this past year to develop new and better methods of rehabilitation. 

Increasing emphasis was placed last year on selected categories of 
severe disability including mental retardation, chronic illness, cerebral 
palsy, and epilepsy. Thirty demonstration projects in 22 States were 
in full operation in these fields by the end of the year, to show that 
these severely disabled persons can be rehabilitated with modern 
methods and techniques. Each of these was based upon a successful 
research project. 

The 1954 amendments to the Medical Facilities Survey and Con- 
struction Act authorized Federal aid for the construction of much 
needed rehabilitation centers. Since then 82 such centers have been 
built at a total cost of more than $60 million, the Federal share being 
about $13.5 million. Federal funds for this work amounted to $2,185,- 
835 during fiscal 1958. ‘The bulk of the funds came from State, com- 
munity, and private sources. Each center serves a wide geographical 
area. And each is a valuable, tangible witness to the worth of the 
intangible factor of cooperation. 


Progress and Cooperation for Education 


Stimulated in part by the launching of the first earth satellite by 
the U.S. S. R., interest in American education increased dramatically 
during the year. There were indications that the American people 
generally were beginning to be more concerned about weaknesses in 
education and more responsive to today’s needs in education. 

A number of events in the past few years had helped lay a basis for 
stepped-up progress in education. 

The White House Conference on Education in 1955 was a major 
step toward identifying educational problems in the elementary and 
secondary schools and setting a course toward overcoming them. 

The President’s Committee on Education Beyond the High School, 
appointed in 1956, made a comprehensive survey of the present status 
and future needs of our colleges and universities. Composed of dis- 


8 Department of Health, Education, and Welfare, 1958 


tinguished educators and laymen, the Committee in two separate re-— 
ports to the President made recommendations for positive action to 
help our colleges and universities meet the mounting and changing 
needs of today’s world. ? | H | 

In addition to these nationwide studies, in communities all over the 
country, parents, teachers, and citizens groups began to focus new 
attention on problems in their own schools. Business and labor, pri- 
vate foundations and organizations, began to increase their interest 
and support. And, as problems and soft spots in American education 
came in for critical, wide-scale examination, many people also found 
new appreciation for strengths inherent in our schools. 


THE PROBLEMS 


Shortage of teachers—One of the most serious single problems con- 
fronting education is the shortage of teachers who train the scientists, 
researchers, social workers, businessmen, doctors, and workers in 
many other fields upon whom our national security and our future 
progress as a nation depend. 

The President’s Committee on Education Beyond the High School 
reported that by 1969 somewhere between 180,000 and 270,000 new 
college teachers must be recruited—between 15,000 and 22,500 an- 
nually. As it stands now, no more than 8,500 of the 9,000 students 
annually awarded Ph. D.’s in our graduate schools become college 
teachers. 

In our public grade and secondary schools we were short last year 
by more than 130,000 qualified teachers. This means that several mil- 
lion children were being short changed in their educational oppor- 
tunities. 

The generally low salaries paid teachers at all levels of instruction 
are unquestionably one of the chief blocks to progress in education. 
At the beginning of the school year in 1957, the average grade school 
teacher earned only $4,325; the average high school teacher only 
$4,840; and the nationwide average for college teachers was only 
$6,120 annually. This is a shockingly low return in view of the re- 
sponsibilities vested in teachers and the large investment of time and 
money involved in their preparation for teaching. 

Classroom shortage.—In the fall of 1957, the States reported almost 
2 million pupils were enrolled in excess of the normal capacity of the 
public elementary and secondary schools. 

The school year began with a shortage of 142,000 classrooms. By 
the end of June 1958, the overall shortage was reduced to an estimated 
135,000, a decrease of only 5 percent. 

The shortage was about evenly divided between the number of 
rooms needed to accommodate pupils in excess of normal capacity 
and the number needed to replace unsatisfactory facilities. 


The Secretary’s Report 9 


Lack of emphasis on science and mathematics——While Americans 
want their schools to offer a balanced program of education in all 
fields of learning, there is no doubt that the teaching of science— 
and its essential base, mathematics—needs greater emphasis. 

A 1956 survey by the Office of Education showed that of the 
2,776,000 students enrolled in the 11th and 12th grades of public 
high schools, only 830,000 were studying science; and 659,000 were 
studying mathematics. At that time 100,000 seniors were in public 
high schools where no advanced mathematics of any kind was taught. 
Fourteen States did not require so much as a single course in either 
science or mathematics for high school graduation. 

Of the men and women who are prepared to teach science and 
mathematics, only about 6 out of 10 actually go into teaching. 

Lack of language teaching—The United States is weaker in the 
teaching of foreign languages than any other major country in the 
world. Some two billion people speak languages that are rarely— 
if ever—taught in the United States. Of the 24 major languages, 
each spoken by more than 20 million people, only Spanish and French 
are studied to any degree in this country. The foreign language 
courses that are offered are studied in any one year by less than 15 
percent of high school students, and not more than 15 percent of 
college students. An estimated 10 million Russians study English, 
but as the school year 1957 began, less than 8,000 Americans were 
studying Russian. 

This weakness in language teaching seriously handicaps our re- 
lationship with the peoples of the world, and places us at a serious 
disadvantage in our efforts to build a durable world peace. 

Loss of talent through school dropouts—Much of the talent in- 
herent in our young people is lost because many potentially capable 
students drop out of high school and college before graduation. This 
represents a tragic waste of human resources, particularly in view 
of our Nation’s need for broadly educated men and women in science, 
engineering, teaching, business, government, medicine, and other 
professions. While studies vary, it is generally believed that every 
year 200,000 of the able students drop out of high school or end their 
formal education with a high school diploma. Some drop out of 
school because they need money—others because they lack interest 
in continuing their education. 

Federal aid to education—In the summer of 1957 a Task Force, 
composed of staff members from the Office of Education and the Of- 
fice of the Secretary, was appointed to make specific recommenda- 
tions as to just what the role of the Federal Government should be 
in helping the Nation’s schools overcome their basic problems. The 
Task Force had the benefit of Congressional studies, the White House 

487270—59 2 


10 Department of Health, Education, and Welfare, 1958 


Conference on Education, the President’s Committee on Education 
Beyond the High School, and studies by many other groups con- 
cerned with education. The proposal, submitted by the President 
to Congress in January 1958, dealt with priority national needs in 
education, while safeguarding the diversity, freedom, and independ- 
ence that are the hallmark of American education. 

The National Defense Education Act of 1958, setting up a four 
year program of about $900 million in Federal aid to education, fol- 
lows generally the proposals made by the President. It became law 
on September 2, 1958. 

The Act provides Federal support for testing, guidance, and 
counseling programs to help identify the talents of our young people 
and encourage their fullest development. It provides support for 
expanded and improved teaching of science, mathematics, and foreign 
languages in elementary and secondary schools. It supports area 
vocational training programs to develop more technicians in fields 
important to national defense. It provides for the training of more 
college teachers and language specialists and for more research in 
the use of television and other modern media. And it will make 
funds available for loans to help deserving students complete their 
college education. 


Progress and Cooperation for Health 


The Nation continued its cooperative drive toward better health. 
Never before have the American people shown a greater interest in 
medical research and medical service. Federal, State, and local gov- 
ernments, the medical and health professions, the numerous voluntary 
organizations concerned with health—all continued to increase their 
efforts. 

esearch for better health.—During the fiscal year 1958 Congress 
appropriated $211 million, an increase of $28.2 million, for the medi- 
cal research and training activities of the Public Health Service’s 
National Institutes of Health at Bethesda, Maryland. 

More than two-thirds of the Institutes funds for research projects— 
$99 million—went for support of more than 7,000 projects in nearly 
700 institutions in every State in the Nation and in 28 foreign 
countries. 

Grants totaling $30 million were awarded on a matching basis to 
134 medical schools, universities, hospitals, and other institutions to 
help build, equip, or expand their health research facilities. 

More than 2,000 scientists were awarded research fellowships total- 
ing over $6 million. Eighty-four United States scientists studied 
abroad on fellowships—and 16 from other countries were awarded 
fellowships for study in the United States. 


The Secretary’s Report 11 


During the year new facilities for specialized study or treatment 
were opened, including a residence treatment center for disturbed 
children, a center to evaluate tranquilizing drugs, and a field labora- 
tory in Panama to study tropical diseases of virus origin. As part 
of a worldwide program to wipe out malaria, the National Institutes 
of Health began an accelerated search for new methods of administer- 
ing anti-malarial drugs, and for finding a more effective combination 
of drugs so that their potency will be extended. 

At the beginning of the fiscal year the Secretary appointed a group 
of prominent medical educators and industry research executives to 
advise him on long-term needs in medical research and medical edu- 
cation. The consultants, under the able chairmanship of Dr. Stan- 
hope Bayne-Jones, reported their findings in July 1958. 

By 1970, the consultants reported, expenditures for medical research 
in this country should be tripled to reach a billion dollars a year; and, 
in order to conduct medical research of this magnitude, the numbers 
of physicians and other scientists engaged in medical research should 
increase from the present 20,000 to 45,000. The consultants expressed 
the opinion that “it would not be in the public interest for the number 
of physicians in the Nation to fall below the ratio of 132 for each 100,- 
000 persons in the population,” a ratio that has remained constant for 
the past thirty years. To maintain this ratio, the report states, would 
involve the construction of from 14 to 20 new medical schools at the 
cost of between $500 million and $1 billion. 

Gains from health research—The research attack against diseases 
of the heart and blood vessels, which kill more than 800,000 people 
every year, was greatly intensified, and notable gains were made. 

Heartening advances in the field of cancer came through studies in 
virology, chemotherapy, and cytology. The relationship between 
viruses and cancer offers one of the more promising areas of study, and 
important advances were made in basic research into the nature of 
normal and malignant cells. 

Basic research was strengthened in the attack on arthritis and other 
rheumatic diseases, and metabolic diseases such as diabetes and gout. 
During the year an oral antidiabetic drug was developed, and is now 
available on prescription, used by an estimated one of four diabetics. 
Another oral antidiabetic drug is in experimental trial stage. 

Two new pain killing drugs were developed, one probably addicting 
but ten to twelve times more potent than morphine, and the other— 
nonaddicting—more effective than codeine or demerol. 

A new method was developed for rapid diagnosis of influenza, which 
led researchers to the uncovering of two previously unknown viruses 
apparently prevalent in young children. 

Tranquilizing drugs, which came into general use by 1956, have 
established a definite place for themselves in psychiatric treatment 


12 Department of Health, Education, and Welfare, 1958 


programs, particularly in mental hospitals. Recently developed drugs 
with apparent effectiveness in treating depressive states point to a 
promising new area for drug treatment in mental illness. During the 
year, a number of studies in mental health were directed toward gain- 
ing more knowledge of the physiological and psychological roles of 
chemical agents in the body. Scientists are also studying the differ- 
ences in the way normal people and the mentally ill react to drugs. 

Community health services.—Last year an all-time high of $54 mil- 
lion, from all sources, was spent on developing community health pro- 
grams. U.S. Public Health Service funds represented only 7.4 per- 
cent of this sum. 

Research in air and water pollution, and in radiological health prob- 
lems, was intensified during the year. 

In March 1958 a new Division of Radiological Health was created. 
Through research and by providing technical assistance, it helps the 
States deal with problems related to radiation exposure from indus- 
trial, medical, and other sources. 

Programs authorized by 1956 legislation to help overcome pollu- 
tion in the Nation’s streams and rivers were well under way. By June 
30, 1958, Federal grants for sewage treatment facilities of more than 
$85.3 million had been made to more than a thousand cities and 
towns—which added an additional $356.5 million of their own funds. - 

Important progress was made under Federal enforcement proce- 
dures to help clean up pollution of interstate streams. During the 
fiscal year seven interstate enforcement conferences were called by 
the Public Health Service. 

Hospitals—During the fiscal year $120 million in Federal funds 
were granted under the Federal-State program for the construction of 
hospitals and other health facilities. This is substantially the same 
amount as for fiscal 1957, and is nearly double the amount granted 5 
years ago. Today’s larger expenditures reflect the growing emphasis 
on the construction of nursing homes, rehabilitation centers, and other 
facilities for long-term care authorized by the 1954 amendments. 

At the end of the fiscal year 1,330 projects were in the construction 
or preliminary planning stages to provide 53,362 beds for inpatient 
care and 418 health units for outpatient care. These units include di- 
agnostic and treatment centers and rehabilitation facilities, public 
health centers, and State health laboratories. 

The most urgent need today is for the construction of hospitals for 
the mentally ill and for patients with chronic diseases. Only 14 per- 
cent of the hospital beds needed for chronic disease care are provided 
now; and mental hospitals today have fewer beds, in relation to the 
need, than they had 10 years ago. 

The Public Health Service last year gave intensive study to the or- 
ganization of hospital services to more nearly fit the medical and nurs- 


The Secretary’s Report 13 


ing needs of the individual patient. A pattern of hospital service. 
known as “progressive patient: care” is under intensive study. Under 
this approach facilities and services may be more precisely matched 
with the particular needs of each individual patient. Intensive care 
is given critically ill patients; intermediate care is given those who 
need only moderate service; ambulatory patients take care of many 
of their own needs; and long-term care is provided in a homelike 
atmosphere, with periodic check-ups and rehabilitation services 
offered. 

Health survey—The U.S. National Health Survey, conducted by 
the Public Health Service, completed its first year of operation in 
June 1958. Preliminary reports have been published on the extent of 
disability in the population, the numbers of persons injured, dental 
care, physicians’ visits, and the prevalence and incidence of acute up- 
per respiratory diseases. This continuing study will prove invaluable 
in planning future health needs of the Nation. 

Asian influenza—From early May, when word first reached the 
United States that a new variant of the Type A influenza virus was 
causing widespread epidemics in the Far East, until the end of the 
year when the crest of the epidemic wave had passed, the Public 
Health Service gave firm leadership to a nationwide, cooperative 
joint effort to combat Asian influenza and to alert—without unduly 
alarming—the public. 

Armed Forces medical personnel, officials of the American Medical 
Association and State Medical Societies, the Association of State and 
Territorial Health Officers, the American Hospital Association, the 
Nation’s drug manufacturers, and a host of other professional and 
voluntary organizations—all worked together to reduce the impact 
of the epidemic. 

As a result, more than 30 million doses of vaccine were produced 
and distributed in the 5 months between isolation of the virus and the 
arrival of the epidemic, and more than 80 million doses by the end 
of the year. The epidemic reached its peak in mid-October when— 
according to the National Health Survey—some 12 million people 
were in bed during the week with respiratory illness, chiefly influenza. 

The 1957 Asian influenza epidemic offers an almost unparalleled 
example of cooperation among the health agencies of the Nation. 
Without this cooperative effort, the effects of the epidemic undoubt- 
edly would have been much more severe. 

International health—During the fiscal year the Division of Inter- 
national Health in the Public Health Service scheduled and super- 
vised the training in this country of about 600 foreign health workers 
from 76 countries, including 887 sponsored by the International 
Cooperation Administration and 110 by the World Health Organiza- 


14 Department of Health, Education, and Welfare, 1958 


tion. More than 100 visiting scientists, research guest workers, and 
post doctoral research fellows carried on their health research with 
assistance from the National Institutes of Health. 

The Public Health Service worked closely with the Department of 
State in preparation for the Eleventh World Health Assembly, which 
met in Minneapolis from May 28 to June 14, 1958, and for the special 
2-day commemorative session marking the tenth anniversary of the 
World Health Organization. 

The Assembly adopted a United States proposal for a study of 
ways in which the World Health Organization can intensify its role 
in stimulating and coordinating international medical research, and 
accepted a special United States grant to WHO of $300,000 from 
Department funds to pay for this study. 

At the end of the fiscal year some 160 Public Health Service officers 
were providing technical assistance to underdeveloped countries in 
all phases of public health as members of ICA overseas health 
missions. 


Progress and Cooperation for Pure Food and Drugs 


During the year the Food and Drug Administration increased its 
activities in a number of important areas. This progress—and gains 
made the previous year—followed recommendations made by the 
Citizens Advisory Committee in 1955 that staff be increased, facilities 
enlarged, and techniques improved, in order to give better protection 
to the consumers of foods, drugs, and cosmetics, and better service 
to American industry. 

Staff has been increased from 806 people, when the study was 
undertaken, to 1,215 at the close of the fiscal year. Plans are under 
way for a new headquarters building in Washington, a new District 
Office in Detroit, and one to serve the Dallas-Fort Worth area in 
Texas. Inspections of establishments increased from 16,287 in fiscal 
year 1956 to over 26,000 in 1958, and the numbers of samples of indi- 
vidual items collected for laboratory testing increased from about 
17,000 to 25,000. 

Major progress throughout the year was made in a number of 
specific areas, resulting in cleaner wheat for food, protection of dairy 
products from contamination by pesticides, prevention of bacteriologic 
contamination on frozen foods, and the further development of codes 
of labeling for drugs and cosmetics, to prevent misleading claims. 

The passage by the 85th Congress of the food additive amendment 
represents one of the most important advances in many years in 
health protection under the Food, Drug and Cosmetics Act. Effec- 
tive March 5, 1959, the amendment requires the manufacturer or 
promoter of a new food additive to submit to the Food and Drug 


The Secretary’s Report 15 


Administration evidence that its safety has been tested and estab- 
lished—before the product can be put on the market. 

The safeguarding of foods, drugs, and cosmetics to assure a high 
degree of purity and quality is becoming more complex every year. 
Hundreds of drug products are developed annually, and frozen, pre- 
pared, and packaged food becomes more and more a part of the Amer- 
ican diet. 

Last year the time spent in ensuring the safe use of pesticides 
increased by 28 percent. The fight against quackery in “health 
foods” and devices continued, and regulations were rigidly enforced 


regarding food for special nibic of infants, old people, pregnant 
women, and those who are ill. Work continued in analyzing radio- 


activity found in food today for comparison with food produced 
before the first atomic explosions 13 years ago. 

Every year more than $56.4 billion worth of food products, $3.9 
billion worth of drugs and medical devices, and $1.4 billion in cos- 
metics move through some 83,692 factories and warehouses, subject 
to Federal inspection. 

In carrying out its programs, the Food and Drug Administration 
works closely in specific areas with the American Medical Association, 
the Pharmaceutical Manufacturers Association, representatives of the 
food manufacturing and food producing industries, the National 
Better Business Bureau, agricultural leaders, consumer organizations, 
and State and local food and drug officials. From this cooperative 
effort and planning on the part of a number of people comes every 
year increased safety for all Americans in the foods, drugs, and cos- 
metics essential to life and well being. 

* * * * of * * 

The spirit of cooperation does not stop at our own shores and 
borders. Growing closer and closer in terms of time and distance, 
the basic interests of the peoples of the world have become increas- 
ingly intertwined. Better health, better education, improved eco- 
nomic and social well being—the particular concerns of this Depart- 
ment—represent values and goals common to all humanity. And 
so, in a mutually helpful exchange of information and ideas, co- 
operation has become a meaningful factor in our relations with the 
peoples and governments of other countries. 


16 Department of Health, Education, and Welfare, 1958 


Table 1.—Grants to States: Total grants under all Department of Health, 
Education, and Welfare programs, fiscal year 1958 


[On checks-issued basis] 


Ameri- — 
Social Public Office of can 

States, Territories, Total Security Health Office of | Vocational | Printing 

and possessions Administra- Service ! Education | Rehabili- | House for 
tion tation the 

Blind 2 
Ota esa crore! $2, 263, 155, 658 |$1, 835, 409, 720 | $158, 941,915 | $227, 676, 648 | $40, 789,375) $338, 000 
ATobatrest . ate osc 63, 612, 483 51, 021, 509 5, 377, 256 5, 866, 313 | 1,341, 934 5, 471 
Awizona We. okt e. 17, 218, 902 11, 662, 412 2, 018, 046 3, 153, 971 82, 660 1, 813 
Avykansassi" itenttns 39, 955, 928 32, 627, 758 3, 252, 898 2,961,128 | 1,108, 704 5, 440 
Calitormig.2= 248, 277, 816 205, 298, 208 8, 025, 843 32, 482,923 | 2, 447, 569 235203 
Coleradots > 2... fee. 42, 996, 432 34, 575, 661 2, 697, 463 5, 413, 342 306, 974 2, 992 
Connecticut 2252-222 19, 775, 532 15, 427, 085 1, 232, 803 2, 731, 548 376, 903 7, 193 
Delaware: 22-2 = —— 3, 582, 872 2, 644, 338 317, 612 436, 454 183, 380 1, 088 
District of Columbia_- 7, 259, 800 6, 102, 703 799, 699 120, 481 235, 587 1, 330 
PIOKS soe saceneek oes 65, 952, 345 53, 178, 254 3, 752, 301 7,459, 207 | 1, 551, 702 10, 881 
Georela.t- 7.2 75, 072, 992 62, 037, 119 3, 721, 138 7,141,017 | 2,164, 983 8, 735 
Tdahge-? 52H yc le ce 8, 828, 472 5, 796, 486 1, 145, 817 1, 746, 686 138, 516 967 
TM O1S 2 Fae se ee 92, 966, 531 80, 003, 830 6, 571, 408 4, 688, 914 1, 686, 572 15, 807 
Jndianazee 2st te 30, 442, 539 22, 598, 688 5, 184, 198 2, 132, 662 520, 100 6, 891 
lOWas- ee bee ee 28, 615, 903 28, 921, 602 | 2, 603, 956 1, 369, 043 717, 131 4,171 
Keansastreg-- ee 7 30, 584, 187 22, 641, 043 2, 323, 315 5, 156, 774 458, 944 4,111 
Kentucky 2.8. ----.-- 46, 353, 713 38, 641, 919 5, 045, 937 2, 209, 073 451, 646 5, 138 
TOUS a tose 22 Se 94, 505, 592 86, 564, 089 3, 635, 704 2, 963,055 | 1,337, 455 5, 289 
DiGinO rn. co oe 14, 076, 212 11, 636, 022 867, 846 1, 309, 683 261, 996 665 
Maryland 42.4 2..+4.. 25, 859, 952 13, 704, 217 2, 794, 741 8, 915, 036 439, 158 6, 800 
Massachusetts-.- ------ 72, 121, 387 63, 848, 574 3, 723, 095 3, 768, 402 763, 514 17, 802 
NMichigar >. ! =.= 72, 915, 638 58, 083, 526 5, 684, 707 7, 784,773 | 1,348, 789 13, 843 
Minnesota_----------- 38, 656, 710 32, 832, 545 3, 460, 879 1, 553, 766 801, 420 , 100 
Mississippi----------- 44, 148, 072 37, 623, 393 3, 680, 466 2, 314, 833 525, 300 4, 080 
Missourii 22 8- s2- a> 91, 922, 539 84, 026, 622 3, 254, 487 3, 853, 112 781, 910 6, 408 
Montana oso 8, 714, 178 6, 536, 307 736, 001 1, 239, 408 200, 195 2, 267 
Nebraska. 3 225.5225 14, 943, 889 11, 597, 485 1, 212, 314 1, 802, 649 328, 9382 2, 509 
Ne@wadae= sc -) sneer 4, 449, 103 2, 359, 411 511, 576 1, 536, 932 41,154 30 
New Hampshire------ 6, 443, 660 4, 122, 093 1, 220, 266 1, 022, 323 77, 618 1, 360 
New Jersey----------- 27, 092, 402 19, 950, 414 3, 147, 682 3, 061, 034 923, 026 11, 246 
New Mexico-.--------- 21, 377, 958 12, 235, 910 1, 485, 015 7, 471, 872 181, 715 3, 446 
INGO iis a, suede Spee 145, 446, 642 129, 084, 431 7, 929, 583 5, 519,377 | 2,878, 976 34, 275 
North Carolina-_------ 55, 042, 686 43, 147, 317 5, 926, 381 4, 323, 336 | 1, 633, 864 11, 788 
North Dakota-------- 8, 376, 205 5, 913, 039 1, 440, 121 810, 191 211, 947 907 
Oost een pees. 28 87, 036, 161 74, 933, 439 5, 032, 031 6, 228, 099 822, 795 19, 797 
Oktahomas.2 2.2.2 -= 78, 701, 470 69, 102, 277 2, 180, 798 6, 487, 662 928, 345 2, 388 
Oregony2=- = Seas 21, 072, 801 16, 829, 042 2, 197, 857 1, 540, 122 501, 246 4, 534 
Pennsylvania--------- 71, 581, 370 59, 036, 670 5, 666, 804 4,080,123 | 2,775, 467 22, 306 
Rhode Island_-_-_------ 11, 386, 757 8, 294, 349 758, 608 2, 085, 441 248, 299 60 
South Carolina------- 28, 975, 326 21, 662, 783 2, 505, 298 4,119, 892 683, 545 3, 808: 
South Dakota_-___----- 10, 520, 958 7, 099, 818 1, 327, 587 1, 858, 329 233, 985 1, 239 
Tennessee... --__------ 45, 469, 037 37, 690, 870 3, 385, 856 3,017,071 | 1,367,714 7, 526 
fs Co Ege em ees Wer ea 137, 161, 688 112, 256, 832 9, 344, 256 14,113,121 | 1, 436, 266 11, 213 
Utahns es Uy ee 13, 034, 097 8, 676, 050 1, 905, 716 2, 271, 261 179, 770 1, 300 
Vermont. 282.22 2 6, 191, 845 4, 314, 901 1, 329, 468 363, 916 182, 804 756 
Virginia :* sash e2. 3 35, 936, 949 15, 626, 654 4, 120, 742 15, 158, 354 | 1,022, 343 8, 856 
Washington_-_-_----_-- 52, 623, 643 39, 901, 729 3, 756, 015 8, 223, 281 738, 628 3, 990 
West Virginia_...-_--- 28, 980, 972 24, 664, 637 2, 282, 118 983, 741 1, 046, 668 3, 808 
Wisconsin-_-__--------- 33, 589, 312 27, 865, 795 3, 237, 775 1, 540, 223 939, 021 6, 498 
Wyoming is3224. 2204 4, 674, 995 2, 910, 022 646, 017 1, 013, 290 105, 334 332 
Ajasieg Bi igs. sesh 6, 893, 810 2, 064, 000 175, 333 4, 548, 579 105, 898 |_.-_-_--_- 
Hawale ss 7528 eee 9, 851, 643 4, 128, 677 1, 863, 218 3, 691, 957 166, 008 1, 783 
Puerto Rico 22535. - 10, 162, 175 6, 502, 071 2, 368, 889 804, 956 483, 871 2, 388 
Virgin Islands___-_-_- 547, 045 405, 094 55, 150 76, 105 10, 394 302 
Guam ssn See. pW Wd Oe 0 beer oe ee 21, 825 1, 151, 807 700: |e ees 


1 Excludes $248,613 paid to water pollution interstate agencies. 


2 Includes permanent annual appropriation of $10,000. 


8 Additional payments were made to Alaska of $638,000 for disease and sanitation investigation and 


$1,000,000 for the mental health program. 


Social Security 


Administration 


Social Security in 1958 


THE IMPORTANCE OF SOCIAL SECURITY in providing basic economic pro- 
tection for its beneficiaries was again demonstrated during the down- 
turn in business activity that marked the middle months of fiscal year 
1958. Total social security payments reached a peak by April, when 
they approached an annual rate of $24 billion. Old-age, survivors, 
and disability insurance benefits accounted for almost one-third of the 
total, unemployment insurance (administered by the Department of 
Labor and State employment security agencies) for more than one- 
fifth, and public assistance payments for about one-seventh. Benefits 
paid under other public programs such as Federal, State, and local 
employee retirement systems, railroad retirement, veterans’ programs, 
workmen’s compensation, and temporary disability insurance ac- 
counted for the remainder. 

At fiscal year’s end, 11.9 million persons were receiving monthly 
benefit checks under the old-age, survivors, and disability insurance 
program; 5.6 million were receiving assistance payments under fed- 
erally aided programs for the needy aged, dependent children, blind 
persons, and persons permanently and totally disabled; 1.2 million 
persons were on State and local general assistance rolls; and 2.8 mil- 
lion unemployed workers were collecting weekly compensation checks 
to help tide them and their families over while they sought new jobs. 
And under new legislation, unemployed workers who had exhausted 
their rights to benefits were beginning to get payments from temporary 
programs for extended benefits. During July 460,000 persons received 
their first checks under the temporary programs. 

Our social security system protected not only these millions of in- 
dividuals but also—particularly in the recession period—assisted ma- 


A Br 


18 Department of Health, Education, and Welfare, 1958 


terially in sustaining purchasing power. In June 1958, social insur- 
ance, related payments, and public assistance accounted for 6.6 percent 
of total personal income in the United States compared with 5.4 per- 
cent a year earlier. The increase was due mainly to increases in bene- 
fits paid under the growing old-age, survivors, and disability insurance 
program and to increased unemployment insurance payments. 

Legislation liberalizing old-age, survivors, and disability insurance 
benefits and revising formulas for Federal grants to the States for 
public assistance and child welfare was in the process of enactment 
as the fiscal year closed. 

The legislation increases old-age, survivors, and disability insurance 
benefits by about 7 percent in recognition of rises in wages and living 
costs since benefits were last increased in 1954. 

To pay for the higher benefits and to help maintain the system on a 
self-supporting basis, contributions to the system are increased one- 
fourth percent of taxable earnings each for the worker and his em- 
ployer and three-eighths percent for the self-employed in 1959 and, 
beginning in 1960, scheduled increases are accelerated to take place at 
5-year intervals instead of 5, as before. The amount of taxable earn- 
ings counted for benefits was raised from $4,200 to $4,800. 

The disability insurance provisions of the Social Security Act are 
amended in a number of ways. Most important is the regulation 
providing the same benefits for dependents of disabled beneficiaries 
as are now provided for dependents of old-age insurance beneficiaries. 

Amendments to the public assistance titles of the Act furnish a new 
formula for Federal participation in public assistance payments that 
will provide additional funds to all the States and more flexibility in 
meeting individual needs, including medical care needs. The formula 
also recognizes the limited fiscal capacity of the lower income States 
and will enable these States, in particular, to raise assistance levels. 

New provisions for child welfare services remove the requirement 
that Federal funds allotted to the States be used in predominantly 
rural areas or other areas of special need. ‘This permits extension of 
services under the program to children in urban areas on the same 
basis as to children in rural areas. Appropriate changes in allotment 
and matching provisions take into account the total child population 
of each State and the State’s per capita income. 

The authorization for grants for child welfare services is increased 
from $12 million to $17 million a year. Authorizations for grants for 
maternal and child health services go from $16.5 million to $21.5 
million and for crippled children’s services from $15 million to $20 
million. The increases are not mandatory but depend on annual 
appropriations until the new ceilings are reached. 

Amendments to the Act also establish two advisory councils. One 
will review the status of the public assistance programs. The other 


Social Security Administration 19 


will be concerned with the extension of child welfare services beyond 
rural areas. The councils are scheduled to report by the beginning 
of 1960. 

The 1958 amendments touch the lives of practically all Americans. 
About 75 million people are now building a basic foundation of 
economic security for themselves and their families by contributions 
at some time during the year to old-age, survivors, and disability insur- 
ance. Almost 12 million—about 1.6 million more than in the preced- 
ing June—received benefits that insured workers had earned by work- 
- Ing in covered jobs. Of these, 9.7 million—about 81 percent—are men 
aged 65 or over and women aged 62 or over; 1.9 million are dependent 
children and widowed mothers, and 200,000 are disabled workers 
aged 50-64. Benefits paid in fiscal year 1958 totaled more than $8 
billion, as compared with $6.5 billion in the previous year. 

A measure of the significance of this program in the lives of bene- 
ficiaries is revealed by a national survey made in the autumn of 1957. 
Highlights of the study show that benefits paid provide— 

e practically the only money income—that is, other than $75 or less 
a year—of about one-fourth of aged beneficiaries, 

¢ practically all the independent retirement income for more than 
half of the aged beneficiaries, 

¢ virtually the sole income of one-eighth of widowed mothers with 
entitled children, 

¢ practically all the income expected to epitannis until the youngest 
child grows up for more than three-fifths of the widows with entitled 
children. 

With the old-age, survivors, and disability insurance program pro- 
viding greater economic security for more and more of our older 
citizens, the number of aged persons receiving payments under the 
federally aided assistance program continued to decline even though 
the number receiving both benefits and assistance increased. 

But as the old-age assistance caseload diminished, the number of 
persons receiving aid to dependent children climbed. In December, 
for the first time since the programs began, persons receiving aid to 
dependent children outnumbered those receiving old-age assistance. 
The number of recipients increased 334,000 over the year to reach 2.7 
million. The increase was attributed in part to economic conditions, 
but long-term factors such as the growth of the child population, the 
number of family breakdowns and the rising rate of illegitimacy were 
also responsible. 

The economic situation was also reflected in State and local general 
assistance programs where the number of cases rose 54 percent over 
the June 1957 total to reach the year’s high in April 1958 of 454,000 
cases, and then declined to 418,000 at fiscal year’s end. 


20 Department of Health, Education, and Welfare, 1958 


The caseload in the program of aid to the permanently and totally 
disabled increased 10 percent over the year—from 284,000 to 313,000— 
while the number of needy blind receiving assistance remained prac- 
tically unchanged at 108,000. 

The Children’s Bureau began its 47th year of service in promoting 
the well-being of our Nation’s children. Programs of the Bureau 
continued to promote child welfare services for neglected children, 
children with physical or mental handicaps, runaway children, chil- 
dren born out of wedlock, and others with a wide variety of problems. 

Figures from the States show that the number of children served 
by State and local agencies under the crippled children’s program 
reached a new peak in 1957, when about 313,000 were given diagnostic 
services or treatment. These services are being extended to an in- 
creasing number of children with nonorthopedic conditions, such as 
congenital heart ailments. 

Under the 1957 program of maternal and child health services, 
210,000 mothers received maternity medical clinic services and 447,000 
received maternity nursing service. About 1.3 million infants and 
other children received well-child conference services and 2.9 million 
received child health nursing service. 

Preliminary figures from the States show that public child welfare 
agencies were providing services to nearly 340,000 children at the 
end of March 1958. 

State health departments are now administering 44 programs for 
mentally retarded children with about $2 million, most of which 
represents Federal funds allocated to maternal and child health. 
Three years ago there were only four such programs. 

Actual expenditures by States for the programs for maternal and 
child health, child welfare, and crippled children’s services rose $23.2 
million to a total of $271.9 million during 1957. The Federal share 
amounted to $38.1 million. 

The growing problem of juvenile delinquency continues to be a 
major concern of the Children’s Bureau. The upswing in the number 
of juvenile court delinquency cases is one indication of the seriousness 
of the problem. The number of cases increased for the ninth con- 
secutive year in 1957. The increase was 16 percent, while the child 
population increased only 7 percent. Bureau staff provided expert 
consultant service and worked with a wide range of agencies on de- 
linquency-related matters. 

Federal credit union assets, after registering steady growth over 
the years, dipped seasonally in January 1958, then recovered and 
went on to a record $1.9 billion in June, an increase of 14 percent over 
the year. At the end of June there were 8,992 active Federal credit 
unions with about 5 million members. 


Social Security Administration 21 


To carry on its programs of service dedicated to the economic and 
social welfare of the American people, the Social Security Adminis- 
tration had 23,540 employees at the end of June, slightly more than 
1,000 over the previous year. The great majority of these employees 
were in district offices and other offices of the Bureau of Old-Age and 
Survivors Insurance. 


International Activities 


Growing interest in promoting the social welfare of the peoples 
of the world was evident from the expansion of international programs 
concerned with social services and social security. The Social Security 
Administration participated in the activities of organizations such as 
the United Nations Economic and Social Council, the United Nations 
Children’s Fund, the International Labor Organization’s Committee 
of Social Security Experts, the International Social Security Associa- 
tion, and the Inter-American Children’s Institute of the Organization 
of American States. 

The Social Security Administration continued active cooperation 
with other international organizations by participating in the work 
of the International Conference of Social Work of the Pan American 
Congress of Social Service. Staff members served on the international 
committees of the National Social Welfare Assembly, the National 
Association of Social Workers, and the Council on Social Work 
Education. 

During the year the Social Security Administration was assigned 
responsibility for representing the Department of Health, Education, 
and Welfare on the Interdepartmental Committee on International 
Social Welfare Policy and the Interdepartmental Committee on Inter- 
national Labor Policy. The Committee on International Social Wel- 
fare Policy participated in preparing papers for the United Nations 
General Assembly, the United Nations Children’s Fund, and sessions 
of the United Nations Economic and Social Council. The Committee 
on International Labor Policy formulated positions for the United 
States delegation on items on the agenda of the June 1958 International 
Labor Conference and the May—June session of the International 
Labor Organization Governing Body. 

A reciprocal exchange of social workers with Austria, Belgium, 
Norway, Sweden, and Yugoslavia was worked out in cooperation with 
the Department of State. The Social Security Administration fur- 
nished administrative services for the program and for a proposed 
committee to assist in selecting the first group of Americans to study 
abroad and to advise on training resources for Europeans in this 
country. 

During fiscal year 1958 the Social Security Administration arranged 
for training for 1,057 from foreign countries, a 87 percent increase 


22 Department of Health, Education, and Welfare, 1958 


over the previous year. Of the 66 nations represented by the trainees, 
21 were Latin American countries, 18 were European, 15 were Asian, 
and 8 were African. The remaining countries were Australia, Canada, 
New Zealand, and the Philippines. 

Most of the 606 participants whom the International Cooperation 
Administration referred to the Social Security Administration for 
training were interested in social welfare administration, program 
development in public assistance, social insurance, and family and 
child welfare. 

Forty-six United Nations fellows and scholars came to study social 
welfare administration and education, social work methods, com- 
munity organization and development, and child welfare programs; 
24 World Health Organization fellows and scholars were concerned 
with maternal and child health. 

The notable increase in the number of foreign persons seeking train- 
ing with the Social Security Administration under sponsorship other 
than the International Cooperation Administration, the United Na- 
tions, and the World Health Organization continued. They num- 
bered 378, or 51 percent more than in fiscal year 1957. These visitors — 
were sponsored by various governments and embassies, the Asia 
Foundation, Atlantique, the Carnegie Corporation, Eisenhower Ex- 
change, Reciprocal Exchange, the Ford Foundation, the National 
Council of Jewish Women, the Rockefeller Foundation, and others. 

The growing number and variety of requests created further need 
for developing fresh resources for training and study in social wel- 
fare agencies and community development projects. Current and 
prospective needs for new resources were outlined in conferences with 
State and local social welfare leaders and with regional representa- 
tives and the central office staff of the Children’s Bureau and the 
Bureau of Public Assistance as well as in visits to schools of social 
work. 

Fiscal year 1958 saw a decline in the number of experts assigned 
to overseas technical missions of the International Cooperation Ad- 
ministration in the fields of social welfare, social insurance, and ma- 
ternal and child welfare—fields in which the Social Security Ad- 
ministration is responsible for nominations and technical support. 
The number on duty this year was 11 experts in 9 countries, com- 
pared to 25 experts in 13 countries during 1957. 

New requests for experts under the International Cooperation Ad- 
ministration program came from Chile, Peru, Tunisia, Pakistan, 
and Paraguay. 

During the year, as a result of meetings with United Nations and 
International Labor Organization experts, the Social Security Ad- 
ministration undertook the recruitment in its various fields of com- 
petence for international positions overseas. Candidates were recom- 


Social Security Administration 23 


mended for social work or social security vacancies in Indonesia, 
Liberia, Pakistan, and Libya. The Administration also made ar- 
rangements to include international organizations in the provision 
of current technical materials assembled for use of social welfare 
personnel in overseas missions. 


Old-Age, Survivors, and Disability Insurance 


During the fiscal year 1958 the old-age, survivors, and disability 
insurance program continued to provide an increasing degree of 
protection for the American worker and his family against loss of 
income resulting from retirement, disablement, or death. Almost 12 
million persons were drawing monthly benefits at the end of the 
fiscal year, and 75 million persons who worked sometime during the 
year made social security tax contributions under the system. 

A most significant development was the enactment soon after close 
of the fiscal year of the Social Security Amendments of 1958. This 
new legislation increased benefits for all beneficiaries, raised the 
amount of total earnings that could be taxed and credited for benefit 
purposes, provided benefits for certain dependents of disabled work- 
ers, and provided an increase in 1959 contribution rates and a stepped- 
up schedule for future rate increases. 

The amendments also included provisions relative to the disability 
freeze and disability benefits, the retirement test, adopted children, 
remarriage of certain beneficiaries, duration-of-marriage require- 
ments, and minor coverage changes. In addition, many simplifica- 
tions in the program were accomplished through these amendments. 
The changes made by legislation resulted in a program which, on bal- 
ance, is easier to administer, explain, and understand than the program 
before the legislation was enacted. 

Considerable attention was directed during the year to the program’s 
financing. For the first time more was paid out from the Federal 
Old-Age and Survivors Insurance Trust Fund than was taken in. 
Estimates toward the close of the year indicated that, under the 
schedule of taxes then in the law, outgo would continue to exceed 
income in most, if not all, years until 1965. After careful considera- 
tion, Congress included in the 1958 amendments a new schedule of 
contribution rates which significantly improves the relationship be- 
tween trust fund income and outgo over the next few years and 
substantially strengthens the long-range financial basis of the 
program. 

During the year, the first Advisory Council on Social Security 
Financing, authorized by the 1956 amendments, was appointed and 
began its study of the status of the trust funds in relation to long- 
term commitments. 


24 Department of Health, Education, and Welfare, 1958 


The Bureau of Old-Age and Survivors Insurance during the year 
faced the second greatest workload in its history and overcame many 
difficulties in maintaining high standards of operation and of per- 
sonal service to the people served by the program. The impact of the 
1956 amendments on the Bureau was evidenced by the more than 
500,000 benefit awards to women age 62 to 64 under the lower-retire- 
ment-age provisions, and by the more than 200,000 disabled bene- 
ficiaries who were drawing benefits by the end of the fiscal year. 

The Bureau continued to make good progress in the automation of 
its machine processes—it extended its use of electronic machines and 
magnetic tape in the maintenance of social security records and in 
the benefit payment processes. Service to the public was improved 
by the opening of twenty-six additional district offices, bringing the 
total of these local service offices to 584. As a step toward achieving 
better over-all disability insurance operations, plans were completed 
for opening a seventh payment center in Baltimore, Maryland. 

A significant development in Bureau management during the year 
was the issuance of a “Statement of Bureau Objectives,” to be used 
as a guide for planning, and as a yardstick against which to measure 
adequacy of performance. The objectives relate to the Bureau’s — 
responsibility to the public in administering the program, its respon- 
sibility for helping to improve the program, its obligation to con- 
tribute to the Government as a whole, and its responsibility as an 
employer to its own employees. Although most of the ideas in the 
statement are general principles and goals already governing the 
Bureau’s operation, the formal statement of the objectives has major 
advantages, particularly in view of the size and geographic distribu- 
tion of the Bureau’s staff and the large number of new employees. 


What the Program Is* Doing 


Beneficiaries and benefit amounts—The number and amount of 
monthly benefits being paid under the program continued to rise 
sharply in fiscal year 1958. In June 1958, 11.9 million persons were 
receiving benefits at a monthly rate of $659.7 million—increases from 
June 1957 of almost 1.6 million in number and $105.0 million in 
amount. Men aged 65 or over and women aged 62 or over made up 
9.7 million (81 percent) of the beneficiaries—6.6 million of them re- 
tired workers and 3.1 million the wives and dependent husbands of 
retired workers and the widows, dependent widowers, and dependent 
parents of workers who had died. Of the remaining 2.2 million (19 
percent), almost 1.6 million were children, some 435,000 were mothers, 
and 200,000 were disabled workers aged 50-64. 

Almost 2.5 million monthly benefits (including disability insurance 
benefits for the first time) were awarded in fiscal year 1958, only 


Social Security Administration | nie 


200,000 less than the record number of awards made in the preceding 
year. New highs were reached for awards of mother’s and of child’s 
benefits. Decreases from the number of benefits awarded in fiscal year 
1957 occurred in old-age, wife’s and husband’s, widow’s and widower’s, 
and parent’s benefits. (‘The record number of awards of these types of 
benefits in 1957 reflected the large number of claims filed by self- 
employed farmers and other workers who qualified on the basis of 
work newly covered under the 1954 amendments and by women who 
qualified under the provision in the 1956 amendments lowering the 
retirement age for women from 65 to 62.) Awards in 1958 of old-age, 
wife’s or husband’s, and widow’s or widower’s benefits were, however, 
much larger than in any fiscal year other than 1957. A record number 
of 737,000 lump-sum death payments were awarded in the 1958 fiscal 
year. 

In June 1958, the average old-age insurance benefit paid to a retired 
worker who had no dependents also receiving benefits was $61.80 a 
month. When the worker and his wife both received benefits, the aver- 
age for the family was $109.90. Families consisting of a widowed 
mother and two children received on the average $148.70. Among 
beneficiaries on the rolls at the end of June 1958 whose benefits are 
based on earnings after 1950 with eligibility to omit years of lowest 
earnings, the average for a retired worker with no dependents receiving 
benefits was about $72.50, for an aged couple about $121.50, and for 
a widowed mother and two children about $180.00. 

Disability provisions.—During the fiscal year, a period of disability 
under the disability freeze provisions that have been in effect since 
1955 was established for almost 207,000 workers at all ages. A worker 
for whom a period of disability has been established has his insurance 
rights preserved during the period in which permanent and total dis- 
ability prevents him from performing any substantial gainful work. 
Thus, such periods will not count against him in determining whether 
he or his survivors are eligible for benefits or in calculating the amount 
of the benefits. 

At the end of June 1958, 200,000 disabled workers aged 50-64 were 
receiving disability benefits at a monthly rate of $14.9 million. About 
178,000 of the beneficiaries were receiving full-rate benefits averaging 
$81.05 a month. Almost 23,000 beneficiaries who were also receiving 
a workman’s compensation benefit or another Federal benefit for dis- 
ability—other than compensation payable by the Veterans Adminis- 
tration for a service-connected disability—had their disability insur- 
ance benefit reduced by the amount of such benefit. As a result, their _ 
reduced-rate benefits averaged only $22.37 a month. The disability 
insurance benefits for almost 14,000 additional workers were completely 
offset by other benefits that they were receiving because of disability. 


487270—_59——3 


26 Department of Health, Education, and Welfare, 1958 


By the end of December 1957 about 50,900 persons were receiving 
old-age benefits that had been increased by an average of $9.54 a 
month as a result of having had a period of disability established. 
The higher benefits were partly attributable to dropping as many as 
5 years of lowest earnings in the computation of the worker’s average 
monthly wage when eligibility for such dropout stemmed from the 
disability freeze. About 16,800 wives and young children of retired 
workers and about 11,100 widows, children, and dependent parents 
of workers who had established a period of disability before death were 
also receiving larger monthly benefits because of the freeze. For the 
same reason, lump-sum death payments during the calendar year ended 
December 1957 based on the earnings records of 10,800 deceased 
workers were increased by an average amount of $24.90 per worker. 

Child’s monthly benefits are payable to totally disabled persons 
aged 18 or over—dependent children of deceased or retired insured 
workers—whose disability began before age 18. About 28,000 persons 
met the disability requirements for these benefits during the fiscal year 
and 6,000 applications were denied. By the end of June 1958, such 
child’s benefits were being paid to 39,500 persons at a monthly rate of 
$1.5 million. About 6,700 women—who would not otherwise receive 
benefits—were receiving wife’s or mother’s benefits as the mothers of 
disabled persons receiving child’s benefits. 

The protection provided.—Of the population under age 65, an esti- 
mated 66.7 million were insured at the beginning of the calendar 
year 1958. Some 29.7 million of these people were permanently 
insured—that is, whether or not they continued to work in covered 
jobs they will be eligible for some benefits when they reach retirement 
age, and their families are assured of protection in the event of their 
deaths. Included in this total were some 0.7 million women aged 
62-64 who were already eligible for old-age benefits. The remain- 
ing 37.0 million were insured but would have to continue in covered 
work for an additional period to make their insured status permanent. 
Nine out of ten mothers and young children in the Nation were assured 
that they would receive monthly benefits in case of the family earner’s 
death. An estimated 7 million insured persons under age 65 also 
met the work requirements for protection against the risk of long- 
term and severe disability. 

Of the 15.1 million people aged 65 or over in December 1957, 67 
percent were eligible for benefits under the program. Fifty-five per- 
cent were actually receiving benefits, and 12 percent were not receiv- 
ing benefits because they or their husbands were receiving substantial 
income from work. The percentage of eligible aged persons is ex- 
pected to rise to more than 70 percent by 1960. 

The coverage of the program.—Approximately 75 million workers 
were under old-age, survivors, and disability insurance coverage dur- 


Social Security Administration 27 


ing the course of the calendar year 1958. An additional 1 million 
people employed in the railroad industry were assured, through the 
close coordination of the railroad retirement and old age, survivors, 
and disability insurance programs, benefits at least equal in amount 
to those that would have been payable if their railroad employment 
had been covered under the Social Security Act. Altogether, includ- 
ing State and local government and nonprofit employees for whom 
coverage is available on a group-election basis; clergymen, for whom 
coverage is available on an individual voluntary basis; and members 
of the Armed Forces, nine-tenths of all persons in paid employment 
or self-employment were covered or could have been covered by old- 
age, survivors, and disability insurance in June 1958. 

Of the workers not eligible for coverage, about one-third were cov- 
ered by other public retirement programs—Federal, State, or local. 
The remaining two-thirds—7 percent of the Nation’s paid employ- 
ment—were not covered by any public retirement program. Those 
without retirement protection under a public system consisted prin- 
cipally of self-employed persons whose annual net earnings were less 
than $400, of domestic and farm workers who did not earn sufficient 
wages from any one employer to meet the minimum coverage require- 
ments of the law, and of self-employed doctors of medicine. 

Income and disbursements.—Expenditures from the Federal Old- 
Age and Survivors Insurance Trust Fund during the fiscal year 
totaled $8,041 million, of which $7,875 million was for benefit pay- 
ments and $166 million, including Treasury Department costs, for 
administrative expenses. Total receipts were $7,824 million, includ- 
ing $7,267 million in net contributions, $556 million in interest on 
investments, and $2 million in transfers from the railroad retirement 
account. Disbursements exceeded receipts by $216 million, the amount 
of the decrease in the trust fund during the year. At the end of June 
1958 this fund totaled $22.8 billion. 

Total assets of the old-age and survivors insurance trust fund, ex- 
cept for $1,048 million held in cash, were invested in United States 
Government securities as required by law; $3.2 billion were invested 
in public issues (identical with similar securities owned by private 
investors), and $18.6 billion were invested in securities of varying 
maturities issued for purchase by the trust fund. The average inter- 
est rate on all investments of this fund at the end of the fiscal year 
was 2.54 percent. 

The Federal Disability Insurance Trust Fund was created by the 
Social Security Amendments of 1956. Contributions to this fund be- 
came payable in January 1957. Benefit disbursements began in Au- 
gust 1957. Expenditures from the disability insurance trust fund 
during the fiscal year totaled $181 million, of which $168 million was 
for benefit payments and the remainder—some $12 million—was for 


28 Department of Health, Education, and Welfare, 1958 


administrative expenses. Total receipts were $942 million, including 
$926 million in net contributions and $16 million in net interest. Re- 
ceipts exceeded disbursements by $762 million, the amount of increase 
in the fund during the year. At the end of June 1958, the fund 
totaled $1,099 million. 

Assets of the disability insurance trust fund consisted of $1,054 
million in United States Government securities and a cash balance 
of $45 million. The invested assets consisted of $59 million in public 
issues and $996 million in securities of varying maturities issued for 
purchase by the trust fund. The average interest rate on all in- 
vestments of this fund at the end of the fiscal year was 2.54 percent. 


Administering the Program 


The primary objective of the Bureau of Old-Age and Survivors 
Insurance in advance planning for fiscal year 1958 was a shift in 
emphasis from the enforced emergency processing of peak workloads 
in 1957 to careful and systematic review and evaluation of its manage- 
ment programs and methods of operation. This emphasis appeared 
feasible in the spring of 1957 since it seemed then that the Bureau, 
for the first time since 1950, would not soon be faced with sharp 
workload increases due to program amendments. Looking ahead to 
a more stable level of operations the Bureau planned to direct its ef- 
forts to improving the quality of its work, the effectiveness of its 
processes and the efficiency of its people with the aim of making good 
progress toward an optimum level of public service in a program 
which has been greatly expanded by a series of amendments. How- 
ever, the economic recession and some delayed impacts of the amend- 
ments of 1954 and 1956 resulted in workload pressures greater than 
anticipated and made it necessary for the Bureau to direct its re- 
sources to work processing and reduction of backlogs to a greater 
degree than planned, while at the same time working to make reason- 
able progress in the long range effort of evaluation and improvement. 

A few key figures illustrate the dimensions of the Bureau’s operat- 
ing task in processing the workloads received during the year. 
Approximately 2,680,000 claims for old-age and survivors benefits 
were filed; about 473,000 claims for disability insurance benefits and 
the disability “freeze” were received. Quarterly receipts of retire- 
ment and survivor claims were heaviest during the January-March 
1958 quarter and the number pending in the district offices increased 
during that quarter to a high point of over 263,000. By the end of 
June 1958, this pending load was reduced to an approximately normal 
in-process figure of 155,000. 

The disability operation was an area of particular concern during 
the year. The first disability insurance benefits were paid early in 


Social Security Administration 29 


August (for the month of July) to about 100,000 disabled workers. 
By the end of the year, 200,000 beneficiaries were receiving payments. 
The backlog of disability claims (resulting from the 1956 amend- 
ments) on hand in the district offices, the State agencies (which make 
determinations of disability under agreements with the Department), 
and the Bureau’s Division of Disability Operations, was reduced from 
about 200,000 in January 1958 to 124,000 by the end of June. In 
addition to a large number of cases to process, the Bureau had to over- 
come the delay in completing action on disability claims which are 
generally more complex than claims for retirement or survivors bene- 
fits and take a correspondingly longer time to process. During the 
year processing time was reduced from 5 or 6 months to 214 to 3 
months. 

New social security accounts were established for approximately 
3.2 million persons and a total of almost 3 million duplicate account 
number cards were issued during the year. Approximately 250 mil- 
lion earnings items were received for posting to individual accounts. 
In addition, 1.9 million requests for a change in records were processed, 
and 960,000 statements of earnings were issued. 

To cope with workloads which exceeded estimates, the Bureau in- 
creased its staff by 890 from 21,471 to 22,423 employees and used over 
1,500 man-years of overtime. The total of 22,423 included 520 tem- 
porary employees. 

In line with expanded needs for serving the public, 26 additional 
district offices were opened in various parts of the country during the 
fiscal year. The new offices were located in areas requiring increased 
facilities for agricultural communities and in growing population 
concentrations developing from industrial expansion. In addition, 
3,665 contact stations were serviced on a regularly scheduled part-time 
basis by the local offices. 

During the year a decision was made to establish a payment center 
in Baltimore to consolidate the disability claims functions performed 
by the other six payment centers and to assume the service, control, 
and files activities of the Division of Disability Operations. The new 
payment center, opened in September 1958, will also perform all func- 
tions related to the review and certification for payment of retirement 
and survivors claims for residents of foreign countries. 

A number of activities during the year were aimed toward improv- 
ing the recordkeeping processes. A study to determine the feasibility 
of microfilming the huge National Employees Index file of account 
number holders in the Division of Accounting Operations resulted in 
a decision to convert the entire file of 160 million strips to microfilm 
with quarterly updating by the use of electronic tape and electronic 
data processing equipment. ‘This will result in net savings of about 
$1,450,000 over a 10-year period. 


30 Department of Health, Education, and Welfare, 1958 


The use of electronic equipment in the earnings record process has 
been extended successfully with substantial savings. The first IBM 
Type 705 electronic data processing system was introduced in fiscal 
year 1957. Early in fiscal year 1958, a second such system was in- 
stalled. As a result of these two installations, operating costs for 
fiscal year 1959 will be at a level some $1.8 million less than if con- 
ventional equipment were used. 

Plans are being developed for the introduction in fiscal year 1960 
of a third electronic data processing system in the earnings report 
process. When this has been completed, practically all of the earn- 
ings records operations, after initial key punching, will be performed 
by electronic equipment at an estimated additional annual savings of 
about $250,000. 

In another area of operations, magnetic tapes have been prepared 
containing data from the payee punch cards used in the payment 
center processes. This tape will be used to prepare the annual tabu- 
lations of beneficiaries and benefits by State and county, and will 
make available a wider range of statistics in shorter periods of time. 
Initial savings are estimated to be approximately $50,000 a year. The 
magnetic tapes were also set up so that they could be used for con- 
version of monthly benefit amounts. This will greatly expedite proc- 
essing the benefit increases effective in 1959. 

During the year the Bureau was surveyed by a group of business 
leaders (under the chairmanship of Mr. Reinhard A. Hohaus, Vice 
President and Chief Actuary of the Metropolitan Life Insurance Com- 
pany) selected by the Secretary to review the broad aspects of the 
manner in which the Bureau discharges its responsibilities in adminis- 
tering the old-age, survivors, and disability insurance program. 

The report of the Committee, submitted to the Secretary on June 
20, 1958, summed up its broad findings by stating that “. . . the Bureau 
is carrying out its mission in a sound and vigorous manner. It should 
be a source of satisfaction to the Secretary to know that the Bureau 
has been a pioneer in the very difficult matter of introducing auto- 
matic machinery into the paper-work area with substantial savings to 
the Trust Funds. ...” It further stated that the consultants “. . . 
were impressed with the effective and competent manner in which 
the staff of the Bureau appeared to be managing their responsibilities,” 
and that they were “. . . well impressed with the way the Bureau per- 
sonnel met and dealt with the public and with the impression of 
both efficiency and friendliness created by the typical OAST district 
office.” The Committee made several recommendations for procedural 
changes dealing with internal Bureau methods and operations and 
primarily concerned with the application of integrated data process- 
ing techniques and automation. 


Social Security Administration 31 


Two recommendations involve Bureau relations with other agencies. 
The first, adoption of the Combined Annual Reporting Plan, which 
involves the Internal Revenue Service, would require legislative au- 
thorization before it could be effected. The second was a recommenda- 
tion that the check writing function associated with benefit payments 
be transferred from the Treasury Department to the Bureau. 

Since July 1, 1955, the Birmingham Payment Center has been is- 
suing benefit checks under a Treasury Department delegation. The 
Treasury Department will resume issuance of these checks early in 
fiscal year 1959. 

During the fiscal year, design of the new Bureau building in Balti- 
more was completed. On October 31, 1957, contracts were signed with 
the general contractors and construction was started in November. 
Under the contract, the building is to be completed in February 1960. 

Total administrative costs for the program in fiscal year 1958 
amounted to approximately 2.1 percent of contributions to the trust 
funds. An assessment of operations in the perspective of recent years 
experience shows that the workload of the Bureau increased approxi- 
mately 208 percent from 1950 to 1958, while average staff increased 
by only about 109 percent during the same period. 


Legislative Developments During the Year 


The most important measure affecting old-age, survivors, and dis- 
ability insurance was the enactment, soon after the end of the fiscal 
year, of P. L. 85-840, the Social Security Amendments of 1958. This 
legislation, originating in the Committee on Ways and Means as 
H. R. 18549, was passed by the House of Representatives on July 31 
and by the Senate on August 16; it was signed by the President on 
August 28. Ten other public laws enacted by the Eighty-fifth Con- 
eress make minor changes in the program. 


PROVISIONS OF THE 1958 AMENDMENTS 


Increase in benefit amounts.—Monthly benefit amounts were in- 
creased by about 7 percent over the levels provided by the 1954 amend- 
ments, effective with benefits for January 1959. The minimum in- 
crease in benefits for workers who retired at or after age 65 was $3; 
the average increase for workers already retired was $4.75. Under 
the new provisions, benefits for workers already retired (except for 
women who draw actuarially reduced benefits before age 65) will 
range from $33 to $116, as compared with $30 to $108.50 under previous 
law. For those coming on the benefit rolls in the future, taking into 
account the increase in the earnings base from $4,200 to $4,800, benefits 
can be as high as $127, although it will be many years before the maxi- 
mum amount will be generally available in retirement cases. 


32 Department of Health, Education, and Welfare, 1958 


Payments to dependents and survivors of insured workers were 
also increased by the amendments. The minimum amount payable to 
a sole survivor was raised from $30 to $33; the maximum family 
benefit payable (within the limitation of 80 percent of the insured 
worker’s average monthly wage) was raised from $200 to $254, effective 
with benefits for January 1959. 

Increase in the earnings base—The maximum amount of annual 
earnings taxable and creditable toward benefits was increased from 
$4,200 to $4,800, effective January 1, 1959. The $4,800 maximum re- 
stores the relationship between workers’ taxable and total earnings 
that existed in 1954, when the $4,200 earnings base was adopted. The 
$4,200 base covered all the earnings of about 56 percent of regularly 
employed men in 1954. In 1957 only 438 percent of such workers had 
all their earnings credited; about 56 percent will have all their earn- 
ings credited under a $4,800 base. 

Increase in contribution rate-—The scheduled contribution rates on 
earnings paid by employers and employees were each increased by 14 
of 1 percent, with an increase of 34 of 1 percent for the self-employed, 
effective in 1959. Scheduled future increases in the tax rates, begin- 
ning in 1960, are to take place at 3-year rather than at 5-year intervals. 

Benefits for dependents of disability insurance beneficiaries.—Bene- 
fits for dependents of disability insurance beneficiaries are payable for 
the first time for the month of September 1958, and are provided for 
the same categories of dependents as in the case of dependents of 
old-age beneficiaries, that is, for wives and dependent husbands who 
have reached retirement age, for unmarried dependent children (in- 
cluding sons or daughters disabled in childhood), and for wives who 
have an entitled child in their care. These monthly benefits are sub- 
ject to the same conditions as are applicable in the case of dependents 
of old-age beneficiaries and, in addition, are suspended if the disabled 
worker refuses, without good cause, to accept vocational rehabilitation 
services. The provision for benefits for dependents of disability in- 
surance beneficiaries closes a gap in the protection which the program 
affords to families whose income is cut off or reduced because the 
breadwinner is no longer able to work. 

fepeal of disability benefits offset provision.—Another significant 
change made by the amendments was the repeal of the disability bene- 
fits offset provision, effective with disability benefits payable for the 
month of August 1958. Under the offset provision, included in the 
disability provisions in 1956 to prevent duplication or pyramiding of 
benefits, disability benefits (and benefits payable to persons disabled 
in childhood) were reduced by the amount of any periodic benefits 
payable to an individual on account of disability under certain other 
Federal programs or under State workmen’s compensation programs. 


Social Security Administration 33 


As of June 30, 1958, about 36,000 disability insurance benefits (and 
less than 1,000 childhood disability benefits) were either reduced or 
withheld under the offset provision. 

Disability work requirements.—The 1958 amendments eliminated 
the currently insured requirement for both disability benefits and the 
freeze and added as a requirement for the freeze that the worker must 
be fully insured. The currently insured requirement had operated to 
deny disability protection in many cases in which there was no doubt 
that an individual had stopped working because of disability. Many 
persons who had worked for substantial periods failed to meet the 
requirement because of interruptions in their work due to progressive 
illness which did not become severe enough to meet the definition of 
disability until after they had lost their currently insured status. 

Under prior law, it would have been possible, after June 1961, for a 
person to qualify for a freeze, and yet fail to qualify for disability 
benefits at age 50 or for old-age retirement benefits. There could also 
have been instances where dependents’ or survivors’ benefits would not 
be payable even though the worker had been allowed a disability 
freeze. It is estimated that the changed work requirements resulted 
in making about 35,000 persons, who could not have previously quali- 
fied, immediately eligible for disability benefits and the disability 
freeze and, in addition, about 15,000 persons eligible for the freeze. 

retroactive disability insurance benefits—The amendments provide 
retroactive payment of disability benefits for as many as 12 months 
before the month in which application is filed for such benefits. 
Applications for disability benefits are thus now accorded the same 
retroactive effect as applications for other types of monthly benefits 
under the program. 

Postponement of deadline for filing fully retroactive freeze appli- 
cations.—The amendments postpone for 8 years the June 30, 1958, 
deadline for filing applications for the disability freeze which permit 
a period of disability to be established as early as the actual onset of 
the disability; with respect to applications for the freeze filed after 
June 30, 1961, the beginning of a period of disability may predate the 
filing of an application by as many as 18 months. Under prior law, 
a period of disability could begin no earlier than 1 year before appli- 
cation if filing occurred after the deadline for fully retroactive appli- 
cations. The postponement of the deadline makes it possible for 
about 30,000 additional disabled workers to become immediately eligi- 
ble for disability benefits; an additional estimated 10,000 can become 
immediately eligible for the freeze. 

The retirement test—The amendments increased from $80 to $100 
the amount of wages an employed beneficiary who has total annual 
earnings in excess of $1,200 may have in a month without losing bene- 
fits, and made changes to improve administration of the test. 


34. Department of Health, Education, and Welfare, 1958 


Dependency provisions.—Changes in the provisions for dependents’ 
benefits increased protection for children and for dependent parents, 
and provided protection for certain beneficiaries who marry or re- 
marry. 

Employees of nonprofit organizations.—The amendments provide 
for a limited period of retroactive coverage for employees of non- 
profit organizations which elect coverage after 1959. Nonprofit organ- 
izations which elect, or have elected, coverage after 1955 and prior to 
1960 may cover employees retroactively to January 1, 1956. Under 
another provision, a nonprofit organization employing persons in 
positions covered by a State or local retirement system who are mem- 
bers, or eligible to become members of such a system, is required to 
treat these employees as a completely separate group for purposes of 
social security coverage. 

P. L. 85-785 makes technical changes which broaden slightly the 
provisions of existing law under which tax returns filed by a nonprofit 
organization before it filed its waiver certificate may establish social 
security credit for wages reported on these returns if the wages were 
paid for services performed before the enactment of the 1956 amend- 
ments. 

Employees of State and local governments.—The 1958 amendments 
make various improvements in the provisions of the law permitting 
States to provide coverage for employees in positions covered under 
State or local retirement systems, particularly in the provisions which 
permit certain specified States to provide coverage for only those 
members of a State or local retirement system who desire such 
coverage. | 

State and local sick-leave payments.—P. L. 85-786 provides that 
sick-leave payments received by an employee of a State and local 
government after he reaches retirement age shall be counted as wages 
if such payments are counted as wages for employees under retirement 
age. Under previous law, most State and local sick-leave payments 
were wages before retirement age but not after retirement age if the 
employee did no work during the pay period. 

Partnership earnings in the year of death.—The amendments pro- 
vide that a partner shall be credited, for social security purposes, with 
his distributive share of partnership earnings in the year of death. 
This change will affect relatively few people but will correct an in- 
equity which sometimes resulted from inability to credit a partner 
with income in the year of death. 

Turpentine workers.—Beginning with 1959, services performed by 
workers engaged in the production of turpentine and gum naval stores 
will be covered under the conditions applicable to other agricultural 
workers. While many of the estimated, 15,000 workers in this new 
coverage group are only seasonally or temporarily employed, this new 


Social Security Administration 35 


source of coverage will in many instances supplement the protection 
they acquire in other covered employment and self-employment. 

Americans who served in the armed forces of allied countries—The 
amendments broaden the provisions of prior law for gratuitous wage 
credits of $160 for months of military service for the United States 
to include military service during World War II for certain allied 
countries. Such credits may be granted for the World War II mili- 
tary service of certain American citizens and former citizens, who, 
before December 9, 1941, entered the military service of a foreign 
country which was, on September 16, 1940, at war with a country 
that became an enemy of the United States during World War II. 
This amendment assures that these individuals will have no gap in 
their social security coverage because of such service. 

Administrative changes.—The definition of fraud under the pro- 
gram was expanded and clarified. The Department was also author- 
ized to charge for services provided the public for non-program pur- 
poses to reimburse the Trust Funds. Other changes were made to 
improve administration. 


Advisory Council on Social Security Financing 


The first Advisory Council on Social Security Financing, appointed 
in October 1957 to review the status of the Federal Old-Age and Sur- 
vivors Insurance Trust Fund and the Federal Disability Insurance 
Trust Fund in relation to their long-term commitments, held a num- 
ber of meetings during the year. It was to submit its formal report 
by January 1, 1959. 

To assure that the system will continue to operate on a sound finan- 
cial basis, these Councils, authorized by the Social Security Amend- 
ments of 1956, will be appointed in advance of each scheduled increase 
after 1960 in tax rate and will report their findings and recommenda- 
tions not later than the first of January before the year in which the 
scheduled increase takes effect. The Councils are composed of the 
Commissioner of Social Security, as chairman, and twelve representa- 
tives of employers, employees, the self-employed and the public. 


Special Studies Requested by the Congress 


The Committee on Ways and Means of the House of Representatives, 
in connection with its consideration of proposed changes in the Social 
Security Act, has asked the Department to make three special studies 
and to report to the Committee on the results. The first of these stud- 
ies is to be concerned with proposals for covering tips as wages, and, 
more specifically, with methods of determining the amount of tips 
to be counted as wages under the program and the method of securing 
reports of these amounts. Second, the Department is to study, with a 


36 Department of Health, Education, and Welfare, 1958 


view to possible change, the provision of the retirement test which 
makes it possible for a beneficiary to receive benefits for some months 
in a year even though he may have had high earnings during the year. 
The third study is of alternative ways of providing insurance against 
the cost of hospital and nursing home care for old-age, survivors, and 
disability insurance beneficiaries. The Committee’s purpose in re- 
questing this study was to obtain more information on the practi- 
cability and the costs of legislative action which might be recommended 
to make such protection available. 


Survey of Resources of Old-Age Insurance Beneficiaries 


The Bureau conducted a national survey in the fall of 1957 in order 
to obtain current information about what resources beneficiaries had 
in addition to their old-age insurance benefits. 

According to preliminary findings from the survey, the median 
independent retirement income of old-age beneficiary couples (both 
entitled) was $1,700 in 1957. Single retired workers had about half 
as much income as the couples; aged widows, a little less than the 
single retired workers. Forty-four percent of the beneficiary couples 
and 60 percent of the single retired workers and widows had no inde- 
pendent retirement income in addition to their old-age and survivors 
insurance benefits, or had less than $75 for the entire year. The others 
had additional income from assets, and from miscellaneous permanent 
sources such as pensions or annuities. Many beneficiaries (35 percent 
of the retired workers, 15 percent of the aged widows) supplemented 
their retirement income with earnings from employment; one in ten 
of the family units (single persons, married couples, and widowed 
mothers with entitled children) received public assistance. Median 
income from all sources was $2,190 for beneficiary couples, $1,140 for 
single retired workers, and $880 for aged widows. 

Median net worth of the beneficiaries was $4,920; a fourth had 
zero or minus net worth; a fourth had more than $13,700. Beneficiary 
couples (both entitled) had a median net worth of $9,620; single men, 
$800; single retired women, $2,080; and aged widows had a median 
net worth of $4,380. Equity in their homes accounted, on the whole, 
for the greater part of the net worth. Half of the family units owned 
their homes—72 percent of the beneficiary couples, 32 percent of the 
single retired workers, and 46 percent of the aged widows. The 
median amount of liquid assets held was $1,580 for beneficiary couples, 
$220 for single retired workers, and $460 for aged widows. A fourth 
of the beneficiary couples, about 40 percent of the single retired work- 
ers, and about 40 percent of the aged widows had no liquid assets. 
Some life insurance, usually only small amounts, was carried by 70 
percent of the beneficiary couples and half of the single retired 
workers. 


Social Security Administration 37 


Program Simplification Project 


Considerable progress was made during the year under the Bureau’s 
program simplification project. As a result of the studies conducted 
of the retirement test and the computation and recomputation of bene- 
fits, a number of proposals for simplifying these two complex program 
areas were developed. Enacted into law as a part of the Social 
Security Amendments of 1958 were the following simplification pro- 
posals: (1) a table for computing benefit amounts replaced the benefit 
computation formulas, (2) a different order was established for al- 
locating excess earnings to the months of the year for deduction pur- 
poses, (3) the amount of wages that could be earned in a month before 
a deduction could be imposed was raised (from $80 to $100) to the 
monthly rate that is used in computing the annual exempt amount of 
earnings ($100), and (4) the requirement for a report of earnings 
where the benefits payable to the individual were suspended for the 
entire year was eliminated. 

Study was begun on two new program areas in 1958—the coverage 
provisions for State and local employees and the benefit category of 
lump-sum death payments. 


Financing the Program 


P. L. 85-840 modified the schedule of contribution rates so as to 
continue to reflect the intent of Congress that the system be self- 
supporting from the contributions of covered workers and employers. 
A revision of the contribution schedule was arrived at after careful 
review of long-range actuarial cost estimates prepared for use by the 
Congressional committees in their legislative considerations. The 
program, as amended, continues to be financed on an actuarially sound 
basis. 

The difficulties involved in making exact predictions of the actuarial 
status of a program that reaches into the distant future are widely 
recognized. If different assumptions as to, say, interest, mortality, 
retirement, disability, or earnings had been used, different results 
would have been obtained. Accordingly, no one set of estimates 
should be looked upon as final. It is the Department’s policy con- 
tinually to reexamine the long-range cost estimates of the program in 
the light of the latest information available. 

Old-age and survivors insurance benefits —Three important changes 
made by the 1958 amendments will result in higher income to the 
system. First, as mentioned previously, there is a uniform 1% of 1 
percent increase in the combined employer-employee rate and an in- 
crease of 34 of 1 percent for the self-employed for all future years 
beginning with 1959. Second, the increases in the contribution rates 
which were scheduled at 5-year intervals in the old law are now ad- 


38 Department of Health, Education, and Welfare, 1958 


vanced to 8-year intervals. Third, the maximum taxable and cred- 
itable earnings base is raised from $4,200 to $4,800 a year. Expressed 
as a level premium percent of payroll, the additional income thus 
realized will be significantly more than is needed to meet the larger 
outlays for benefits resulting from the amendments. As a result, the 
long-range financial basis of the program has been very substantially 
strengthened. 

In addition, the relationship between trust fund income and outgo 
over the next few years will be significantly improved. Income will 
be somewhat less than outgo during calendar years 1958 and 1959. 
Beginning in 1960, income will again exceed outgo—under the old 
law, outgo was expected to exceed income during most, if not all, 
years until 1965—and the assets of the trust fund are expected, under 
the intermediate cost estimates, to increase each year throughout this 
century and for many years thereafter. 

The level premium cost of old-age and survivors benefits on an inter- 
mediate basis, with interest at 3 percent, figured into perpetuity is 8.27 
percent of payroll. Contribution income is equivalent to 8.02 percent 
of payroll on a level basis. This leaves an actuarial insufficiency of 
0.25 percent of payroll. In view of the very long range over which 
these projections are made, and the many variable factors included, 
the insufficiency is so small that the system may be considered in close 
actuarial balance. 

Disability insurance benefits —The Social Security Amendments of 
1956 established a system for financing disability benefits through a 
separate trust fund which is entirely apart from the financing of old- 
age and survivors insurance benefits. The level premium cost of the 
disability benefits, as amended in 1958, on an intermediate basis, with 
interest at 3 percent, is 0.49 percent of payroll. Contribution income 
has been specifically allocated to finance these benefits; this income is 
equivalent to 0.50 percent of payroll, thereby producing an actuarial 
surplus of 0.01 percent of payroll. 


Public Assistance 


During 1958 the Bureau of Public Assistance worked closely with 
State public assistance agencies in further implementing the 1956 
amendments to the public assistance titles of the Social Security Act, 
especially those concerned with helping to increase the capacity of 
needy persons for more independent living and strengthened family 
life. Attention also continued to be directed toward efficient adminis- 
tration as an integral factor in maintaining effective and constructive 
operation of State and local public assistance programs. 

In addition, increased efforts were made to learn more about the 
causes of dependency and other characteristics of persons receiving 


Social Security Administration 39 


public assistance and to evaluate the adequacy of assistance and serv- 
ices available to them. These efforts both sharpened the outline of 
areas of need and made more Clearly visible significant factors con- 


tributing to dependency of a relatively small, but important, segment 
of the Nation’s people. 


Consideration of some of these and many other related factors 
similarly claimed the attention of many individuals, organizations, 
and congressional committees during the year and culminated in re- 
visions of the public assistance titles of the Social Security Act which 
make possible further strengthening of the assistance and services 
available to needy persons. 


1958 Amendments Affecting 


Public Assistance 


Amendments to the Social Security Act in August 1958 revised the 
basis of Federal financial participation in State expenditures for pub- 
lic assistance in three significant ways: 


(1) For the first time, the fiscal ability of each State is considered in 
part in determining the Federal share of a State’s expenditures for public 
assistance. 

(2) The Federal share is related to a single average expenditure per 
recipient for both money payments to recipients and vendor payments for 
medical care. 

(3) The amount of State expenditures for public assistance, including 
medical care, in which the Federal Government will participate is limited 
to an amount equal to $65 a month times the number of aged, blind, and 
disabled recipients in the State and $30 times the number of recipients of 
aid to dependent children.* 


Effective October 1, 1958, the formula used in determining the Fed- 
eral share of State expenditures (except for Puerto Rico, the Virgin 
Islands, and Guam) is as follows: 


For the aged, blind, and disabled the Federal Government pays % of 
payments up to $30 per recipient, and for aid to dependent children, 147 of 
payments up to $17 per recipient. 

The Federal share of the remainder of a payment ranges from 50 to 65 
percent (depending on each State’s fiscal capacity based on per capita in- 
come data supplied by the Department of Commerce, except that 50 percent 
is specified for Alaska and Hawaii) up to an avérage limitation of $65, 
including medical care, per recipient in old-age assistance, aid to the blind, 
and aid to the permanently and totally disabled and $30 per recipient in 
aid to dependent children.’ 


1Provisions of (1) and (8) above do not apply to Puerto Rico, the Virgin Islands, and 
Guam. 

2Previously, the Federal maximum share was determined in relation to payments to 
each individual recipient and to an average expenditure per recipient for payments to 
suppliers of medical care. Maximums for individual payments in which the Federal Gov- 
ernment shared were $60 a month for the aged, blind, and disabled; $32 a month each 
for the first child and the person caring for him, and $23 for each additional child in the 
family receiving aid to dependent children ; and an average of $6 a month per adult recipi- 
ent and $3 a month per child recipient for vendor payments for medical care expenditures 
in their behalf. 


40 Department of Health, Education, and Welfare, 1958 


These changes (1) increase the amount of Federal funds available 
to all States for public assistance (2) make possible greater flexibility 
in meeting individual needs of people and (3) simplify State fiscal 
procedures for claiming Federal funds. 

The additional Federal funds are expected to enable States, espe- 
cially those with limited fiscal resources, to make more adequate as- 
sistance payments and to help achieve greater equity in the level of 
assistance available to needy persons in different parts of the country. 
However, responsibility for determining how the additional Federal 
money is to be used is a matter for individual State determination. 

Federal participation in public assistance expenditures is continued 
on a 50-50 matching basis in Puerto Rico and the Virgin Islands. 
Limitations on total expenditures in which the Federal Government 
will participate were revised to relate to average expenditures per re- 
cipient as in other jurisdictions but at lesser amounts ($35 a month 
per recipient for old-age assistance, aid to the blind, and aid to the 
permanently and totally disabled, and $18 a month per recipient for 
aid to dependent children). The annual limitation on the authoriza- 
tion of Federal funds for Puerto Rico was raised to $8,500,000 (from 
$5,812,500) ; and for the Virgin Islands, to $300,000 (from $200,000). 

The public assistance provisions of the Social Security Act now 
apply to Guam on the same basis as to Puerto Rico and the Virgin 
Islands. The dollar limitation for Guam is $400,000 a year. 

In addition, special provisions relating to aid to the blind programs 
in Pennsylvania and Missouri were extended from June 30, 1959 to 
June 30, 1961; and Federal sharing was provided in payments to 
persons judicially appointed under State law as legal representatives 
of assistance recipients whether or not they are the legal representa- 
tives of such persons for other purposes. 

Provision was also made for establishing an Advisory Council on 
Public Assistance to review the status of public assistance programs. 
The Council is to report its findings and recommendations to the Sec- 
retary and the Congress by January 1, 1960. 


Trends in Caseloads and Expenditures 3 


In June 1958, 6.7 million persons (3.8 percent of the total civilian 
population) received either federally aided categorical public assist- 
ance—old-age assistance, aid to the blind, aid to dependent children, 
aid to the permanently and totally disabled—or general assistance, 
which is financed only by State and/or local funds. Aid was received 
by 800,000 more persons than a year earlier, an increase of 13.6 
percent. 


3 Caseloads, averages, and total expenditures in all programs except general assistance 
are based on data which include vendor payments for medical care and cases receiving 
only medical care. 


\. Social Security Administration 41 


The largest increases occurred in the number of persons receiving 
either general assistance or aid to dependent children, the two types 
of assistance most sensitive to economic change. There was a smaller 
increase in the number receiving aid to the permanently and totally 
disabled. ‘The number of blind recipients was virtually the same at 
the end of the fiscal year as at the beginning. The number receiving 
old-age assistance, however, continued to decline. 

Total expenditures for public assistance from Federal, State, and 
local funds, including payments for medical care, were $3,249.7 mil- 
lion during fiscal 1958, an increase of $280.5 million (9.4 percent 
over 1957). (See table 6, page 76.) The largest increases occurred 
in aid to dependent children ($114.9 million) and in old-age assist- 
ance ($75.0 million). A fifth of the total increase in aid to dependent 
children and nearly a third of the increase in old-age assistance 
occurred in one State alone, reflecting both State policy lberaliza- 
tions and vendor payments under its new medical care provisions. 
National expenditures rose by $23.4 million in aid to the permanently 
and totally disabled, $4.8 million in aid to the blind, and $62.4 million 
in general assistance. The Federal share of total expenditures, ex- 
cluding general assistance, was 56.4 percent. Assistance payments 
for the past year represented about %v9 of a cent per dollar of total per- 
sonal income in the Nation during 1957. 

Old-age assistance—Almost 2,500,000 persons, about 1 in 6 per- 
sons (16.2 percent) in the country 65 years of age or over received 
old-age assistance in June 1958. This number was 1.7 percent 
(48,000) less than the number aided in June 1957. The national 
average monthly payment per recipient for old-age assistance was 
$61.89 in June 1958, an increase of $2.73 over the previous June. 
Average payments ranged from a low of $29.85 in Mississippi to 
a high of $106.40 in Connecticut (except for $8.12 in Puerto Rico 
and $18.66 in the Virgin Islands). 

Aid to dependent children—The number of persons receiving aid 
to dependent children in June 1958 was nearly 2,733,000, the largest 
number in any month since the beginning of the program, and 334,000 
more than in June 1957. This number includes 3.8 percent of all 
children in the Nation under 18 years of age. The national average 
payment per recipient in June 1958 was $27.29, an increase of $1.25 
over the previous June. Average payments ranged from a low of 
$8.44 in Alabama to a high of $45.23 in California (except for $3.72 
in Puerto Rico). 

Aid to the permanently and totally disabled—About 313,000 per- 
sons received aid to the permanently and totally disabled in June 
1958, or 10 percent more than in June 1957. New programs in 
California and Texas brought to 48 the number of jurisdictions now 


487270—59—4 


42 Department of Health, Education, and Welfare, 1958 


administering federally aided programs for the disabled, and ex- 
pansion of programs in Illinois and Pennsylvania contributed to the 
increase of 29,000 persons receiving such aid. The national average 
assistance payment per recipient in June 1958 was $60.71, an increase 
of $1.61 from the previous June. Average payments ranged from a 
low of $29.58 in Mississippi to a high of $122.57 in Connecticut 
(except for $8.73 in Puerto Rico and $20.39 in the Virgin Islands). 

Aid to the blind—Approximately 108,000 persons received aid to 
the blind in June 1958, virtually the same as in the previous June. 
The national average payment in June 1958 was $66.72, an increase 
of $2.85 over June 1957. Average payments ranged from a low of 
$36.16 in Alabama to a high of $113.39 in Massachusetts (except for 
$8.03 in Puerto Rico). 

General assistance.—The 1,164,000 persons in 418,000 cases receiv- 
ing State and/or locally financed general assistance in June 1958 
represented a 71 percent increase in persons and a 42 percent increase 
in cases over June 1957. Most of the increase occurred in the winter 
and spring. Additions to the general assistance rolls in the spring 
included a number of unemployed persons who had exhausted their 
rights to unemployment insurance benefits. In April the increase 
in the general assistance caseload was relatively slight, and in May 
and June the number of cases dropped 5.1 percent and 2.9 percent 
respectively. The national average payment in June 1958 was $61.55 
per case, an increase of $6.66 over June 1957. Average payments 
ranged from a low of $11.84 a month per case in Arkansas to a high 
of $93.11 in New Jersey (except for $6.64 in Puerto Rico). 

Public assistance supplementing insurance benefits—Public as- 
sistance is used to supplement social insurance benefits in instances 
where low wages or the length of time worked in covered employment 
have entitled the beneficiary to receive benefits in an amount which 
does not meet his basic needs. It is also used to meet special needs, 
such as medical care, for those whose insurance benefits plus other 
personal resources are insufficient to meet this additional expense. 

The number of persons receiving both insurance benefits and old- 
age assistance continued to increase during the past year. About 
596,500 or 24.2 percent of those receiving old-age assistance in Feb- 
ruary 1958 received both insurance benefits and assistance payments, 
compared with 22.2 percent a year earlier—an increase of 116 percent 
from September 1950. About 20 percent of all old-age assistance 
payments (approximately $29.3 million) was made to aged benefi- 
claries in February 1958 to supplement benefits. The average as- 
sistance payment supplementing benefits, however, was a fourth lower 
than payments to other aged persons, $49.09 compared with $64.73. 
The average insurance benefit received by these aged assistance re- 


\ Social Security Administration 43 


cipients was $40.68, or about 70 percent of the average amount paid to 
all aged beneficiaries. 

The 87,200 families receiving both insurance benefits and aid to 
dependent children represented 5.4 percent of all families receiving 
aid to dependent children in February 1958 compared with 5.1 per- 
cent in February 1957. They received 4 percent (about $2.9 million) 
of the total payments to aid to dependent children families. The 
average assistance payment to families receiving both types of pay- 
ments was $78.27, compared with $102.71 for families not receiving 
insurance benefits. The average benefit received by these families 
was $66.19 or less than half the average benefit paid to all beneficiary 
families consisting of widows and children. 

The extension of benefits under the 1956 amendments to the Social 
Security Act to totally disabled workers aged 50-64 and to an insured 
worker’s dependent child 18 years of age or older who was disabled 
before he became 18 had little measurable effect on public assistance 
programs. Only about 3 percent of those receiving aid to the dis- 
abled and 1 percent receiving aid to the blind became eligible to re- 
ceive such benefits. 


Significant Trends and Their Implications 


Trends revealed in the above data have several important program 
implications. These trends are: (1) a steady decline in the number 
of persons receiving old-age assistance and a rising proportion re- 
ceiving assistance to supplement social insurance benefits; (2) a sharp 
increase in the number of cases receiving general assistance, especially 
during the winter months; (3) a steady rise in the number receiving 
aid to dependent children, with this program now aiding the largest 
number of assistance recipients; (4) a lower total expenditure for 
aid to dependent children than for old-age assistance, even though 
the number of persons receiving aid to dependent children is greater 
than the number receiving old-age assistance; and (5) a relatively 
larger increase in the average payment per recipient for the aged, in 
comparison with the rise in average payment per recipient for needy 
children. 

Trends in old-age assistance and aid to dependent children are 
highlighted in the charts below which depict contrasting trends in 
the number receiving old-age assistance and aid to dependent chil- 
dren and portray the wide margin between the amount of expendi- 
tures for these two programs. 

The declining number of aged receiwing assistance. “aothe number 
of aged persons receiving assistance declined about 2 percent during 
the past year, and 12 percent since 1950 even though the total number 
of persons 65 or more years of age increased 22 percent during this 


44. Department of Health, Education, and Welfare, 1958 


CHART 1.—TRENDS IN RECIPIENTS AND ASSISTANCE PAYMENTS IN OAA AND ADC, 
OCT. 1950-—JUNE 1958 


THOUSANDS OF RECIPIENTS MILLIONS OF DOLLARS 

3,000 160 ene 
2,900 me 150 i= = 
2,800 |< OLD-AGE ASSISTANCE| | 140 i a (ae 


SSISTANCE 


2,700 130 

2,600 120 fe = 

2,500 110 =f t + o 
2,400 100 | Whe 
2,300 90 | 

2,200 80 Se 
2,100 ORs -} + 


2,000 60 |—AID TO DEPENDENT CHILDREN[#——_J 

1,900 ina 4 I 
= : : 40 ' 1 ‘ ' ar 1 ‘ 

4 1950 '51 ‘52 '53 '54 '55 '56 ‘57 ‘58 i950 '51 ‘'52 ‘53 ‘54 ‘55 56 57 58 


period. As a result, only 16.2 percent of the total aged population 
received assistance in June 1958 compared with 22.6 percent in 1950. 

With nine-tenths of all persons in paid employment now covered 
by the old-age, survivors, and disability insurance program, it can 
be expected that fewer and fewer older persons will be dependent 
primarily on old-age assistance. However, if the past trend con- 
tinues, an increasing proportion of old-age assistance recipients will 
probably need to receive assistance to supplement insurance benefits 
to meet basic or special needs such as medical care. 

The trend in the number of recipients of other assistance programs 
has been upward since 1953, due in large part to population increases, 
rising costs of living, direct and indirect effects of the recent recession, 
and to the relatively smaller influence so far of the insurance program 
on the blind, disabled, and children dependent for reasons other than 
the father’s death. 

General assistance on the rise-—The number of persons receiving 
help under State and/or locally financed general assistance programs 
increased 71 percent from June 1957 to June 1958. Although the 
number aided declined in May and June, the 45 percent increase from 
December 1957 to April 1958 is a significant indicator of the need of 
unemployed workers who were either not covered by unemployment 
insurance or who exhausted their benefits and for whom no provision 
is made under federally aided assistance programs. 

General assistance, although available in some parts of all States, 
is frequently limited to temporarily or permanently unemployable 
persons. Some States provide no assistance to employable persons 


Social Security Administration 45 


and their families even in emergencies. For example, in February 
1958, general assistance was available to employable persons in 26 
States on a statewide basis; in 16 it was available in some but not all 
parts of the State, not even in areas hardest hit by unemployment in 
10 of these States; and in 5 the granting of assistance was a matter for 
local determination. General assistance is financed by State funds 
alone in 11 States; by State and local funds in 26 States; and by local 
funds alone in 16 States. 

Most general assistance payments were lower than federally aided 
public assistance payments. Although most States met additional 
requests for assistance under their current standards for general assist- 
ance, many of these standards were extremely low. In some States 
funds were inadequate to meet need as determined even within these 
standards. 

Perhaps the most profound effect of the recent period of unemploy- 
ment has been to highlight the inadequacy of many State and/or 
locally financed general assistance programs to meet need even after 
Federal legislation extended unemployment compensation benefits. 
Voluntary welfare agencies and other community groups helping to 
meet economic need during the winter of 1957-58 have brought into 
sharper focus the relationship of voluntary and public agencies in the 
relief area. 

Many of these groups have also expressed concern about the hard- 
ship of the unemployed in those instances where residence require- 
ments restrict eligibility of such persons for public aid. All but 5 
States have residence requirements for old-age assistance; all but 7 
for aid to the blind and aid to the disabled; and all but 8 for aid to 
dependent children. Most have State residence and some also have 
local settlement requirements for general assistance. 

An important argument in favor of residence requirements is made 
by some States which fear the expense of caring for nonresidents, 
migratory laborers, for example, for whom they traditionally have 
assumed no responsibility. Several other States have tried to mini- 
mize the restrictive effect of residence requirements through uniform 
State laws, reciprocal agreements, or interstate compacts. 

The increasing role of aid to dependent children—National eco- 
nomic and social problems are reflected in the gradual upward trend 
in the number of recipients of aid to dependent children. The number 
of persons presently aided under this program is nearly 30 percent 
larger than 4 years ago. As indicated in Chart 1, above, the number 
receiving aid under this program in December 1957 exceeded the num- 
ber receiving old-age assistance. In June 1958 aid to dependent chil- 
dren recipients totaled 2,732,800 compared with 2,460,300 old-age 
assistance recipients. 


46 Department of Health, Education, and Welfare, 1958 


Other significant long-term factors, in addition to the recent reces- 
sion, have contributed to this increase. For example, the number of 
children in the Nation has increased until children under 18 years of 
age now constitute 35 percent of the total civilian population. There 
has also been a substantial increase in the number of families and an 
even greater relative increase in the number of broken families 
headed by women. Since these families usually have much less in- 
come than families headed by men, an increasing number of children 
in broken families are liable to need financial help. 

Death of the father as a cause of dependency accounts for only about 
12 percent of the families currently receiving aid to dependent chil- 
dren; in about 22 percent need is due to the incapacity of the father, 
but in about 60 percent need is related to the absence of a father be- 
cause of divorce, separation, desertion, unmarried parenthood, or 
other reasons. However, dependency on public assistance of about a 
fifth of the Nation’s families broken by separation or unmarried 
parenthood is only a part of the increasing evidence of social prob- 
lems in all elements of society. 

For example, the number of broken families with children under 18 
increased from 1.5 million in 1950 to 2.8 million in 1956. Also, the - 
number of children in the total population reported as born out of 
wedlock more than doubled between 1938 and 1956, rising from 87,900 
to 193,500. The Bureau estimates the relative increase between 1938 
and 1954 in nonwhite illegitimate births to be 148 percent compared 
with white illegitimate births of 52 percent. About 70 percent of white 
children born out of wedlock are adopted, but fewer than 5 percent of 
nonwhite children. Few adopted children need aid. The nonwhite 
illegitimate child, who usually remains with his mother, is more liable 
to be in financial need. 

In March 1957 about 1.3 million mothers in the labor force were 
widowed, divorced, or married but not living with their husbands. 
Families with a female head have shared to a relatively smaller extent 
than families with a male head in the general increase in money in- 
come in recent years. For example, their median total money income 
in 1956 of $2,754 represents a 24.1-percent rise from 1951 compared 
with a 29.7-percent rise to $4,965 for families with a male head. 

The concentration within the aid to dependent children program of 
families whose need is often associated with socially disapproved 
behavior has made this program a ready target for criticism. 
Although these social problems affect people at all income levels, they 
are more clearly visible in the causes of dependency of those receiving 
assistance under the aid to dependent children program. 

Experience has shown that dependency of children due to family 
instability has not been remedied by legislation, administrative reg- 
ulation, or financial aid alone. However, wider recognition of the 


Social Security Administration 47 


value of increasing efforts by the States to help bring about more 
desirable adjustments within the family group resulted in 1956 in a 
Social Security Amendment emphasizing the provision of social serv- 
ices in all the federally aided public assistance programs. Passage of 
the “services” amendment, in turn, stimulated State agencies to in- 
crease their activities in providing social services in their aid to de- 
pendent children program to help maintain and strengthen family 
hfe and thus give children a better opportunity for health and 
emotional stability. The aid to dependent children program thus 
is playing an important part in helping to deal with the problems of 
children, harassed not only by poverty, but also by illness, incapacity, 
death or estrangement of parents, or unmarried parenthood. 


Program Developments 


In addition to providing technical assistance to Congress during 
their consideration of legislative changes, Bureau effort continued 
during the year, as in 1957, to further advance implementation of the 
1956 amendments. These activities included interpretation of the 
amendments, issuance of basic policies for use by States, and work 
on major problems requiring resolution. Fiscal and administrative 
procedures were developed to effect necessary changes in grants to 
States, and technical assistance was provided to State agencies for 
implementing the new legislation. In addition, the Bureau issued 
information explaining the amendments to interested individuals and 
groups, and prepared a booklet interpreting social services in public 
assistance and pointing up the values of cooperative community efforts 
in providing social services for needy people. 

Considerable progress was made also by the Bureau and the States 
in providing social services to help public assistance recipients increase 
their capacity for self-care and/or self-support. 


STRENGTHENING SERVICES FOR NEEDY PEOPLE 


The nature and extent of social services provided by public welfare 
agencies vary greatly between States, within a State, within a locality, 
and even between workers in the same agency depending on their 
awareness, skills, and the acceptance of such practice as an essential 
part of the effective administration of public assistance. Efforts dur- 
ing the past year, therefore, were increasingly directed toward helping 
the States to strengthen the services aspects of their programs. 

By July 1, 1957 (as required by the 1956 “services” amendment) 
States had developed descriptions of the services available in their 
public assistance programs, and of the steps taken to assure maximum 
utilization of services furnished by other agencies. This process led 


48 Department of Health, Education, and Welfare, 1958 


the States to a critical evaluation of existing services and planning for 
their extension and increasing effectiveness on a statewide basis. 

These services plans indicate progress in clarifying the services made 
available by the State welfare agency and increasingly effective utili- 
zation of other community resources. Although there is variation 
between States, certain common problems are recognized in the plans 
of most States, namely, the effects of financial need, illness, family 
breakdown, and lack of education and training for employment. These 
plans also indicate areas needing further nationwide emphasis, such 
as increasing utilization of such resources as child welfare services 
within the agency and in the community, and more active participation 
of the public assistance agency in planning for the development and 
utilization of new and needed resources in the community. Certain 
proposals for expanding social services developed by individual States 
utilizing new and dynamic concepts have identified policy areas re- 
quiring further consideration. 

The Bureau also continued its efforts in planning for the increasing 
provision of appropriate social services for needy people. For ex- 
ample, a staff committee of the Children’s Bureau and the Bureau 
of Public Assistance is considering services to families and children 
under public assistance and child welfare programs as a basis for 
making recommendations regarding program relationships in areas 
of service common to both. The Bureau is also represented on an 
intradepartmental committee to consider the problems of working 
mothers in relation to programs within the Social Security Adminis- 
tration. In addition, the Bureau maintains liaison with the Child 
Welfare League of America in developing standards on protective 
services for children and is represented on the American Public 
Welfare Association’s Committee on Services to Children. Work is 
continuing to strengthen cooperative relationships between State pub- 
lic assistance and vocational rehabilitation agencies in providing serv- 
ices to needy individuals. 

The Bureau is also helping to plan the second National Conference 
on Homemaker Service to be held in February 1959 under the joint 
sponsorship of 8 constituent units in the Department and 26 national 
voluntary social and health agencies. Preconference activities in- 
cluded Bureau participation in planning a Public Health Service 
survey of existing homemaker services and the development and issu- 
ance of a descriptive directory of agencies providing homemaker and 
related services in 1958. State and local public welfare personnel 
are also serving on most of the study groups organized in various 
parts of the country to develop basic work materials for the Con- 
ference. 

Bureau staff also worked closely with the Public Health Service 
in efforts to improve nursing homes and institutional care for the 


Social Security Administration 49 


aged. For example, it participated in the National Conference on 
Nursing Homes and Homes for the Aged called by the Public Health 
Service in February 1958. It is also planning for implementing the 
recommendations made at this conference, including regional meet- 
ings that will assist both the personnel of licensing agencies in im- 
proving their educational and consultative services to nursing homes 
and homes for the aged, and personnel of welfare agencies in improv- 
ing their services to individuals requiring care in these homes. 

The Bureau’s interest in the aging is also reflected in many other 
activities, including membership on the Social Security Administra- 
tion’s Committee on Aging; participation in the Social Security Ad- 
ministration’s representation on the Department’s Committee on 
Aging; and collaboration with American Public Welfare Association 
committees in developing statements on social service needs of older 
people, community planning responsibilities of public welfare agen- 
cles, and the educational needs of staff working with aged persons. 
Similarly, it participated in the various activities of the National 
Social Welfare Assembly’s Committee on Aging. The Bureau is cur- 
rently developing a statement of its program responsibilities in the 
field of aging and is planning to participate in the Department’s 
preparation for the White House Conference on the Aging authorized 
by Congress under Public Law 85-908. 

Improvement in medical care for public assistance recipients.— 
Separate Federal matching in vendor payments for medical care pro- 
vided under a 1956 amendment effective July 1, 1957, required exten- 
sive planning and preparation on the part of both Federal and State 
agencies during the year. At the Federal level discussions were held 
with representatives of various groups to interpret the amendments 
and to get the benefit of their specialized knowledge and suggestions 
for implementation. 

By June 30, 1958, 41 State agencies in 37 different States were pro- 
viding medical care with Federal participation through vendor pay- 
ments for one or more categories of federally aided public assistance, 
including 17 agencies which previously made no vendor medical pay- 
ments, and 4 States that had made such payments in 1 or more 
programs but now extended them to other categories. Nursing-con- 
valescent home care was the item included most frequently for adult 
categories as of January 1958; and drugs, the item most frequently 
included in the aid to dependent children program. Nursing services 
provided by registered or practical nurses other than those made 
available in hospitals and nursing-convalescent homes was the item 
supplied least often. States used the vendor payment method more 
often for hospitalization than for other items of medical care. 


50 Department of Health, Education, and Welfare, 1958 


Vendor payments for medical care made in behalf of recipients of 
federally aided public assistance programs totaled $21.6 million in 
June 1958 and $236.1 million for the fiscal year 1958. 


RELATED SOCIAL WELFARE ACTIVITIES 


In addition to administering the public assistance provisions of the 
Social Security Act, the Bureau carries other broad public welfare 
responsibilities on a nationwide basis. These include, for example, 
planning for defense emergency welfare services and services to re- 
patriated American nationals and to refugees from other parts of the 
world. In addition, Bureau staff take an active role in international 
social welfare developments. 

Defense welfare services.—Although activities were suspended on 
Federal Civil Defense Administration delegations with the termina- 
tion of supporting appropriation on June 30, 1957, the Bureau partici- 
pated in Operation Alert 1958 and continued limited activity in plan- 
ning for emergency organization and operations during a disaster. 
These included preparation of materials for protecting essential rec- 
ords, delegations to the field, lines of succession, and self-triggering 
regulations and guidelines for implementation of field delegations. 
With possible additional delegation of functions from the new Office of 
Civil and Defense Mobilization under Reorganization Plan No. 1 of 
1958, and an allocation of limited funds, consideration is being given to 
possible resumption of a broader range of defense planning activities. 

Services for repatriated Americans——The Bureau continued its 
cooperative activities with the Department of State in arranging 
for assistance and services needed by repatriated American nationals. 
Although Federal funds are not available for this purpose, the Bureau, 
through its regional staff, enlists various community resources in pro- 
viding essential reception services at ports of entry, contacting rela- 
tives and friends, arranging for needed hospital or medical care, or 
providing temporary financial aid or help with family relationship 
problems. During the year such help was requested for 40 persons 
repatriated from 20 countries. | 

The Bureau also continued its work with the Department of State 
and Department of Defense in developing a legislative proposal for a 
program to cover both repatriation of American nationals from abroad 
during a national emergency and peacetime repatriation needs. An 
Interdepartmental Ad Hoc Committee on Repatriation of American 
Nationals, inactive since 1954, was reconvened at the request of the 
Department of the Army to assess the status of these plans and to 
determine needed next steps. 

Services to refugees.—Following active participation in the tem- 
porary program of the President’s Committee on Hungarian Refugees, 
the Bureau evaluated the most effective ways, in relation to our na- 


Social Security Administration 51 


tional interests and safety, of making income maintenance programs 
applicable to the specific needs of refugee and immigrant families. 
From this experience the Bureau also contributed to the Departmental 
Task Force report on refugees and immigrants in outlining the De- 
partment’s potential role in this area. 

International activities—The Bureau participates in the training, 
reporting, and policy development activities of the International 
Service of the Social Security Administration. 

The Bureau Director continued to serve as chairman of the Inter- 
departmental Committee on International Social Welfare Policy and 
Bureau staff participated in the preparation and review of technical 
materials for use at the United Nations and other international meet- 
ings. The Bureau Director served as one of two vice chairmen of the 
United States Committee of the International Conference of Social 
Work, which held its biennial meeting in Tokyo in November 1958. 
Bureau staff also assisted in developing the United States exhibit for 
this conference. 

Bureau staff in regional offices provided consultation and planned 
or arranged observation programs in cooperation with State and local 
public and voluntary welfare agencies for visitors from 66 different 
countries during the past year. In the central office staff specialists 
provided consultation to foreign visitors and to international groups 
referred by various U. S. Departments, such as the labor leader teams 
referred by the Department of Labor; and also assisted in orientation 
sessions for foreign visitors at the American Council on Education’s 
International Center in the District of Columbia. 

Bureau staff also make a substantial contribution to the preparation 
of United States material for the United Nations biennial surveys of 
programs of social development. This year, in addition to sections 
on public assistance and related services, sections were prepared on 
organization and administration of public social services, training of 
social welfare personnel, public administration and social develop- 
ment, and social welfare measures relating to urbanization. 


Administrative Developments 


During the year special attention continued to be directed toward 
a more effective and efficient administration of public assistance pro- 
grams as well as improving Bureau administration and management. 

The study, “Federal Participation in Administrative Costs of State 
and Local Administration of the Public Assistance Programs,” which 
explored numerous factors relating to questions raised by Congress, 
gave assurance that the Federal Government participates only in 
those costs that are essential for proper and efficient administration 
of State public assistance programs. 


52 Department of Health, Education, and Welfare, 1958 


The findings of the study also pointed up the importance of the 
relation between administrative costs and the social service functions 
of a public welfare agency and clarified areas in which further guide 
materials and technical assistance are needed by the States. This 
gave new impetus to work already initiated in such areas as case 
recording, organization and staffing patterns of local agencies, and 
workload management; and provided the basis for planning several 
regional conferences to be held during the coming year for joint ex- 
ploration of these areas with the States. The Bureau also has been 
keeping in touch with experimental projects undertaken by some 
States to evaluate the effect of selected staff carrying limited case- 
loads, especially in the aid to dependent children program. 

The evaluation of staff needs and long-range planning for staff 
development initiated by the States in anticipation of Federal funds 
under the 1956 “training” amendment, plus the pressing need of States 
for skilled staff, has motivated a series of significant developments. 

Some States made funds available for staff-development personnel, 
educational leave, or other training needs. For example, 44 States had 
staff development personnel in December 1957 compared with 14 
States in 1950. Many States made progress in strengthening line 
staff, identifying knowledges and skills needed for staff services, and 
clarifying the staff-development function. Many States also devel- 
oped orientation or induction training plans and held short-term 
courses to increase supervisory and administrative staff skills. 

Similarly, most States made efforts to improve the educational 
level of staff, since only about 1 of 5 public assistance workers have 
some professional social-work training. About 475 staff were granted 
educational leave in 1958 in comparison with 325 in the previous 
school year. Also, study of education and experience of current staff 
resulted in some States raising educational requirements for be- 
ginning positions; others intensified staff recruitment; and some are 
considering readjustment of salary scales in order to retain personnel 
with professional training. 

Several States reported greater success in recruitment campaigns 
because of higher salary scales, improved benefits, and more frequent 
merit system examinations. To meet the need of rising caseloads or 
new or expanded medical care programs, or to reduce the number of 
cases per worker, 46 of the 59 State agencies administering one or 
more public assistance programs had larger State or local staffs in 
June 1957 than a year earlier (an increase of 1,400 to a total of 
66,500). However, while 35 agencies reduced caseloads, the 15 agen- 
cies which increased cases per visitor indicated they were unable to 
add more staff because low salaries limited their ability to compete 
in the labor market. 


EE 


Social Security Administration 53 


Although progress made in staff training has been significant, 
progress to the extent needed to develop enough competent staff is 
seriously hampered by lack of funds to implement the training pro- 
gram passed by Congress in 1956, and undoubtedly will retard the 
provision of services directed toward self-support, self-care, and 
strengthened family life—prime objectives of public assistance pro- 
grams in 1958. 

In general, public assistance activities in 1958 have made significant 
strides in providing essentials of living and other needed services for 
many needy individuals and families in the country. However, the 
realization of the fullest potentials of the public assistance pro- 
grams, even within existing legal and administrative framework, 
provides a challenge in the years ahead in order to utilize their in- 
herent strengths in helping to build strong family life in America. 


Children’s Bureau 


For the 47th year, the Children’s Bureau continued to reflect in the 
Federal Government the Nation’s special concern for its most cherished 
human resources. It operated, first, under its original mandate from 
Congress in 1912 “to investigate and report upon all matters pertain- 
ing to the welfare of children and child life.” Secondly, in its respon- 
sibility under Title V of the Social Security Act of 1935, the Bureau 
administered grants to the States totalling $41,500,000 to assist them 
‘in extending and improving health and welfare services to children. 

To implement its overall concern for improving the conditions 
under which children are born and grow, the Bureau made studies 
and reports, worked cooperatively with a wide range of public and 
voluntary agencies, helped create guides and standards for services, 
and administered the grants voted by Congress for maternal and child 
health, crippled children and child welfare services. 

A major step forward, following the close of fiscal 1958, was the 
enactment of new amendments to the Social Security Act. These 
amendments authorize an increase of $5 million in future appropria- 
tions for each of the three grant programs administered by the 
Children’s Bureau: 

Maternal and Child MHealth Services: from $16,500,000 to 
$21,500,000. 

Crippled Children’s Services: from $15,000,000 to $20,000,000. 

Child Welfare Services: from $12,000,000 to $17,000,000. 

Other changes, all relating to child welfare services, include: 

1. For the first time, child welfare services are authorized for 
children in urban areas on the same basis as services for rural children. 

2. A revision of the formula for allotment of Federal funds so that 
grants will be in direct proportion to total child population and in 


54 Department of Health, Education, and Welfare, 1958 | 


inverse proportion to State per capita income. However, no State 
will receive less than the amounts it would have received prior to the 
amendments, with an appropriation of $12,000,000. | 

3. A new requirement by which State and local funds must match 
Federal child welfare funds, beginning with fiscal year 1960. 

4. Broadening of provisions on runaway children, to increase the 
age limit from 16 to 18 and to permit using Federal funds for mainte- 
nance up to 15 days pending their return. 

5. Authorization to reallot Federal funds when a State certifies it 
will not need them to carry out its child welfare program. 

6. A new section establishing an Advisory Council on Child Welfare 
Services. The Council will report findings and recommendations to 
the Secretary and to the Congress on or before January 1, 1960. The 
Council membership, appointed by the Secretary, will consist of 12 
persons, representing public, voluntary, civic, religious, and profes- 
sional welfare organizations and groups, and the public. 

Effective July 1, 1959, Guam will be included in all of the grant 
programs. 


Some Facts and Figures About Parents and Children 


Live births in the Nation continue to be above 4 million annually. 
Since 1950, crude birth rates have remained about 25 per 1,000 popu- 
lation and fertility rates in relation to women of child-bearing age 
have continued to increase. Women in this age group in 1957 had 
borne 22 percent more children, on the average, than women of the 
same age range in 1950. Increases in fertility have been greater in 
urban than in rural areas, among nonwhite than white population, and 
among the low or middle income than the high income groups. 

The number of children under 18 rose from 47 million in 1950 to an 
estimated 59 million in 1957, an increase of 27 percent, while adults 
in the age group 18 to 64, to whom children look for support, increased 
by only 5 percent. Children now constitute 35 percent of the total — 
population. 

The death rate for infants under 1 year per 1,000 live births moved 
up slightly in 1957 for the first time in 22 years. The rate was 26.4 
compared with the 1956 figure of 26.0, the lowest rate ever recorded. 

Maternal mortality continued its steady decline, with only 3.9 
maternal deaths per 10,000 live births in 1957. 

For children above 1 year, accidents, cancer, congenital malforma- 
tions, influenza, and pneumonia are still the most frequent causes of 
death. 

Births out-of-wedlock rose again in 1956 to 193,500. The ratio per 
1,000 live births increased to 46.5, and the rate per 1,000 unmarried 
women, aged 15 to 44 years, was 20.2. About 77,000 unmarried moth- 
ers were under 20 years of age. 


Social Security Administration 55 


In March 1957, about 7 million mothers with children under 18 were 
in the labor force. They were about 28 percent of all mothers with 
children of this age. Nearly 2.6 million of them had children under 
6. About 1.3 million were widowed, divorced, or married but not 
living with their husbands. 

In 1957, more than 58 million children under 18 were living in 
family homes—their own or relatives’ homes. About 390,000 were 
living in foster family homes, in institutions, in boarding houses, or in 
other unrelated households. 

The number of broken families with children under 18 has increased 
from 1.5 million in 1950 to 2.8 million in 1956. 

Juvenile court delinquency cases more than doubled between 1948 
and 1956. In that year an estimated 450,000 different children, or 2.2 
percent of all children aged 10 through 17, were referred to courts in 
the United States for delinquency. Preliminary data for 1957 indicate 
further increase to about 520,000 children. The recent increases, both 
in juvenile court delinquency cases and in police arrests of children, 
are much greater than can be accounted for by population increases or 
better reporting procedures. 


Preparation for the 1960 White House Conference 
on Children and Youth 


In May 1958, the President announced March 1960 as the date for 
the Sixth White House Conference on Children and Youth, and asked 
the Secretary of the Department of Health, Education, and Welfare 
to invite State and Territorial Governors to appoint special committees 
to begin a State-by-State stocktaking on problems of the young. Such 
a conference has been held every 10 years since President Theodore 
Roosevelt convened the first in 1909. 

The President asked the Children’s Bureau to serve again as the 
focal point in the Federal Government for the conference planning and 
Congress appropriated $150,000 for development of a Conference staff 
in the year ahead. The actual theme and scope of the Conference will 
be determined by a national committee named by the President. 

In advance of such steps, the Children’s Bureau, during the year, 
sought to lay groundwork for the 1960 Conference by consulting with 
various professional groups—physicians, educators, and social work- 
ers, to learn of their interests in the Conference planning and program. 
In September 1957, advance suggestions had been sought in a meeting 
of representatives of three national groups—the Council of National 
Organizations, the National Council of State Committees on Children 
and Youth, and the Interdepartmental Committee on Children and 
Youth. 


56 Department of Health, Education, and Welfare, 1958 


Federal Interdepartmental Committee 


on Children and Youth 


In the decade since this Committee was formed, the Federal agencies 
participating in it to coordinate their interests and activities for 
children have increased from 11 to 34. Subjects of special interest 
during the past year included: need of rural youth; radiation, as it 
affects children; urban renewal programs; and a special report on 
Soviet children by a member of the United States Mission to that 
country. 

A Special Committee was formed to provide for Federal agency 
participation in the 1960 White House Conference on Children and 
Youth. 

Continuing its close working relationship with the National Council 
of State Committees for Children and Youth, the Interdepartmental 
Committee again cosponsored the Joint Conference on Children and 
Youth in Chicago in March. Attending were representatives from 
25 State Committees and 100 national organizations. 

In June, 22 Federal agencies joined in a seminar, sponsored by the 
Interdepartmental Committee, on the reasons why many adolescents 
fail to get along in school and the ways in which Federal agencies can 
assist local efforts to help them. 


Programs of the*Bureau 
& 
RESEARCH IN CHILD LIFE 


The Bureau’s research staff has a major responsibility for carrying 
out the mandate “to investigate and report upon all matters pertaining 
to the welfare of children.” In addition to conducting its own studies 
and cooperating in joint studies, the Bureau stimulates other agencies 
to undertake research in child life by formulating the questions re- 
quiring study, developing research methods, and providing technical 
advice and assistance. 

A prime emphasis in the Bureau’s technical research has been the © 
development of methods of measuring the effectiveness of programs 
designed to deal with some of the current pressing problems in child 
life. A study on evaluation of casework and other social services has 
been completed. Various approaches to gauging the effectiveness 
of official programs for juvenile delinquents have been examined to 
determine the most promising line of research in this field. The 
Bureau has reached the final stage of a joint study, with the Florida 
State Department of Public Welfare and the Russell Sage Foundation, 
to assess the outcome of independent adoptions and, as a byproduct, 
to discover the factors associated with successful and unsuccessful 
placement of children for adoption. 


Social Security Administration 57 


During the year the Bureau, with the cooperation of the State 
departments of public welfare, the Child Welfare League of America, 
the Family Service Association of America, and their constituent 
agencies, has been studying the reasons for the large number of staff 
losses in operating agencies, in an effort to improve administration. 
To get some of the basic facts concerning maternal and child health, 
particularly the handicapping conditions of childhood, plans were 
made for several studies to be conducted in conjunction with the Na- 
tional Health Survey. Factfinding studies were planned also on the 
nature and extent of public child welfare services for mentally re- 
tarded children, the effects of maternal employment on children, and, 
in cooperation with the National Probation and Parole Association, 
on court probation services for children. 

The Bureau compiles and publishes statistical data received from 
State agencies administering the maternal and child health, crippled 
children’s, and child welfare grant-in-aid programs. It also pub- 
lishes certain statistical data on voluntary child welfare services, the 
work of juvenile courts and public training schools for juvenile de- 
linquents, and on child adoption. These reports are occasionally sup- 
plemented by special statistical analyses, such as Crippled Children’s 
Program, A Statistical Review, and Financing Public Child Welfare 
Services, both published during the year. 

As part of its research interpretation activities, the Bureau has been 
exploring channels through which the findings of research in child 
and family development, parent-child relationships, and mental health 
in family life can be more effectively shared with the public and has 
encouraged interdisciplinary discussion of problems in parent educa- 
tion requiring further study. A revision of Prenatal Care, one of the 
series of publications for parents on child growth and development, 
has been started. Two issues of Research Relating to Children, an 
inventory of current research in child life to keep investigators mu- 
tually informed, were published during the year. 


MATERNAL AND CHILD HEALTH SERVICES 


All of the States, the District of Columbia, Hawaii, Puerto Rico, 
and the Virgin Islands receive Federal funds to extend and improve 
services for promoting health of mothers and children. 

For the fiscal year 1957-58, Congress increased the appropriation 
for maternal and child health to $16,500,000 and earmarked $1,000,000 
to be used only for special projects for mentally retarded children. 

Ongoing programs of the State maternal and child health agencies 
continue to make a major contribution to the health of the Nation. 
State maternal and child health reports show that about 241,000 moth- 

487270—59 5 


58 Department of Health, Education, and Welfare, 1958 


ers received services at maternity medical clinics in 1957. In addition, 
health nurses served over 447,000 mothers before or after delivery. 

About 558,000 infants and 768,000 other children received health 
supervision through well-child clinics. In addition, health depart- 
ment programs provided nursing service for over 2,878,000 infants 
and other children. 

Almost 1,715,000 children were vaccinated for smallpox, and nearly 
8 million were immunized for diphtheria by State and local health 
departments through grants provided by the maternal and child 
health programs. Polio immunization through these programs 
reached 11,809,000 children. | 

Continued emphasis on services for mentally retarded children re- 
sulted in the development of 44 State programs with a total] allocation 
of about 2 million dollars. Each of these is operated as part of the 
State health department’s mental and child health program, 30 are 
financed by Federal funds for special projects, and 14 are supported 
by the States’ regular MCH funds. 

Progress was made in extending geographically and in improving 
services for mentally retarded children by continued recruitment and 
training of professional staff, by better integration of services for the 
mentally retarded into overall MCH programs and into other com- 
munity facilities. Clinic teams were enlarged and better administra- 
tive practices adopted in order to reduce the backlog of cases awaiting 
diagnostic evaluation. Several States inaugurated plans for early 
detection and treatment of specific causes of mental retardation, such 
as phenylketonuria, in which prevention is possible. 

Two national conferences with significance for future program de- 
velopment were held. One conference of MCH directors and di- 
rectors of clinical services for mentally retarded children representing 
50 States and Territories recommended that a committee be established 
to advise the Children’s Bureau on how the experiences of the various 
State programs could be exchanged for the benefit of all. The second 
was an institute of professional workers on nutrition and diet in re- 
lation to mental] retardation, probably the first of its kind. 

A third important conference for public health nurses working in 
special projects for mentally retarded children discussed home train- 
ing programs. In addition, a number of statewide conferences and 
workshops for nurses, physicians, and other health personnel were 
held. 

Material for a manual on “Home Training” of mentally retarded 
children was completed; also “Newer Concepts of Mental Retardation 
in Medical Care Programs for Children,” the report of the 1957 in- 
stitute of the Tulane School of Social Work was issued. 


Social Security Administration 59 


Maternal and neonatal mortality rates in scattered areas and 
among certain groups sparked fresh interest and activity in maternity 
care in a number of State programs. 

In July 1957, the 7th American Congress on Maternal Care, spon- 
sored by the American Committee on Maternal Welfare was held, with 
participation by many Children’s Bureau staff members and State 
MCH directors. The keynote, “Complete Maternity Care,” expressed 
a broadened concept of maternity care. The year ended with a work 
conference on the nurse-midwife, her role and training, sponsored 
by the Maryland State Health Department in cooperation with the 
American College of Nurse Midwifery and the Children’s Bureau, 
and financed by a Children’s Bureau grant. 

Concurrent with increasing numbers of hospital deliveries, over- 
crowded and inadequately staffed nurseries and increased use of anti- 
biotics, has been the emergence of antibiotic-resistant staphylococcal 
infections. The epidemics in hospital nurseries were of particular 
concern to maternal and child health programs. One beneficial ef- 
fect of these has been a closer working relationship between hospitals 
and health departments and an increase in hospital consultation to 
maternity and newborn services by maternal and child health person- 
nel. The number of States starting perinatal mortality studies, usu- 
ally in cooperation with medical societies and hospitals is increasing. 
The community obstetrical study which began in the hospitals of 
Hartford, Connecticut, has expanded to include hospitals of Hart- 
ford County. Some significant statistical information on medical 
care given to maternity and newborn patients is being collected. 

Increasingly, health agencies are recognizing the potentialities of 
parent group education. In-service training programs for the prepa- 
ration of staff in leadership skills were held in New York State, 
Massachusetts, and Texas. 

Adaptation of services to the health needs of migrants was evident 
in the special migrant project in Florida. There, family clinics are 
held during evening hours after the field work is finished. Mothers 
and fathers are seen by a general practitioner, while a pediatrician 
examines the children. Preclinic planning sessions and _ post-clinic 
conferences are features of the service. A project worker, acceptable 
to both professional staff and migrants, acts as a liaison. “Colorado 
Cares,” a color film on community organization for migrant workers, 
was developed by the Colorado migrant project. 

Because accidents are the chief cause of death in children from 
1 to 18 (up to 25) years, and because the pain and disability from 
accidents affects a much larger number of children, MCH and Crip- 
pled Children activities in accident prevention and poison control 
are increasing. Not only are MCH funds going into these programs, 


60 Department af Health, Education, and Welfare, 1958 


but CC agencies are cooperating in preventive programs as well. 
In a number of States, health educators have been assigned to MCH 
divisions to assist with this activity. In at least two regions, con- 
ferences on accident prevention, sponsored by Public Health Service, 
in cooperation with Children’s Bureau, were held. 

Interest in developing health services for adolescents is growing. 
A clinic for children 12 to 18 years of age at Colorado General Hospi- 
tal, conducted by the University of Colorado Department of Pedi- 
atrics, was approved as a special project. Clinic services (pediatric, 
nursing, medical social, nutrition, psychiatric, and remedial reading) 
are being coordinated with the school health program; objectives will 
be service, training and research. 

The Children’s Bureau, Office of Education and Public Health 
Service are represented on the Department Committee on Health of 
the School-age Child. Each agency has responsibilities and inter- 
ests in the development and promotion of school-community health 
programs. 

Ever since the inauguration of health services for children under 
the Social Security Act, the Division of Health Services has stressed 
the importance of early casefinding among children. -This position 
has been reinforced during the last year by the National Congress 
for Parents and Teachers, which in the future will emphasize the 
importance of health supervision and medical care from infancy 
throughout the school years. 


CRIPPLED CHILDREN’S SERVICES 


All of the 53 States and Territories, with the exception of Arizona, 
are participating in the Crippled Children’s program. Though the 
State agency auspices vary, the objective is uniform, namely: to lo- 
cate children who require care, and to provide restoration through 
diagnosis, medical and surgical treatment, and alleviation of un- 
favorable social and psychological influences which adversely affect 
the degree and duration of the disability. The appropriation for 
Crippled Children’s Services is $15,000,000, the amount authorized. 

A new peak was reached in 1957 in the number of handicapped 
children served under federally aided programs, preliminary figures 
from State reports indicate. Of the 313,000 children cared for dur- 
ing the year, 246,000 were seen in clinics; about 66,000 received 
physician’s services through home or office visits. About 52,000 chil- 
dren were hospitalized. Convalescent home care was given to the 
smallest group, around 38,700. 

As States attempt to more adequately meet the needs of handi- 
capped children, they are moving toward the concept of child- 
centered, rather than disease-centered programs, and are giving more 
comprehensive service to each child and his family. Examples of 


Social Security Administration 61 


coordination of services to children with many types of handicaps 
are the children’s diagnostic and. rehabilitation center programs at 
the Universities of Kansas and Buffalo, New York. Two centers 
in Maryland, at Johns Hopkins University and the University of 
Maryland, have been developed to serve children with multiple handi- 
caps. Neurological aspects of handicapping conditions are receiving 
increased attention at each of these centers as elsewhere in this 
country. 

The trend of States to accept children with chronic illnesses which 
require long continued medical management rather than surgery or 
appliances is continuing. Begun in 1940 with the rheumatic heart 
disease program, it has been further extended by the inclusion of 
cystic fibrosis, nephrosis and similar chronic diseases by a number of 
States. 

Progress in research in prostheses for child amputees continues 
through special projects at the University of California at Los Ange- 
les, and the Child Amputee Center at Grand Rapids, Michigan, where 
children with more and more difficult amputations are being fitted 
and trained. In addition, a special project to be conducted by New 
York University for Field Studies in Prosthetic Rehabilitation of 
Children was approved this year. 

At present, 30 States are voluntarily reporting services to child 
amputees under the crippled children’s program to the Children’s 
Bureau. An increasing number of States are able to care for their 
own cases as amputee teams are trained at the California, Michigan, 
or New York University Amputee Centers and special clinics for 
child amputees are opened. 

In Pennsylvania, an important study of hearing impairment in 
school-age children was begun with Crippled Children’s B funds, as 
a joint undertaking of the University of Pittsburgh and the American 
Academy of Ophthalmology and Otolaryngology. Crippled Chil- 
dren’s B funds also support studies of profoundly deaf preschool 
children at the John Tracy Clinic. 

Services to children with speech and hearing defects continue to 
expand. 

Surveys in local areas indicate that the number of children with 
congenital heart disease is much larger than formerly estimated. 
Among State crippled children’s program, the congenital heart pro- 
gram is one of the most rapidly growing. An increasing number of 
States are now able to provide heart surgery within their own State. 
For patients needing more advanced heart surgery and those in States 
without facilities, regional heart centers have been established in five 
States: California, Illinois, Maryland, Minnesota, and Texas. 

More than 10,000 children suffering from congenital malformations 
of the circulatory system were served by crippled children’s programs 


62 Department of Health, Education, and Welfare, 1958 
in 1957. This is about five times the comparable number for 1950. 
The number of States accepting children with congenital heart disease 
has steadily increased. Factors which have contributed to this 
growth, include: (1) the brilliant and rapid advances in heart surgery 
within the past decade, making repair possible in many types of con- 
genital heart defects; (2) the widespread development of heart centers 
as diagnostic and surgical teams are trained; (3) the return of children 
with previous anastomotic operations for closure of shunts and cor- 
rection of the original defect; (4) increasing public and professional 
awareness that many types of congenital heart disease are now ame- 
nable to treatment; and (5) high cost of care. 

Because progress has been so rapid, the regional heart program has 
had difficulty keeping step. Since the bulk of patients apply to the 
regional center performing the most advanced heart surgery, the fa- 
cilities for that center have become overcrowded. 


CHILD WELFARE SERVICES 


Child welfare services are experiencing the effects of broad and sig-- 
nificant technological and sociological changes, of new developments 
in social work, and of new interest and demands on the part of the 
public. The child welfare staff of the Children’s Bureau strives con- 
tinuously to provide help and leadership as major changes in our cul- 
ture and society have effect on children. 

Some of the immediate areas of expanded public concern are the 
care of children while mothers work; the problems of mentally re- 
tarded and emotionally disturbed children; increase in neglect and 
abuse of children; expansion and changing practices in the field of 
adoption; care and protection of children in disadvantaged groups 
such as migratory families, Indian children and low income families; 
and the pressing need of adolescent boys and girls to find guidance 
and security essential to their maturing in these times when the only 
sure thing is change. 

During 1957, the overriding emphasis in child welfare has been on 
deeper understanding of what a child’s own home means to his well- 
being and growth. Staff development programs are being focused on 
early recognition of problems of children and on work with parents. 
Several States report more “reaching-out” services by agencies to 
serve multiproblem families. Studies of children in foster care are 
being made to determine whether more adequate diagnosis, plus serv- 
ices to families, might have averted placement and whether return to 
their own homes may now be indicated for some children. 

A forward step in strengthening families is the progress being made 
in providing protective services to neglected or abused children. The 
Children’s Bureau has given consultation to both public and private 


Social Security Administration 63 


agencies engaged in protective services and is currently cooperating 
with such national voluntary agencies as the Child Welfare League of 
America, and the American Humane Association, Inc., in developing 
definitions, standards and guides to improve practice. 

With an increasing number of women in the labor market, there is 
new emphasis on day care as a service to enable children to continue 
living at home, even though they need several hours of care away from 
families each day. In some States, agencies having child welfare 
responsibility are operating day care facilities. In other States, such 
agencies have been given authority to license day care facilities, with 
emphasis on consultation and stimulation rather than on enforcement. 

The Children’s Bureau is taking steps to find out more about the 
effects of employment of mothers on children. At the Bureau’s re- 
quest, the Census Bureau’s current population survey for one month 
included a series of questions for enumerating the children whose 
mothers work and the kinds of care arranged during the mother’s 
absence. The Bureau is also working with the Department of Labor 
in evaluation of day care needs. Within the Department of Health, 
Education, and Welfare, the Bureau of Public Assistance, the Bureau 
of Old-Age and Survivors Insurance, and the Children’s Bureau are 
in active cooperation on a Committee on Working Mothers. 

Homemaker Service is receiving increasing recognition as a basic 
part of the community program for health and welfare, for strengthen- 
ing family life, and for assisting parents in caring for children in their 
own homes. Significantly, this service is now being used in a wide 
variety of situations in contrast to its single original purpose of fur- 
nishing temporary care of children during the absence of the mother. 
Agencies may now use it to relieve mothers from constant care of a 
handicapped child, for continuing care of a motherless family while 
the father works, or to teach parents ways of giving better care to their 
children. 

In 1942, Homemaker Service was found to be available in only 41 
agencies in 28 cities. The 1958 Directory of Homemaker and Related 
Services shows the service available in 145 agencies in 104 cities and 
32 States and the District of Columbia. Consultation from the Chil- 
dren’s Bureau has been used by both types of program. 

The Children’s Bureau has initiated plans for a National Confer- 
ence on Homemaker Service to be held February 10-11, 1959. Because 
of their shared interest, seven other constituent units of the Depart- 
ment of Health, Education, and Welfare were asked to join in spon- 
sorship of the Conference. Twenty-six national voluntary agencies, 
whose member agencies either administer, support, or have promoted 
homemaker service programs, also agreed to sponsor the Conference. 

Along with increasing effort toward strengthening families to better 


64. Department of Health, Education, and Welfare, 1958 


care for their children, there is recognition that there will always be 
some children for whom alternate care must be planned. ‘The estimated 
number of children in foster care reached an all-time high of 268,000 in 
1957. While this represents an increase of 8,000 children over the 
estimate for 1956, the proportion of children in foster care out of the 
total child population remained the same. In contrast, the proportion 
of children in foster care declined from 496 per 100,000 children in 
the 1933 population to 414 per 100,000 in 1956. 

More and more emphasis in foster care is toward better diagnosis at 
intake so as to permit more adequate planning and avoid placement 
of children if services can strengthen their own homes. When a 
child must be placed away from home, sound diagnosis would help to 
determine care according to each child’s specific need. 

In institutional care, the primary question seems to be whether the 
right children are coming for care or whether children are coming 
for care because community and foster family services are not avail- 
able. In general, institutions are slowly moving their infants and 
preschool age children out into foster family care. Many institutions 
are carefully “retooling” to give skilled care to emotionally disturbed 
children. 

Much interest is being shown by agencies, institutions and licensing 
staff in the development of agency operated “group homes.” These 
are being used for adolescents, certain emotionally disturbed children, 
unmarried mothers, and others. Entering this new field, agencies 
are interested in developing criteria for intake, examining special 
uses and limitations, and weighing costs. From consultation and 
work with State and local child care agencies, came much of the mate- 
rial for “Child Caring Institutions—Their New Role in Community 
Development of Social Services,” a recent Bureau publication. 

In the field of adoptions, the Children’s Bureau has continued the 
project undertaken in 1957 to bring together representative profes- 
sional groups to work toward clarification of their various roles in 
adoption. <A report of a meeting of social workers, held in 1957, with 
a statement of the social worker’s role, is now being published. A 
meeting of physicians was held in November 1957, and another with 
lawyers in May 1958. ‘The statements of the roles of these two pro- 
fessions are almost completed. 

Amendments to the Immigration and Nationality Act in 1957 pro- 
vided for the issuance of special non-quota immigrant visas to eligible 
orphans under age 14, adopted or to be adopted by United States 
citizens. Immigration and Naturalization Service of the Department 
of Justice was made responsible for determining that satisfactory 
assurances have been given to the Attorney General that the new 
parents will accept care for the child properly and that preadoption 
requirements of the State where the child will live have been met. 


Social Security Administration 65 


Since the amendments, the Children’s Bureau has worked closely with 
Immigration and Naturalization Service and with national voluntary 
agencies such as International Social Service, United Hebrew Immi- 
grant Aid Society, and Catholic Committee for Refugees, to imple- 
ment services to children brought into this country for adoption. 

With proxy adoptions of foreign children believed to be on the in- 
crease, there are continuing reports of the breakdowns of many of these 
adoptions and tragedies for the children, adoptive parents and natural 
parents. 3 

Growing public understanding of both the capacities and special 
needs of mentally retarded children and the expansion of community 
resources to meet these needs are major factors contributing to the 
emphasis on rehabilitation services for this group. As more retarded 
children are enabled to remain in their own homes or foster homes, 
professional casework help is being widely recognized as a vital need 
in building the social and emotional well-being of the total family. 
With a trend away from long-time custodial care, institutions are 
coming to be regarded as training resources. These changing con- 
cepts point up the importance of individual evaluation and planning 
for each mentally retarded child and the responsibility of the child 
welfare field for strengthening casework services and community 
planning. 

Activities of national and State welfare organizations are demon- 
strating that social services are an essential part of a multidisciplinary 
approach to the needs of retarded children. Some professional schools 
of social work are making student field work placements in services 
for the mentally retarded and sponsoring summer institutes in their 
area. 

The Bureau’s Social Services Specialist for Mentally Retarded 
Children has conducted workshops and institutes in Utah, Colorado, 
Missouri and Kansas for social workers, for professional personnel in 
health, education, recreation, and related fields; and for parents and 
interested citizens. 

Continuing attention is being given to the needs of the children of 
migratory farm workers in a number of States. These needs are inten- 
sified by such factors as a family’s remoteness from friends, relatives, 
and resources; low, irregular, and unpredictible income; denial of aid 
because of residence requirements, etc. 

During the long working hours of the parents, the service most 
widely needed by migrant children is day care; however, whenever 
social workers have worked on day care facilities for migrant children, 
they have found that multiple child welfare services were needed. 
These include foster family care for young infants; counseling and aid 
to unmarried mothers and their children; adoptive placement; pro- 
tective services for children who are neglected, abused, abandoned or 


66 Department of Health, Education, and Welfare, 1958 


exploited; and services to unattached teenage children traveling un- 
supervised in the work group. 

In Pennsylvania and Ohio, combined State, local and Federal child 
welfare funds have been used to develop and operate day care centers 
for migrant children. 

Because of the establishment and strengthening of all child welfare 
services in each State, the Children’s Bureau has added a specialist 
on child welfare legislation to lead and assist in developing guides to 
standards for State child welfare legislation. 

The shortage of professionally trained personnel has stimulated 
activity in breaking down some of the barriers to staffing in State 
agencies. In addition to increased educational leave, a number of 
States have been working on a variety of recruiting plans. The per- 
centage Increase in the amount budgeted for professional education 
in 1958 reflects a significant move by the States to step up their efforts 
to obtain better qualified staff and thereby improve services. The 
Bureau has issued a revised guide for educational leave policies in 
State public welfare agencies. 


JUVENILE DELINQUENCY SERVICE 


With reports showing an increase in youthful offenses, juvenile 
delinquency continues to be one of the major social problems in the 
country. 

Public interest in the problem of juvenile delinquency remains 
high. Many local welfare planning councils are including study of 
juvenile delinquency in the range of social problems with which they 
are concerned. At the same time, they are giving support to State 
and metropolitan youth commissions by identifying gaps in de- 
linquency-related services and encouraging improved coordination 
and cooperation between them. In many cases they are helping to 
finance demonstration projects sponsored by some of their members, 
especially those involving services to organized groups of hostile, de- 
linquent youth. 

Many State, county, and city governments have assumed greater 
responsibility for stimulating and integrating State and community 
efforts to combat delinquency. They are, for example, establishing or 
extending official planning bodies and offering consultant services to 
communities to help them study and develop solutions to youth 
problems. 

As a result of recent court decisions and law journal articles, the 
legal rights of children and parents appearing in juvenile courts 
are receiving increased attention. Such questions as the right to coun- 
sel and a fair hearing, parental liability, and publicity have been re- 
celving increased attention from court personnel, attorney sagt and 
Ren Rear IN workers in related fields. 


Social Security Administration 67 


The trend towards specialization within police departments appears 
to be slowing up. National police organizations and a number of 
police adminstrators have begun to question some of the involvement 
of specialized juvenile units in a number of character-building activ- 
ities aimed at the prevention of delinquency. Greater stress is being 
placed on the police role, in general, in dealing with juveniles and 
the improvement of standards of the entire department. Evidence 
of a greater recognition of the police role is found in the fact that 
four States now have State consultants in this area and three other 
States are contemplating such action. 

In the institutional field, a number of States are reviewing or have 
already changed the State administrative structure relating to train- 
ing schools. The older aggressive delinquent has also been the object 
of increased concern, particularly with respect to court procedures and 
institutional care. 

Interest in training in the institutional, probational, and police 
field remains high. A number of workshops and institutes were con- 
ducted by Children’s Bureau staff, including a second one at Rutgers 
University on Staff Development for Administrators of Institutions 
for Juvenile Delinquents. 

Development of a much closer interaction between the field of cor- 
rections and social work education is now discernible. Inclusion of 
the findings of the Committee on Corrections in the Council on Social 
- Work Education curriculum study reflects this, as does the growing 
participation by schools of social work in inservice training and spe- 
cialized training courses. 

Bureau staff worked with a variety of agencies in a variety of 
areas during the year. Cooperative effort has continued with the 
National Council of Juvenile Court Judges and the National Pro- 
bation and Parole Association to develop Standard Juvenile Court 
and Family Court Acts. Similarly, the Bureau has been working 
cooperatively with the National Probation and Parole Association 
on the publication Standards and Guides for the Detention of Chal- 
dren and Youth. At the Association’s request, the Bureau partic- 
ipated in five statewide studies. Other joint activities included work 
with the National Social Welfare Assembly and Council of State 
Governments on the development of an interstate compact related 
to residence and settlement laws; with the Interstate Compact Admin- 
istrators Association on the operation of the Interstate Compact on 
Juveniles, and with the Family Service Association of America on a 
project to promote understanding and cooperation between attorneys 
and social agencies. Close working relationships were maintained 
with the Council on Social Work Education, the National Association 
of Training Schools and Juvenile Agencies, and the organization of 
training school superintendents. 


68 Department of Health, Education, and Welfare, 1958 


Among the important publications completed during the year were: 
Staff Training for Personnel in Institutions for Juvenile Delinquents 
(CB Pub. 364), a report on the first Rutgers Workshop; Youth Groups 
in Conflict (CB Pub. 365), a report of a national conference of people 
involved in working with groups of hostile, delinquent youth, was 
also published. 


INTERNATIONAL COOPERATION 


The new Chief of the Children’s Bureau was appointed by the 
President to serve as United States Representative on the Executive 
Board of the United Nations Children’s Fund (UNICEF). At her 
first session in this capacity, in the spring of 1958, she introduced a 
resolution for the United States suggesting the possibility of expan- 
sion of UNICEF aid in the area of child welfare, with a beginning 
step in concern for children in institutions and day care centers. As 
a means to determine UNICEF’s possible role in this area, she sug- 
gested a study by the United Nations Bureau of Social Affairs and 
UNICEF with consultation from WHO, with a report to be made in 
the Spring of 1959. This proposal was warmly received by many 
representatives on the Board, was approved, and the study is now in 
progress. 

Under the continuing, cooperative program with the International 
Cooperation Administration, the Bureau’s international staff recruits 
Americans for maternal and child health and child welfare positions | 
abroad, provides technical materials and information as requested, 
and plans and arranges training programs for persons from other 
countries. The trend in requests, both for recruiting and for training 
in the health field, is toward the clinical specialities of pediatrics 
and obstetrics rather than the general areas of maternal and child 
health. In the child welfare field, there has been a similar trend and 
away from general child welfare, particularly toward juvenile de- 
linquency specialists in the training program. 

The maternal and child health specialists recruited and back-stopped 
by the Bureau contributed to programs in six countries. During the 
year a pediatric nurse-educator arrived in India. There were ma- 
ternal and child health physicians in Iraq and in Paraguay, a nurse- 
midwife in Bolivia, a pediatric nurse-educator in Brazil, a maternity 
nurse-educator and a pediatric nurse-educator in Guatemala. 

During the year, the Bureau’s international staff planned and ar- 
ranged programs of study in this country for 75 long-term trainees 
and observers and 182 short-term visitors. The trainees were in pro- 
grams 12 months or more, the observers 2 to 6 months, and the short- 
term visitors a few hours to 2 months. They came from 35 countries 
under the auspicies of the International Cooperation Administration, 


Social Security Administration 69 


at tana 


the United Nations, the World Health Organization, and the Inter- 
national Exchange Service of the Department of State. 

Of the 75 long-term trainees and observers, 49 were in the health 
field, and 26 in the welfare field. In the health field, there were 36 
physicians, of whom 19 took courses in public health with a specialty 
in maternal and child health, and 17 took graduate work in pediatrics 
or other clinical specialties as applied to children. Of 12 nurses, 11 
studied children’s dentistry. Here to study in the area of juvenile 
delinquency, were two police officers, an institutional director, a psy- 
chologist, and several group workers interested in work with “problem 
children.” An additional ten people came for study in the general 
field of child and youth welfare. Three social workers received 
training in medical social work. 

Appointments were arranged also for 182 short-term visitors from 
59 countries. Of this number, 114 were interested in child and youth 
welfare, 52 in maternal and child health, and 16 in a combination of 
maternal and child health, crippled children’s programs, and child 
and youth welfare. 


INFORMATION FOR PARENTS AND THOSE WORKING WITH CHILDREN 


In March 1958, the Government Printing Office reported that four 
of the five best-selling Government publications were those of the 
Children’s Bureau, including /nfant Care, Prenatal Care, Your Child 
From One to Siw, and Your Child From Six to Twelve. The fact 
reflected both a heavy demand from the public for information about 
children, and a long history in the Bureau of reporting information 
which could contribute to the well-being of children and advancement 
of services in their behalf. 

The Division of Reports is the Bureau’s central channel for imple- 
menting its reporting function. Working with administrative and 
technical staff in developing written and visual materials, it released 
during 1958, 26 new and revised publications, while 13 more were 
in press at the end of the year. Five of the 39 were directed to 
parents and 34 of a technical or professional nature. 

In addition, information on children’s problems and services was 
supplied to press and other media, or given in response to queries 
from parents themselves. Nearly 150 direct requests came from news- 
papers, magazines, professional journals, broadcasters, and other com- 
munication channels. 


Federal Credit Unions 


Substantial growth again characterized the Federal credit union 
program in fiscal year 1958. Charters were issued to 617 new groups, 


70 Department of Health, Education, and Welfare, 1958 


and 810 credit unions entered liquidation during the year, bringing 
the number of active charters to 8,992 on June 30, 1958. As member- 
ship, savings, and lending activities continued to increase, asset ac- 
‘cumulation moved up to a new high level. By the middle of the fiscal 
year, median assets exceeded $70,000, and 340 Federal credit unions, 
or 4 percent of the total number in operation, had assets in excess of 
$1 million. 

Total assets moved up to about $1,860 million on June 30, 1958, an 
increase of 14 percent during the current fiscal year in contrast to a 
19-percent rise in the preceding twelve months and a 22-percent gain 
during fiscal year 1956. Members’ shareholdings increased at about 
the same rate—14 percent—during fiscal year 1958. Active member- 
ship in Federal credit unions exceeded 50 percent of the potential num- 
ber eligible for membership for the first time during the fiscal year. 
By the end of June 1958, more than 5 million individuals held mem- 
bership in a Federal credit union while another 5 million who were 
included in the field of membership had not yet joined by the end of 
the fiscal year. 

Individual credit unions made significant progress during the fiscal 
year in strengthening their financial position in the face of rising de- 
linquency rates. In order to combat the trend toward slower repay- 
ment of loans, many credit unions set up special reserves or increased 
their regular reserve by setting aside out of undivided earnings an 
amount in excess of the required 20 percent of their net income for 
the year. The fiscal year for Federal credit unions is the 12-month 
period ending December 31. At the end of 1957, reserves in all Fed- 
eral credit unions exceeded loans classified as delinquent by 20 percent. 
Regular and special reserves set aside to protect members’ sharehold- 
ings increased 27 percent in 1957 in contrast to a rise of only 16 percent 
in shares. | 

After intensive study by the Washington and Regional Office staff 
of the Bureau, a new examination procedure was developed and put 
into effect early in 1958. The new procedure was designed to achieve 
more nearly uniform examinations throughout the country by the 
institution of examining techniques culled from the experiences of 
examiners in all areas. Standardization of numerous work papers, 
and development of printed sets of report forms are expected to enable 
the examiners to complete a thorough examination in less time, and 
thus reduce the expense to the credit unions for these examinations. 
Emphasis has been placed under the new examination procedure on 
activities of the Supervisory Committee. 

The work of this committee is of major importance to the credit 
union, and may very well represent the difference between success and 
failure, particularly among newly organized units. The Supervisory 
Committee is responsible for periodic internal audits of the credit 


Social Security Administration 71 


union in order to ascertain that all actions of the directors and officers 
conform with established procedures and are in the best interests of 
the members. Under the new examination procedure, the Bureau will 
determine whether or not the Supervisory Committee is carrying out 
its responsibilities, and will be in a better position to render effective 
assistance to the credit unions. | 

The heaviest workload of the Bureau is in the examination activity. 
For many years, the Bureau has been faced with the problem of 
recruiting and training a sufficient number of examiners to keep up 
with the increasing workload as the program continues to grow. Dur- 
ing fiscal year 1958, the Bureau was able to recruit a full staff of 
examiners for the first time. Henceforth, a regular examination of 
all Federal credit unions will be scheduled annually. In the current 
fiscal year, the Bureau completed 8,693 examinations of Federal credit 
unions, or 22 percent more than the number completed during fiscal 
year 1957. 

There were no amendments to the Federal Credit Union Act during 
fiscal year 1958. 


Table 1.—Social Security Administration: Funds available and obligations 
incurred, fiscal years 1958 and 1957 7 


[In thousands; data as of June 30, 1958] 


Funds available 2 Obligations incurred 
Item 
1958 1957 1958 1957 
PL Ole et be are rol Flr se seit fat voce Us $1, 960, 587 | $1, 741, 948 | $1,937,598 | $1, 751, 997 
Grants to States: 

WC TESS SEAM COs 2 ooo esa nano eon o ccc ane 3 1, 767,177 | 41,575,000 | 1, 745, 173 1, 586, 361 
old-age assistance a. feo eset tile came) Foc padtlon. eventos! Was, ceisleus 1, 052, 708 993, 284 
25h ONO) CIM GS UIT Kg (SI a 3 1, 767,177 | 4 1, 575, 000 44,192 41, 361 
AAG to.dependent:childrenes tes. settee 22ceS 1b lscwes seoecle sec cclecss 525, 318 443, 210 
Aid to the permanently and totally disabled_-._|__..._.__.-_]__--_------- 122, 955 108, 506 

Maternal and child health and welfare services-_-_-_- 41, 500 39, 361 40, 722 38, 253 

Maternal and child health services.._........-.---- 16, 500 16, 000 16, 336 15, 498 

Services for crippled children......_-._.....-------- 15, 000 15, 000 14, 847 14, 835 

@hitdswelfane:services yo22- J2oo). sedsu sek suseces cs 10, 000 8, 361 9, 539 7, 920 

Administrative expenses: 5 

Office of the Commissioner 6___....----...-.-------- 541 - 372 504 361 

Bureau of Old-Age and Survivors Insurance 7- - ---- 144, 692 121, 500 144, 449 121, 413 

Bureau of Public Assistance_..-..-....--.---.-.---- 1, 982 1, 748 1, 97 1, 730 

Cimdhen a Bureaus. 5 22S. k a cee eke kaso 2, 048 1, 822 2, 045 1, 811 

Bureau of Federal Credit Unions.....--._--..------ 2, 647 2, 145 PASTISS| 2, 068 


1 Funds available and obligations reported by administrative agencies. 

2 Funds made available by regular and supplemental appropriations, authorizations, transfers, allotments, 
recoveries, and fee collections for services rendered. 

3 Excludes $3.4 million transferred to other DHEW appropriation accounts pursuant to P. L. 85-472 for 
meeting portion of increased pay in 1958. 

4 Excludes $11.4 million spent from 1958 appropriation for 1957 requirements. 

5 Funds made available and obligations incurred for salaries, printing and binding, communications, 
traveling expenses, and all other objects of expenditure. 

6 Appropriations by Congress from general revenues accounted for approximately 56 percent of the ad- 
ministrative expenses of the Office of the Commissioner in 1957 and 1958; balance from old-age and survivors 
insurance trust fund. 

7 Administrative costs of the old-age, survivors, and disability insurance program which involved ben- 
efit payments of $6,515,000,000 in 1957 and $8,043,000,000 in 1958. Does not include eonstruction eosts of 
new building as follows: Funds available; 1958, $30, 140, 163; 1957, $24,491,787. Obligations incurred: 1953, 
$22, 370, 702; 1957, $61, 624. 

8 Includes expenses for investigating and reporting on matters pertaining to the welfare of children au- 
thorized by the act of 1912, as well as expenses for administration of grants to States. 


72 Department of Health, Education, and Welfare, 1958 


Table 2.—Financing social insurance under the Social Security Act: Contribu- 
tions collected and trust fund operations, fiscal years 1956—58 


[In millions] 
Item 1958 1957 1956 
Contributions collected under— 
Federal Insurance Contributions Act: ! 
Retirement angisunvivor. aies2 sees eaece cae ae eee ee eae $7, 269 $6, 540 $6, 442 
Disabilitys4zi tls vere we ey ee ee Sere ee ee 925 SE bd| tee Ae ee sali 
Mederal Unemployment a axcA Cheese an see ae eee 336 330 325 
State unemployment insurance laws 4 5_.___-...---.-----.------ 1, 500 1, 537 1, 329 
Old-age and survivors insurance trust fund: 

Receipts total sic sare eee CEE ee eee re rae PO eee ee ee 7, 826 7, 100 6, 937 
Transfers, appropriations, and deposits !__...--------------- 7, 269 6, 540 6, 442 
Interest and profit on investment 6_..___..-...--..----.----. T 657 561 495 

Pxpendituress total --2e2 tee ee ee ee ee ee 8, 041 6, 665 5, 485 
Monthly benefits and lump-sum payments 8_______.-.------ 7, 875 6, 515 5, 361 
AGiMiIniStration 9250-6 SERS. R aa ee eee 166 150 124 

Assetscendiofiyear. “22 CT eeey _ st. ee Pte pe ee eee 22, 814 23, 029 22, 593 

Disability insurance trust fund: 2 

Receipts; total’. 2.29 5 .eeae per iee 2 Voret Se eee ees bees a See 941 SBO4)2 eee Ser eee 
Appropriations and Ceposits tas. eae see eee 925 Bey Wend gaps 2s liye 
Interest and profitonsinvestmenti-s 228 =. sss 716 gE oe ae Aero ee 

Hxpenditures.:totalies 7 ieee ee See ee ee eee ee 180 WE PS ae AS at SE? 
Monthiy: benefitsy§ 1 rte: see ner cee eee wanes & eres 168° 2 £84. oe | eee poe 
Administration: 2. 32408. eee ees Fe Se Se ewe ee 12 1S | Sears 

IASSCESWEMC OL Gal. eee eee 2 ee ee et ee eR ee 1, 097 San (45: 28 sere 

State accounts in unemployment trust fund: 

Receipts: totalua crs. b. See Ff eer Pu ee ee A ee 1, 724 1, 790 1, 520 
Deposits. sss 22. eee teers Feed See ee See 1, 501 1, 578 1, 333 
TnteneSta 228 20) eke se ee ee ee nae ee a ee ere ee ee 220 212 187 

Waithdrawalsifor: benefit pay ments>2. 2. 22 ee ee eee 2, 926 1, 513 1, 287 

ASSEUS <ONG (OL VOaTs cee a een = sae sin eae ers ee es es 7, 360 8, 492 8, 216 


1 Contributions on earnings up to and including $4,200 a year beginning Jan. 1, 1955. Contribution rate 
paid by employers and employees: 2 percent each through Dec. 1956 and 214 percent each beginning Jan. 1, 
1957, the additional 4 percent each being for disability insurance. Contribution rate paid by self-employed: 
3 percent through Dec. 1956 and 33 percent beginning Jan. 1, 1957 (the additional 38 percent for disability 
insurance). Includes deposits by States under voluntary agreements for coverage of State and local em- 
ployees. Includes deductions to adjust for reimbursement to the general Treasury of the estimated amount 
of taxes subject to refund on wages in excess of wage base. 

2 Under the 1956 Amendments to the Social Security Act, Federal disability insurance contributions 
began Jan. 1, 1957, and benefit payments began Aug. 1957 (for July 1957 eligibility). 

2? Tax paid by employers of 8 or more through 1956, beginning Jan. 1957 by employers of 4or more. Em- 
ployers offset against this tax—up to 90 percent of the amount assessed—contributions which they have 
paid under State unemployment insurance laws or full amount they would have paid if they had not been 
allowed reduced contribution rates under State experience-rating provisions. Rate is 3 percent of first 
$3,000 a year of wages paid to each employee by subject employer; because of credit offset, effective rate 
is 0.3 percent of such wages. 

4 Contributions plus penalties and interest collected from employers and contributions from employees, 
reported by State agencies. 

4 5 Contributions and deposits by States usually differ slightly, primarily because of time lag in making 
eposits. 

§ Includes interest transferred from the railroad retirement account under the financial interchange 
provision of the Railroad Retirement Act, as amended in 1951. 

7 Reflects transfer of interest from disability insurance trust fund to old-age and survivors insurance 
trust fund on account of adjusted administrative expenses for prior fiscal year. See footnote 9. 

8 Represents checks issued. 

® Beginning Jan. 1, 1957, subject to subsequent adjustment between the old-age and survivors insurance 
and disability insurance trust funds. First such adjustment in June 1958 for fiscal year 1957 resulted in 
transfer of $9 million from the disability insurance to the old-age and survivors insurance trust fund. 


Social Security Administration 


73 


Table 3.—Old-age, survivors, and disability insurance: Estimated number of 
families and beneficiaries receiving benefits and average monthly benefit in 
current-payment status, by family group, end of June 1958 and 1957 


[In thousands, except for average benefit; data corrected to November 1958] 


Family classification of beneficiaries 


Worker and aged wife._........_-..-__-_-- 
Worker and young wife !___.__._...._____- 
Worker and aged dependent husband.---_-_ 
Worker and 1 or more children. __________- 
Worker, wife aged 65 or over, and 1 or more 
oS Ae SS ee ee 
Worker, young wife, and 1 or more 
co SS aS £5 ek | 
Worker, husband, and 1 or more children... 
SuLVviviontanpilles=. seat 
PA eumWnOOWs stein Ie ee td 
Aged dependent widower_____-_-..-__-_-- 
Widowed mother only !______.-__.-__..__- 
Widowed mother and 1 child___..______-- 


Widowed mother and 3 or more children_- 
Divorced wife and 1 or more children_-___- 
LECSLENT YS O70] Ni SORA) A 6 SR cacao 
PATA CN IVS 1°77 Se A ga 
SICiianoleece ener sk FP ee 
ED ECUNERS fro BUSI MAS SS i rea ee a ee Be 
1 aged dependent parent_______.._-_-.._-- 
2 aged dependent parents__.________-___-- 
Disabled worker families 2_____-__----___.___- 


3 Benefits to children were being withheld. 


June 30, 1958 June 30, 1957 


Average Average 
Number| N ae monthly | Number| NU™mber| monthiy 

hs. bene- | 2mount of bene. | #2mount 

families | ¢ ciaries eae families | goiaries aie 
8, 794.4 |11, 905.3 |__--.--.-- 75050! SAO 7842. Toss. see 
G1659; Oss ( OO Ly (se See ae D Soa le daelOsie ease oe 
4,661.2 | 4, 661.2 $61.80 | 4,092.2 | 4,092. 2 $60. 30 
2,498.9 | 2,498.9 69.50 | 2, 273.0 | 2, 273.0 67. 10 
2 162.3 | 2162.3| 53.00 | 1,819.2 | 1,819.2 51. 70 
1, 835. 4 | 3, 670.8 109.90 | 1,628.4 | 3,256.8 107. 70 
1.0 2.0 107. 00 ff 1.4 100. 00 
13. 7 27.4 94. 00 12.8 25.6 91. 80 
29.9 70.8 104. 00 2152 52.9 101.00 
7.8 23.8 138. 00 3.0 9.2 135, 50 
89. 4 328. 8 128. 00 74, 1 272.0 125. 30 

a) a 132. 00 

iD, 955.5. leo, 01988 | see se. F-3 13748. 621525632..0).| sae 
1,165.5 | 1, 165.5 OL GO AROLT. ZA OLT.-7 50. 70 
1.5 1-5 48. 50 1.3 1.3 47. 30 
1.0 10 49. 00 KS 1.5 49. 00 
149.6 299, 2 116. 60 134. 6 269. 2 111. 70 
102. 6 307.8 148. 70 92.6 Diidiend 143. 70 
97.2 461.4 147. 90 87.4 414.6 141. 70 
a} avi 133. 00 so wud 135. 00 
254. 9 254. 9 51. 20 237.6 237.6 49. 80 
98. 9 197.8 87. 90 94.3 188. 6 85. 80 
34. 7 104. 1 113. 80 33. 8 101.4 109. 20 
21.6 96. 5 125. 10 21.0 93. 6 117. 30 
26. 0 26. 0 52. 70 24.7 24.7 51. 60 
1.7 3.4 99. 60 1.7 3.4 98. 60 
200. 4 200. 4 i 407 eee Salles eee ee ere 
158.8 158. 8 WO SDM See. 228 S| 2b eee 
41.6 41.6 1 LO Pie ce Salles Ai eae eee 


2 Benefits to disabled workers aged 50-64 began July 1957? 


487270—59—6 


74. Department of Health, Education, and Welfare, 1958 


Table 4.—Old-age, survivors, and disability insurance: Selected data on bene- 


fits, employers, workers, and taxable earnings, by State, for specified periods, 
1955, 1957, and 1958 


{In thousands, except for average taxable earnings; data corrected to Oct. 24, 1958] 


Monthly bene- Em- Calendar year 1955 
fits in eurrent- Benefit payments fiscal |ployers sey 
payment status, year 1958 ! report- 
end of fiscal ing tax- Amount of taxable 
year 19581 . able | Work- earnings 4 
State put be epenivettaly 2 ots cote obo Reb a dn PLE WADES CRS satin 
July- |taxable 
Lump-| Sep- earn- Average 
Num- |Amount] Total | Monthly} sum |tember] ings 3 Total per 
ber benefits | pay- 1957 2 worker 
ments 
Totals sues ss 11, 905. 3/$659, 684|$8, 043, 353/97, 900, 639}$142, 714) 4,150! 66, 000/$157, 700,000} $2, 390 
Alahamal sme 2 22 180.4} 8,075 98, 690 96,713) 1,977 59 990} 1, 734,090} 1, 750 
Wlaskas 2 eho ee 5.3 269 3, 262 3, 187 76 4 70 135,900} 2,040 
Arizona ze (oan B 59.6} 3, 206 39, 227 38, 420 807 23 390 705, 000} 1,830 
Arkansas_=.2.--.-- 121.6) 5,340 65, 091 64,909} 1,082 ahs 560 875,000) 1, 580 
© alifornia ae eat 928.6} 53,436] 651,513} 640,243) 11, 270 351] 5,610} 13,870,000} 2,470 
Coloradofze 2222.2. 98.1) 5,316 64, 815 63, 718} 1,097 4) 640} 1,256,000} 1,970 
Connecticut. ._-...- 188.7} 11,850] 144,335} 141,861} 2,474 66; 1,100) 2,942,000) 2,670 
Delaware_-_--------- 26.9) 1, 548 18, 870 18, 533 337 13 180 427,000} 2,320 
Dist. of Col_.-__---- 41,5] 2,280 27,917 27, 312 605 31 500} = 1, 038, 000} ~=2, 040 
Ploridaxct sts = 357.1] 20,282) 246,364) 243,016] 3,348 116} +1, 530} = 2,591,000} 1, 700 
Georgia.c ost t. 186.9} 8,457} 103,496} 101,289) 2,207 80} ..1,.830| . 2;330;.000} = An750 
Hawali.l ee seer 24.8} 1,259 15, 361 15, 128 233 12 170 387,000) 2, 220 
Tdaho.2 2 43.5) 2,287 27, 874 27, 431 443 15 250 482,000} 1,910 
Hlinoistes se See 695.9} 41,314) 504,104} 494,716) 9,388 240; 4,430) 11,312,000} 2, 550 
Indiana 2 te aes Fe 348.2} 19,583} 238,584) 234,584) 4,000 96] 1,960) 4,463,000} 2, 280 
TOW Ee. so re a 211.6} 11,398) 138,742} 136,629) 2,113 69] 1,100} 2,344,000) 2,130 
WCANSSS oe Sate oo Se 155.6} 8, 149 99, 157 97,684] 1,473 51 860} 1,670,000} 1,940 
Kentucky seteass" 210.7) 9,932) 121,071} 119,017) 2,054 58 980} 1,853,000} 1,890 
Mowisiangs2 esse 137.2} 6,451 79, 124 77, 269} 1, 855 64 920} 1,856,000; 2,010 
Mginen 2 seek 2c ss 88.4) 4,654 56, 690 55, 756 934 25 400 735, 000} 1, 820 
Moryland. 223° 5.2- 159.3} 8,784) 107,625} 105,182) 2,443 71; 1,040) 2,294,000} 2,200 
Massachusetts-__.._- 441.9) 26,501) 322,859) 317,291] 5,58 127; 2,170) 5,120,000} 2,260 
Michigan__._..----- 509.3} 30,806] 375,387} 368,898! 6,489 160} 3,370} 8,742,000} 2,600 
Minnesota._._--_--- 234.7) 12,874) 156,832} 154,327) 2,505 75) | ol, 230) 2, 657,.000he G2, 160 
Mississippi-_-_-_-.---- 114.1} 4,635 56, 645 55, 593} 1,052 35 570 902,000) 1,570 
IMbissouria.- © ses. 8 325.6} 17,605) 214,698} 210,912) 3, 786 103} 1,780} 3,861,000} 2,170 
Montana-_-_-.------- 46.2} 2,565 31, 265 30, 764 501 16 280 559,009} 1,990 
Nebraska_-__-------- 102.1; 5, 408 65, 943 64,840} 1, 103 35 590} 1,083,000) 1,840 
Nevadars. shertee 124 694 8, 552 8, 319 233 7 140 235,000] 1, 690 
New Hampshire---- 54.5] 3,051 37, 202 36, 558 644 17 280 542,000} 1,940 
New Jersey__------- 437.3} 27,005} 329,625} 323,297) 6,328 154} 2,550! 6,050,000} 2,370 
New Mexico___----- 34.2) 1, 563 19, 077 18, 753 324 Wn 230 381,000} 1,670 
Newiyorkicse2ea02 1, 245. 7| 74,512} 909,295) 892,332) 16, 963 512} 7,790} 19,624,000) 2,510 
Nortb Carolina_-_-- 227.0} 10,219) 125,145) 122,414) 2,731 90} 1,620) 2,677,900} 1,650 
North Dakota__-__-- Sosole. a S23 22, 241 21, 875 366 13 210 367,000} 1, 750 
Obig ee hes eee 661.5} 38,901] 474,274) 465,816) 8, 458 207} 4,290) 11,290,000} 2, 630 
Oklahoma. -_--_------ 140.7| 7,005 85, 377 83,953} 1,424 52 870} 1,624,000} 1,870 
Orevoniot 2 ee ee 144.9) 8,237} 100, 204 98,747) 1,457 44 770} 1,721,000; 2,240 
Pennsylvania_____-- 881.8} 51,726] 630,191) 619,090} 11,101 257| 4,680) 11,558,000} 2,470 
Puerto Rico__...--- 67:3). 2, O11 23, 568 23, 270 298 16 430 382, 000 890 
Rhode Island_-____-- 76.0} 4,485 54, 580 53, 689 891 22 410 865, 000} 2, 120 
South Carolina-_--_-- 111.7; 4,926 60, 377 58, 991 1, 386 45 720} 1,220,000} 1,690 
South Dakota___-_-- 46,5) 2,417 29, 429 29, 002 427 16 220 414,000} 1,840 
Tennessee _ __.....-- 199.9} 9,025) 110,125) 108,142) 1,983 73} 1,140} 2,054,000} 1,810 
‘Texas? foe eee 445.7| 21,749} 265,962} 260,624) 5,338 223} 3,389) 6,781,000) 2.010 
Witahe 2% i. hee. 45.1] 2,462 30, 018 29, 520 498 16 350 672,000} 1,920 
Vermont___..------- 32.9) 1,780 21, 352 20, 960 392 11 160 331,000} 2,970 
Virgin Islands_-_-__-- ot 26 303 302 1 1 10 6, 000 47 
Virginias 2252 211.6) 10,223; 124,927| 122,425; 2, 502 84) 1,340] 2, 853,00C; 1,910 
Washington ____-__- 208.0} 11,995} 145,991! 143,713) 2,278 65| 1,020}; 2,330.000) 2,290 
West Virginia_____. 150.4) 7, 669 93, 295 91,812} 1,483 37 600} 1,265,000} 2,120 
Wisconsin. __.__---- 300. 6] 16,948} 206,522} 203,039] 3, 483 91 1,550} 3,817,000} 2,470 
Wyoming.._.._____- 17.4 946 11, 539 11, 348 191 9 150 266,000} 1,800 
Worelen$s~ oe ae 72.9} 4,055 48, 640 48, 326 314) eee 50 149,000) 2, 760 
Maritime 6 ooo. 3 2 fen ce a he ee ah ke ee ian ce 150 394,000} 2, 690 


1 Distribution by beneficiary’s State of residence estimated. 

2 State data represent number of empioyers 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 employcd. 

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 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. 

6 Relatse to employment of officers and crews of American vessels. 


Social Security Administration 


v5) 


Table 5.—Old-age, survivors, and disability insurance: Selected data on benefits, 
employers, workers, and taxable earnings for specified periods, 1956—58 


[In thousands, except for average monthly benefit and average taxable earnings; corrected to Oct. 24, 1958] 


Item 1958 | 1957 1956 
‘ Fiscal year 
Benefits in current-payment status (end of period): 
(Ean ROSE RS ag a Sea Se ae y e oo ee Sg ee ee 11, 905. 3 10, 342. 1 8, 374. 5 
COULCESESLZS i el, 0 SU cS Sa a oe 6, 638. 5 5, 832. 3 4,731.9 
Re OMiUSDaAnd Sen en rn ree See oe 1, 947.4 1, 719.0 1, 255. 0 
Rectan te ee ace ee oe rs ee ee 1, 571.9 1, 427.4 1, 316. 7 
nme SOF WLOOWE! 8. eee eet 1,172.8 1, 020. 5 747.8 
EDEN ONE QQ pn Sa cee a a a A 344. 9 314.9 297.3 
Penance eter Sha ce. ne eS OS 29. 4 28. 1 PAST 
POISAD Min Aseee ee een we Seow ed oeeeee se ee wesc PLN UY. Nf Ce > SS te) Ne Se games a 8 
PROLaInonenlycaImoun tess 2.26 So soos ones Sess Ses Pais $659, 684 $554, 637 $439, 424 
Nn 5 kn cae eek ean ag de ac 4x $436, 244 $373, 230 $296, 976 
NV ersiOr NUSODaNG S- sel. St Quel ane tese Cee a ee $67, 821 $58, 749 $41, 968 
CLES OS) Ts EV Sea aa peepee, ee ieee $61, 471 $54, 283 $48, 662 
Pied Om cre IGOWOI Ss... Soo ee $60, 457 $51, 707 $36, 648 
IV POMC Nan een ae Se ae a et oe ele ol ws See $17, 241 $15, 224 $13, 876 
Teno ae eee ee ae ee en Rone eee See ee ee ee $1, 538 $1, 445 $1, 293 
BOIS, Vea Se oe ee to te STATO ee ee | ee, 
Average monthly amount: 
Jah od) hn opm a ta ta a A SS $65. 71 $63. 99 $62. 76 
Waterson muspand Sisco. . 22 = coo. ole Sek ee eee $34. 83 $34. 18 $33. 44 
CIES seca a ye le ng aid el a reali i eee $39. 11 $38. 03 $36. 96 
Widows OrawidOWwer So. 2=—.--262 2262. 3 ee $51. 55 $50. 67 $49. 01 
TOULOUSE DVT Sis oli 5 a A Ss cp aie i> $49. 99 $48. 35 $46. 67 
ACG Sten et re err Se ree edascccnewenaaweeels $52. 34 $51. 38 $50. 31 
SDT 21 oS gC Rn Hi a a aS Loge ae > He ar Pf: t8: (A » Se ne = ner,” 
Benefit payments during period: 
nla OR GUNG a] Ofc) 0.5) i MSc a ae ae ag ee ea $7, 900, 639 $6, 391, 690 $5, 245, 476 
Cong EDISTO ern $5, 245, 778 $4, 340, 271 $3, 531, 824 
GE ae ee Sl ee, Saeco a $860, 488 $679, 289 $531, 831 
SINAN RO eee ee ee eee $1, 625, 953 $1, 372, 130 $1, 181, 821 
oJ SETI TILE. ae ig nh aD pp alae a eg a a ale SIGS 420) |: Se se Spe a 
MEPS AO MIONTSa0. ce ee oa eee ee SE $142, 714 $122, 891 $115, 337 
Insured workers (midpoint of period—Jan. 1)3___.___-------_-- 74, 000 ei 70, 900 
LDV SP WEISTUE SY (eat a I cep ee ee ee 73, 000 72, 200 70, 100 
Current yapiuih NOL ily imsured = 1, 000 300 800 
Estimated number of employers reporting taxable wages, Ist 
Gilatte Ot nSeWLVOOl 50 <2. on Wb. onncn gece ncpeobectosens 44,150 44,050 4 3, 950 


Calendar year 


Estimated number of workers with taxable earnings__._---_-- (5) 74, 000 68, 000 
Estimated amount of taxable earnings____-_------------------ (5) $183, 000,000 | $170, 000, 000 
LAS SESE He GY OU LEM ST ig 9 1 TD ee  e  e pe (5) $2, 470 $2, 500 


1 Data for 1957 and 1958 include benefits payable to disabled persons aged 18 or over—dependent children 
of deceased or retired insured workers—whose disability began before age 18. 

2 Monthly benefits to disabled workers aged 50-64. 

3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising 
from: (1) provisions that coordinate the old-age, survivors, and disability insurance and railroad retirement 
programs and (2) wage credits for military service. Estimates are only partially adjusted to eliminate 
duplicate count of persons with taxable earnings reported on more than 1 account number. 

4 Excludes agricultural employers. 

5 Not available. 

6 Rounded to nearest $10. 


Department of Health, Education, and Welfare, 1958 


76 


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16 'F9 869 ‘OT 6 E¢ G00 ‘F 0°22 OFZ ‘GZ 8 "C9 6PL ‘$8 z00 ‘2 PLT S E92 ‘ST 160 ‘9¢ Toe. eee ee ~~~ TIMOSsT AL 


80 Department of Health, Education, and Welfare, 1958 


Table 8.—Maternal and child health and welfare services: Grants to States for 
maternal and child health services, services for crippled children, and child 


welfare services under the Social Security Act, by program and State, fiscal 
year 1958 * 


[In thousands] 
Maternal Crippled Child 
State and child children’s welfare 
health services services 
services 

United States: 2) 2s. ee ee $16, 336. 4 $14, 846. 7 $9, 539. 5 
Alabama ooo ccs se et wo ee ee eee ee 536. 6 504. 0 297. 5 
Alaska”. 0 S28 Se eS a ee eae ee ee 120.8 193. 2 47.6 
ATIzOn gee oo. ee Se ee ee oe ee ee 15]: 2 | See 90. 4 
Arkansas 5 28s Re 10 See As pce ames omental ape oe ee 276. 8 266. 5 210. 4 
California cS ecccl ec kL ee 833. 6 731.2 342. 6 
Colorado. 222 See bs ee Be eee ee 313. 4 166. 4 113.9 
Connecticut. 22.0202 35 et ee eee See 257.9 214. 5 90. 1 
Delaware s.& - 40 ee Cd ae ee re ee ee eee 111.9 94.6 51.3 
District-of-Columbisvs =e es eee eee 201.9 169. 1 33.3 
Mlorida ee: 2 ee er ee ere en eer eee 379.3 247.9 184. 2 
Goorgia® 22288 ee ee cee ee 449.8 460. 4 331.8 
await: oP ee ee es a ee te ee 206. 0 136. 5 56. 4 
Tdahto. 225 ee Pe Se ee en ee eee 165. 4 106. 4 B94 Tf 
Dinos. 2.2... cc jceeuecese decsctisetese seen kod sas aeeeeunren 468. 3 448. 6 295. 0 
Indiana® 23-2422 oo a ee aE oe eee ee 309. 7 242. 3 119.0 
Towat.c2e oie oo ee ee ee eee 168. 6 288. 9 214. 6 
Karnsasgit hoo) 52 Lie. oo ee eee ee re 178.1 199. 1 151.8 
Kontucky 32.3 2s. 22a ee ee eee 368. 7 427.5 307. 2 
Woulsiana rs. 2555202 Se oo Se ee ee eee 371.9 356. 2 240. 0 
Maine: 2: 252-0220. Je ee ee er eee 133. 8 114. 8 90. 2 
Maryland 2.02.26. 50 2d eee 4 ere 396. 1 284. 5 141.8 
Massachusetts. 2 oe se ee eee ee eee 417.7 311. 5 98. 4 
Michigan -"¢ 200 Sas oe 2 oe ee oe ae ee eee 515. 7 502. 1 325. 0 
MiNmESOtas: Ses ao et a PS ee ree eee ee ae 335. 0 400. 8 233. 8 
IMASSISSIDDEa. lee see we eae te ara ce Rare spent, ns eee ee 400. 9 297.7 274. 4 
Missouri? 522. Soe ee ee ee eee 317.6 307. 3 237.9 
Montane. 22225595. See LE Se ees 123. 3 144, 2 81.8 
Nebraska 522 ee. Se ee a ee eee ee 115.1 131.2 77.5 
INGVada ke. 2. 8 go ae ee ee eee 150. 6 67.6 21.0 
Newt ELampshire se. Pe eee eee he ee 97.6 105. 2 61.3 
New? Jersey... «....2ssteseeceete ne nee le eRe nes re 205. 7 205. 4 109. 0 
INewsMiexieos2. 303s 2 oe oo ee eee eee 203. 9 140. 2 95.3 
New Y ork 2... 22-22 22 ee ee eee 742. 5 560. 4 283. 3 
Worth: Caroling. $2202 Cee a a ee ee ee 647.3 613. 1 450. 3 
INoréh: Dakotas. 2.2222 Lo: Si eee ie cee eee 113.6 105. 5 99.9 
ONO) 2522s 50 bc Oe Ce Se ee ee 563. 4 497.1 375. 4 
Oklahoma 3228-2620 25.2 eel ee eee eee 240. 8 257.0 179.0 
Orefon. .@ 5.2 2s ee ee eee eee 148.0 176.1 111.3 
Pennsylvania:: oso. See eee ee eee 713. 4 657.6 441.8 
PUeEto RIC0s So. ku c3 0 Se ee ee ee eee ee 382. 7 413. 5 277. 5 
Rhodewsland 22. Fo ae ee ee ee alee 127.6 93.8 48.0 
South Caroling. 2.220... Be eee ee ee Sisne 368. 8 261.8 
South Dakotal i222... 2 eS ee Eee eee ee 73.3 79.0 94.6 
"TANNOSSRO 5.0 ones oda conse ae eee eee eee = ee 521.9 474. 6 303. 1 
"ROX8SS Se cessed oe oe eee ee Ree eae eee 699. 5 706. 0 476.8 
Utah. 294 2202 ee ee epee eae note er ae 147.5 175.6 77.5 
Vier MOnG 22. oh ba oo I ee eee ee a eee 105.6 91.9 64.1 
Mirgin Islands...2.2..0. 0 22 3 2 eee. Se eee 93. 3 87.5 34.9 
Mirginiay 22022 8 co ee ee eee eee 522. 1 398. 5 263. 1 
Washington i202. 2 a ae. Bee ee 259. 4 170.6 140. 5 
Woosh Virginia... insedewtcniwnsSeguaesbenseoewweeneneerees 233. 4 247. 5 224. 6 
Wisconsin Be 5 Ee I TEs 237.0 322. 4 241.3 
Worn dn Os SS es 2 Es a ee ea a Be ee 108. 0 84. 4 33. 5 


1 Based on checks issued less refunds. 


Social Security Administration $1 


Table 9.—Federal credit unions: Number of members, amount of assets, 
amount of shares, and amount of loans outstanding, Dec. 31, 1935—57 * 


Number of 
operating Number of Loans out- 
Year Federal members Assets Shares standing 
credit 
unions 
Os jee ee LHP: 119, 420 $2, 372, 100 $2, 228, 400 $1, 834, 200 
HUB. Lo a eS ee ea ea 1, 751 309, 700 9, 158, 100 8, 510, 900 7, 343, 800 
OS (eee ee 2, 313 483, 920 19, 264, 700 17, 649, 700 15, 695, 300 
IRE. o oS oa 2, 760 632, 050 29, 629, 000 26, 876, 100 23, 830, 100 
GES) ee 3, 182 850, 770 47, 810, 600 43, 326, 900 37, 673, 000 
IND) SS re 3, 756 1, 127, 940 72, 530, 200 65, 805, 800 55, 818, 300 
(MOAUL A! Se 4, 228 1, 408, 880 106, 052, 400 97, 208, 900 69, 484, 700 
EO ee ee ok kk 4, 145 1, 356, 940 119, 591, 400 109, 822, 200 43, 052, 500 
4 cy eee ete ee we ek 3, 938 1, 311, 620 127, 329, 200 117, 339, 100 35, 376, 200 
IES Ss NO eae 3, 815 1, 306,000 | 144,365,400 | 183, 677, 400 34, 438, 400 
DS oN sy 5 = Se Sloe 1, 216, 625 153, 103, 120 140, 613, 962 35, 155, 414 
jAPANG ca ee 3, 761 1, 302, 132 173, 166, 459 159, 718, 040 56, 800, 937 
WAG 57 Se ee 3, 845 1, 445, 915 210, 375, 571 192, 410, 043 91, 372, 197 
(ISS = nye Se a ae 4, 058 1, 628, 339 258, 411, 736 235, 008, 368 137, 642, 327 
TAGVNR DS oe ah i ee re 4,495 1, 819, 606 316, 362, 504 285, 000, 934 186, 218, 022 
LO SUE e meee case eel 4, 984 2,126, 823 | 405,834,976 | 361, 924,778 263, 735, 838 
DE EL ek ee 5, 398 2, 463, 898 | 504,714,580 | 457, 402, 124 299, 755, 775 
Ogos fo 5, 925 2, 853, 241 662, 408, 869 597, 374, 117 415, 062, 315 
OR es 8 6, 578 3, 200, 422 854, 232, 007 767, 571, 092 5738, 973, 529 
LE oo Se 2, See ie eee Wea 3, 598, 790 |1, 083, 179, 042 931, 407, 456 681, 970, 336 
(OE oo RS ee 7, 806 4, 032, 220 |1, 267, 427,045 |1, 1385, 164, 876 863, 042, 049 
URS. a eee 8, 350 4, 502, 210 |1, 529, 201, 927 |1, 366, 258, 073 | 1, 049, 188, 549 
es eee eer pee 8, 735 4, 897, 689 |1, 788, 768, 332 |1, 589, 190, 585 | 1, 257, 319, 328 


1 Data for 1935-44 on membership, assets, shares, and loans outstanding are partly estimated. 


Table 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1957, and 
Dec. 31, 1956 


Amount Percentage dis- 
tribution 


Assets and liabilities 
Change Dee. 31, | Dec. 31, 


Dec. 31, 1957 | Dec. 31, 1956 during 1957 1956 
year 

Number of operating Federal credit 
CV serene ee eee ee ee oe 8, 735 8, 350 Peto h it be cayenne a a ets Sega 
MOvanassetsete es ee ee $1, 788, 768, 332 |$1, 529, 201, 927 | $259, 566, 405 100. 0 100. 0 
Loans to members. 2. 22... 2:----- 1, 257, 319, 8328 | 1, 049, 188,549 | 208, 130, 779 70.3 68. 6 
‘CRGID So Se ee ee 135, 115, 485 118, 900, 595 16, 214, 890 7.15 7.8 
wmited states bonds... — (222-2 2_- 90, 921, 596 88, 009, 631 2, 911, 965 Biel 5.8 
Savings and loan shares_______-.__--_- 251, 614, 676 228, 565, 099 23, 049, 577 14.0 14.9 
Loans to other credit unions__-.-_-_--_- 38, 827, 893 31, 647, 416 7, 180, 477 Ph, Pesil 
iandiande buildings 2k ka 4, 587, 837 3, 449, 730 1, 138, 107 .3 Re 
OU OYS 6 SITS a al SS 10, 381, 517 9, 440, 907 940, 610 6 6 
MPotarmiaiities:2..22- 22222 2c 22 1, 788, 768, 332 | 1, 529, 201,927 | 259, 566, 405 100. 0 100. 0 
Notes payable Scapa pelea epi a 41, 281, 715 34, 572, 441 6, 709, 274 a3 eS 
Accounts payable and other liabilities_ 5,273, 78 4, 344, 517 929, 264 vo .3 
SUD SES) a a 1, 589, 190, 585 | 1, 366, 258,073 | 222, 9382, 512 88. 9 89.3 
Huecmlar reservie.s.- 8-02. 2 ti. 62, 344, 129 49, 668, 568 12, 675, 561 3.5 BY 
Special reserve for delinquent loans--_- 8, 674, 115 3, 469, 216 204, 899 Aes 2 
Other reserves i. 3-22 so 222252 5.5 522 2, 536, 571 692, 884 1, 848, 687 nal sul 
Wneivided-earmings. _222/Li2.22 0-2). 2- 84, 467, 436 70, 196, 228 14, 271, 208 4.7 4.6 


1 Reserve for contingencies and special reserve for losses. 


Ft te be pba “or 
a a a a aiacaie ate 


£ apa aed 


aed wee shea lebeoege Baw 


Public Health Service 


Health of the Nation 


THe AMERICAN PEOPLE continued their march toward better health 
during the past year. The Nation’s health status remained high, 
despite the impact of a worldwide influenza epidemic in the fall and 
winter of 1957. Public interest in health activities continued to grow 
and expenditures for health purposes again rose. This interest and 
support resulted in significant progress in such major areas as re- 
search, health manpower and facilities, and public health practice. 

Medical research probed deeper into the basic processes affecting 
life and health. At the same time, there was widespread study of 
specific techniques to add to the skill, equipment, and resources of the 
Nation’s health workers. 

The growth of training programs, particularly those aided by the 
Federal Government, helped to expand the national reservoir of 
health manpower and to increase its professional competence. 

The Nation’s health facilities, especially those geared to the needs 
of long-term care and chronic disease, continued to expand. 

Wider use of new scientific knowledge helped save lives, prevent 
disability, and restore some measure of independence to thousands of 
ill and handicapped people. Health leaders agreed, however, that an 
unfinished task of utmost importance is to reduce the lag between the 
discovery and application of knowledge. 

The responsibilities of the Public Health Service continued to 
grow in response to these and other current challenges to health. AlI- 
though there were few new legislative measures in fiscal year 1958, 
increased appropriations and administrative actions resulted in the 
expansion of several programs. ‘These developments and other sig- 
nificant activities of the year are covered in the pages that follow. 

83 


84 Department of Health, Education, and Welfare, 1958 


HEALTH RECORD 

The vital rates that measure the Nation’s health have shown a very 
different picture for the two extremes of life during recent years. 
Great gains in life expectancy for the young have been accompanied 
by increases in death rates for conditions characteristic of the latter 
part of life. 

The death rates for infants under 1 year and for mothers in child- 
birth, for example, have declined in the last decade. The infant death 
rate dropped 18 percent, from 32.2 deaths per 1,000 live births in 
1947 to 26.3 in 19572 The maternal mortality rate for 1957 was 3.9 
per 10,000 live births, compared with 13.5 in 1947—a 71-percent drop. 

Deaths from childhood disease also declined sharply. Scarlet fever 
and streptococcal sore throat, diphtheria, whooping cough, and 
measles caused about 8 deaths for every 100,000 youngsters under 15 
years of age in 1947. In 1957, however, these diseases were responsi- 
ble for only about 1 death per 100,000. 

The death rates for a number of infectious diseases which affect 
the young and the old alike have also dropped since 1947. ‘Thus, the 
death rate for tuberculosis was 7.8 per 100,000 population in 1957, 
compared with 8.4 in 1956 and 88.5 in 1947. There have also been 
proportionately fewer deaths from syphilis, particularly among in- 
fants. The epidemic of Asian influenza last year produced an in- 
crease in the influenza and pneumonia death rate (except for pneu- 
monia of the newborn) from 28.2 per 100,000 in 1956 to 35.8 in 1957. 
It also caused a much larger increase in the number of deaths in older 
people with cardiovascular disease. 

Death rates for suicide, homicide, and accidents have decreased since 
1947. While suicides increase with age, homicide is more likely to 
occur in the middle years. Most fatal accidents, except for motor- 
vehicle accidents, tend to occur at the two ends of life. No definite 
trend has been apparent for motor-vehicle accidents, but the death 
rate has remained at a high level. It was 22.7 per 100,000 in 1957 and 
22.8 in 1947. For all other accidents, however, the death rate dropped 
from 46.4 in 1947 to 33.2 in 1957. 

In contrast to the generally favorable picture in the infectious dis- 
eases, the chronic diseases characteristic of the latter part of life con- 
tinued to take heavy toll of lives. ‘Together, diseases of the heart and 
blood vessels and cancer accounted for 70 percent of all deaths in 
1957. ‘The death rate for the major cardiovascular-renal diseases was 
523.7 per 100,000 in 1957, compared with 491.0 in 1947. The 1957 
cancer death rate was 148.7, substantially higher than the 182.3 rate 
of 10 years ago. 

All the trends in the Nation’s health are summed up in the general 
death rate and in life expectancy figures. Over the last few years, 


1 All vital statistics are given for the calendar year. 


Public Health Service 85 


these indicators have remained virtually unchanged, showing a stand- 
off between the forces working for longer life and the forces working 
for death. Since 1946 the general death rate has not risen above 10.1 
per 1,000 population nor fallen below 9.2; it has varied only between 
9.2 and 9.6 since 1952. The rate stood at 9.6 in 1957, slightly higher 
than the 9.4 rate in 1956. 

The average length of life for the entire population increased from 
66.8 years in 1947 to 69.6 years in 1954, but the figure has remained 
practically unchanged since then. It was 69.5 years in 1955 and 69.6 
years in 1956 (the last year for which the life span has been calculated) . 
The average life expectancy in 1956 was 67.3 years for white males, 
73.1 for white females, 61.1 for nonwhite males, and 65.9 for nonwhite 
females. The life span for women has been increasing more rapidly 
than for men, and the gap between the white and the nonwhite popu- 
lation has continued to decrease. 


BIRTHS, MARRIAGES, AND DIVORCES 


The Nation’s birth rate has remained at a high level since the end 
of World War II, while the death rate has declined slightly. About 
4,301,000 live births occurred in 1957, for a birth rate of 25.3 per 1,000 
population. There were 4,218,000 births in 1956, and a rate of 25.2 
per 1,000. Since there were 9.6 deaths per 1,000 people in 1957, or a 
total of 1,633,128 deaths, the rate of natural increase came to 15.7 
persons per 1,000—slightly lower than last year’s rate of 15.9. The 
highest rate of increase in a single year—16.5—during the past 25 
years for which national data are available occurred in 1947. 

The estimate of marriages performed in 1957 was 1,518,000, or 4.2 
percent less than the figure for 1956. The marriage rate was 8.9 per 
1,000 population, compared with 9.5 in 1956. 

The estimated number of divorces granted in 1957 was 381,000, 
less than 1 percent below the figure for 1956. 


INFLUENZA 


In the fall and winter of 1957, the United States experienced its 
most widespread influenza epidemic in 40 years, caused by a new Asian 
strain of the influenza virus. The Service’s National Health Survey 
estimated that about 80 million people spent one or more days in bed 
between July 1 and the end of the year from acute upper respira- 
tory illnesses, a substantial amount of which was Asian influenza. 

Localized outbreaks were reported in this country during the sum- 
mer, and the first community-wide outbreak occurred in a Louisiana 
parish in early August. For the Nation as a whole, the peak of the 
epidemic was reached in mid-October when National Health Survey 
estimates indicated that some 12 million people were in bed during 
the week with respiratory illness, chiefly influenza. 


86 Department of Health, Education, and Welfare, 1958 


The Nation had been alerted to the danger of an epidemic in the 
spring when the disease first appeared in the Far East. A number of 
steps were taken by the Nation’s health leaders to minimize the impact 
of the epidemic which was expected in this country. A new vaccine 
was developed against Asian influenza and rushed into production by 
the pharmaceutical industry. Vaccine began to be available by Sep- 
tember and about 60 million doses were produced by the end of the 
year. 

In the fall of 1957, when the vaccine was in short supply, the produc- 
ers agreed to a voluntary allocation system. This was administered by 
the Public Health Service and enabled each State to receive supplies of 
vaccine which were proportionate to the size of its population. Rec- 
ommended priorities were also established to give first preference to 
those people who were essential in maintaining health and other basic 
community services and to people who constituted special medical risks. 

Cooperative plans were also made for other measures to meet the 
anticipated epidemic. Beginning early in the spring, the Public 
Health Service held a series of meetings with representatives of the 
medical profession, State health officials, voluntary health agencies, 
hospital administrators, and the producers of influenza vaccine. Plans 
were developed for the use of the vaccine, the control of outbreaks, 
and for emergency medical care needs in local communities. An in- 
formation program was carried on to keep the public informed about 
the nature of the disease and the precautions, including vaccination, 
which could be taken. A reporting system was established so that 
the extent and virulence of the epidemic could be checked. And 
State and other viral laboratories were equipped with diagnostic re- 
agents to assist in rapid detection of outbreaks. 

As a result of these activities, a comprehensive program was devel- 
oped before Asian influenza made its appearance in the United States. 
Even though the epidemic struck earlier than had been expected, the 
Nation was well prepared to deal with it. 

Partly because of the preparations, and also because the virus strain 
was generally mild, no serious disruption of community life occurred, 
and medical and hospital facilities were not overtaxed. The most 
serious consequences occurred after the epidemic phase of the disease 
had ended. During January and February of 1958 the death rates 
from influenza and pneumonia rose markedly. Although the reason 
for this rise could not be definitely ascertained, epidemiologists believed 
that the virus was reaching elderly people who had been protected from 
earlier exposure. 

A post-epidemic evaluation of what the Nation had gained from 
dealing with this epidemic included the following: 

1. Knowledge and experience which will enable health leaders to 
predict with greater confidence the course of future epidemics. 


Public Health Service 87 


9. A stronger research program and improved laboratory facilities 
for the study, diagnosis, and surveillance of virus diseases. 

3. A tested pattern of organization which mobilizes public health, 
medical, hospital, voluntary health agency and drug industry resources 
into a coordinated action program. 

4, Evidence that American industry is capable of producing 60 
million doses.of influenza vaccine in 6 months and probably could 
produce even more in an extreme emergency. 


POLIOMYELITIS 


The incidence of paralytic poliomyelitis continued to decline during 
1957 as more and more people took advantage of the protection af- 
forded by the poliomyelitis vaccine. The total number of paralytic 
cases reported in 1957 was 2,499; this was a 68-percent reduction from 
the 7,911 cases reported in 1956 and an 82-percent reduction from the 
13,850 cases reported in 1955, the year the vaccine first became 
available. 

By the end of 1957, at least 45 million people under 40 years of age 
had had one or more injections of the vaccine; most of them had had the 
full initial course of three injections and a few had had a fourth in- 
jection. However, there remained some 66 million people under 40 
who had had no vaccine at all. Consequently, the Advertising Coun- 
cil’s vaccination promotion campaign, which was initiated in the fall 
of 1957 under the sponsorship of the Public Health Service, the Ameri- 
can Medical Association, and the National Foundation for Infantile 
Paralysis, was continued through the spring of 1958. 

Following a brief period of shortage in the spring of 1957, vaccine 
remained in plentiful supply throughout the year. By early 1958, all 
manufacturers were reporting inventories of unshipped vaccine. 


Funds and Personnel 


A total of $718.4 million was available to the Public Health Service 
in 1958. (See table 1, p. 145.) About $565.9 million of this amount 
was in appropriations and authorizations. The balance was made up 
of reimbursements for services rendered to other agencies and in un- 

obligated balances from previous years. 

About two-thirds of the total amount available was allocated to 
agencies and institutions outside the Federal Government in the form 
of grants for research and training, for State and community public 
health programs, and for the construction of hospital and medical 
facilities and of sewage treatment plants. The remainder supported 
the direct activities of the Service, including the operation of PHS 
hospitals, foreign and interstate quarantine, and Indian health 
services. 


88 Department of Health, Education, and Welfare, 1958 


At the close of fiscal year 1958 there were 24,483 full-time employees 
in the Public Health Service. (See table 2, p. 147.) This number 
included 1,478 members of the regular Commissioned Corps of the 
Service, 1,883 members of the Reserve Corps on active duty, 142 mem- 
bers of the Commissioned Reserve on temporary training duty, and 
20,980 full-time Civil Service employees. 


National Library of Medicine 


A major change in the National Library of Medicine operations 
occurred in September 1957, when interlibrary loans and photodu- 
plication service were unified into a single system. Integration of the 
two services provided a more efficient instrument for making the Li- 
brary’s extraordinarily complete resources of medical literature avail- 
able throughout the country. Implementation of the new service was 
expedited by conversion of photoduplication processes to Xerography 
and by accompanying procedural changes designed to speed the 
processing of requests for interlibrary loans. 


IMPROVEMENT OF INDEXING OPERATIONS 

With financial assistance in the form of a grant of $73,800 from the 
Council on Library Resources, Incorporated, the Library began a 
2-year program for improving its indexing publication mechanisms. 
Aims of the project are to experiment with and develop mechanical 
systems for the filing and layout operations involved in preparing 
printer’s copy for the Current List of Medical Literature; to achieve 
maximum convenience of consultation through improved format; to 
improve methods for preparing cumulative indexes; and to seek meth- 
ods for rapid retrieval and publication of material relating to 
specialties within the medical field. 


FOREIGN LANGUAGE MATERIALS 

The Library continued to increase its procurement of Soviet medical 
literature by resumption of an exchange relationship with the State 
Central Medical Library in Moscow, and by enlarging existing agree- 
ments with Eastern European countries. Of the foreign language 
journal articles indexed last year in the Current List of Medical Lit- 
erature, 11,000 were from 156 Russian and other East European 
publications. 


NEW BUILDING PROGRAM 

Construction funds for the new library building were included in 
appropriations for fiscal year 1959. Final working drawings for the 
~ new building are expected to be completed by December 1958, and it 
is anticipated that the structure will be completed by the summer of 
1961. Estimated cost has been set at $7,300,000 for a building of 
approximately 232,000 square feet consisting of five levels, two above 


_ Public Health Service 39 


and three below ground, to be located on the grounds of the National 
_ Institutes of Health. 


| PROGRAM STATISTICS 

_ During fiscal year 1958 the National Library of Medicine acquired 
18,447 books, 75,028 serial pieces, and 1,157 new serial titles; it pur- 
' chased 469 old and rare items for its History of Medicine Division, 
cataloged 23,595 titles, and added 1,492 pictures and portraits to the 
art collection. The number of volumes circulated to users of the 
_ Library was 111,594; 8,205 reference questions were answered and 334 
_ bibliographies were compiled. There were 12,199 major entries pre- 
| pared for the annual volume of the Wational Library of Medicine 
_ Catalog, and 110,708 items were published in the Current List of Med- 
| tcal Literature from 1,594 journal titles. Over 1.8 million pages of 
| medical literature were microfilmed in response to 64,421 requests. 


Public Health Methods 


| The Division of Public Health Methods has principal staff responsi- 
_ bility for program planning in the Office of the Surgeon General. 
In discharging this responsibility, the Division conducts selected 
| studies on public health needs and problems, analyzes economic, so- 
cial, and public policy trends which affect Public Health Service 
_ programs, and cooperates in public health planning activities. 
NATIONAL HEALTH SURVEY 

_ In June 1958, the U. 8. National Health Survey, located in this 
| Division, completed its initial year of operation on an annual basis. 
During the year, preliminary reports were published on the prevalence 
_ and incidence of acute upper respiratory diseases, on physician visits, 
| dental care, persons injured, and the extent of disability in the popu- 
lation. Preliminary studies indicated that persons visit physicians 
/ at a rate equivalent to slightly under five visits a year, and visit 
| dentists at a rate equivalent to 1.6 visits per person per year. About 
| 25 million persons were injured during the last 6 months of 1957, 
| according to National Health Survey data. Moreover, during the 
| period July-September 1957, an estimated total of 662.8 million per- 
son-days of restricted activity due to illness or injury occurred. In 
other parts of the Survey, field work had been completed, by the end 
| of the fiscal year, on a number of contract studies relating to methodo- 
logical problems of a projected health examination survey, alternate 
methods of collecting morbidity data, and household interviewing. 


HEALTH RESOURCE STUDIES 


In a study of health resources, the future supply of physicians in 
the continental United States was predicted under four series of est1- 


487270—59——_7 


90 Department of Health, Education, and Welfare, 1958 


mates of graduates of medical schools. Under the assumption of 
graduation rates currently predicted for existing and planned schools, 
the number of physicians in 1975 will be 290,409—a rate of 127 per 
100,000 population, in contrast to the 1955 rate of 182 per 100,000. If 
the number of graduates were to be increased sufficiently to regain 
and maintain the 1955 ratio of physicians to population, the equivalent 
of 20 new medical schools would have to be added to the 87 scheduled 
for existence in 1965. 

As part of its study of health services, the Division provided an 
executive secretary for a National Conference on Homemaker §Serv- 
ices, organized under the aegis of the Children’s Bureau with the 
joint sponsorship of 7 other units of the Department, and 26 national 
voluntary agencies. In preparation for the Conference, the Division 
collected data from the 143 agencies which provided this service in the 
spring of 1958. A total of 110 programs—3 out of 4—are under pri- 
vate auspices. During the study week, a total of 1,715 homemakers 
was employed and served 2,188 families. 

In preparation for a monograph that will show methods for col- 
lecting information on community needs of and resources for long- 
term patients, questionnaires designed in the Division were tested by 
three local communities, which conducted their own surveys. The 
information includes data on institutions serving long-term patients, 
outpatient facilities, public health nursing agencies, vocational re- 
habilitation agencies, and other resources. 

Several activities of the Division during the past year were con- 
cerned with the health problems of older adults in the population. 
Data were compiled on the health status of the aged and the inter- 
relationship of health and socioeconomic factors. Among the geron- 
tological health problems, economic status continues to be prominent 
due to the composite effect of the increase of expenditures for medical 
care as age advances, a consequence of higher rates of disabling and 
chronic illness among older persons; the comparative decline, with 
age, in income and in health insurance protection; the tendency of 
persons with lower income to experience proportionately more illness 
than those of better economic status. 

In collaboration with the Bureau of Labor Statistics, a study is 
being made of various indexes of medical care prices compiled by 
public and private agencies, their uses, design, and relation to med- 
ical care costs. Medical care expenditures of urban dwellers were 
also studied during 1958, including differential in medical spending by 
age, characteristics of large medical expense, dental spending of urban 
residents, and other aspects of medical expenditures. 


: 
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Public Health Service 91 


National Institutes of Health 


_ The National Institutes of Health conducts medical research in its 
_ laboratories at Bethesda, Md., and supports research, training, and 
_ research construction in institutions throughout the Nation. Its 
grants are awarded after careful review by non-Federal groups— 
_ study sections composed of technical experts, and advisory councils 
_ composed of leaders in science and public affairs. 

In fiscal year 1958, changes were made in the advisory structure of 
NIH to facilitate the administration of research. Boards of scientific 
counselors were established to advise the Institutes on intramural 
studies, and two new study sections were created to review the in- 
creasing number of grant applications in the fields of genetics and 
cell biology. A new Division, General Medical Sciences, was created 
to strengthen support of the sciences basic to medicine; and the Di- 
vision of Research Grants, responsible for general administration of 
research grants and fellowships, was reorganized. 

In fiscal year 1958, Congress appropriated $211 million for the 
Institutes’ programs and an additional $30 million for grants to 
finance the construction of health research facilities. Research and 
training grants approved by the Institutes reached an unprecedented 
| level. There were 7,028 research grants and 1,725 training grants, 
_ totaling $134 million. 

_ The first in a series of long-term, university-centered programs to 
_ coordinate studies in basic science with others on the social, economic, 
_ and behavioral problems affecting the country’s aging population was 
initiated at Duke University. 

_ In support of the worldwide program of malaria eradication, NIH 
has undertaken an accelerated 5-year search for cheap, effective, 
nontoxic drugs. 

_ The cancer chemotherapy program, now in its third year of opera- 
_ tion, clarified procedures for protecting both the rights of industry 
| and the public interest when chemical agents useful in the control of | 
_ cancer are developed through Government contracts with industry. 
A program of grants for studies in physical biology stimulated the 
expansion of this increasingly important field. 

_ A modest extension of the postdoctoral research fellowships pro- 
| gram has made the awards available to scientists of foreign coun- 
| tries. Fellowships were awarded in 1958 to 13 outstanding medical 
scientists in Western Europe, permitting them to conduct research in 
| this country. To increase the number of trained scientists in the 
| United States, a general research training program in such areas as 
| pathology, pharmacology, genetics, anesthesiology, epidemiology, and 


92 Department of Health, Education, and Welfare, 1958 


biometry was established at the graduate level by some American uni- 
versities with the support of training grants. 

A number of facilities for specialized treatment or study were ~ 
opened during the year. Among these were a residence treatment — 
center for disturbed children, a center for the evaluation of psycho- 
pharmacologic agents, and a small field laboratory—the Middle 
America Research Institute in Panama—for the study of tropical 
diseases, particularly of virus origin. 

The seven Institutes comprising NIH are named for the health 
problem areas on which they concentrate—allergy and infectious dis- 
eases, arthritis and metabolic diseases, heart, cancer, dental research, 
mental health, and neurological diseases and blindness. Recent de- 
velopments in these programs, in the supporting divisions, and in 
the Clinical Center are described in the following sections. 


Clinical Center 


The 516 research beds of the Clinical Center form a major national 
resource for medical research. Having attained this maximum- 
planned bed capacity late in 1957, a particular goal of NIH during 
1958 was optimal utilization of the clinical research facility. <A series 
of intensive studies of the many elements involved, together with ap- 
propriate action, resulted in the attainment of an average daily census 
of approximately 400 patients during the last months of the year. 
This is the patient load considered ideal in terms both of superior 
clinical study and of the high quality of care required for research 
patients. 

Each year the Clinical Center’s importance as an influence for 
interchange of scientific facts and viewpoints becomes increasingly 
evident. The number of visitors has increased from about 2,000 
in 1953, when the Center was opened, to nearly 10,000 in 1958. Of 
this number, 31 percent were professionals and 33 percent students 
in fields related to medicine and medical research. Of particular 
interest is the fact that 500 of the professional visitors were from 71 
foreign countries. 


Division of Biologics Standards 


The Division of Biologics Standards prescribes and maintains 
standards to ensure the safety, purity, and potency of commercial 
biological products. These include vaccines, serums, toxins, anti- 
toxins, and related products, as well as human blood and its deriva- 
tives. Close surveillance of production and quality is accomplished 
through the licensing of both the manufacturer’s establishment and 
his products. Standards for each product are developed by DBS, 


Public Health Service | 93 


and production processes are inspected periodically to ensure com- 
pliance with requirements. 

Within recent years, the nature of the programs needed to meet 
these responsibilities has changed considerably. Large-scale use of 
tissue-culture methods for quantitative assay, serologic diagnosis, 
and vaccine preparation has greatly expanded the potential range of 
biologics. Thus, the Division must maintain a research program of 
sufficient flexibility to provide information as the need arises. 

Production of the Asian-strain influenza vaccine in 1957 demon- 
strated both the research and control functions of DBS. Tests were 
developed, reference vaccines established, and data from investiga- 
tions correlated. Specifications for a vaccine containing a hitherto 
unknown strain of influenza virus were provided for the guidance of 
industry. 

The Division also contributed to the formulation of standards for 
a vaccine that protects young adults against respiratory illnesses 
caused by three types of adenovirus. The first license has been 
granted for its manufacture. ‘Tissue culture methods have been 
studied in relation to the production and standardization of smallpox 
vaccine, and to the antigenicity of measles vaccine. Recent dis- 
coveries relating to the enteroviruses—the ECHO and Coxsackie 
groups—indicate that vaccines may also be developed for these agents. 


Division of Research Grants 


The recent expansion of NIH grants and training programs was 


| reflected during the year in the largest volume of applications yet 


received. The review procedure was characterized by the same high 
standards that were established at the beginning of the program in 
1946. This was achieved through the appointment of additional ad- 
visory groups. 

During the year, a General Research Training Program was initi- 
ated. It will help stimulate and expand research training in areas 
basic to the biological and medical sciences as well as in other spe- 
cialty areas where acute shortages of research-trained manpower 
exist. Moreover, the acceleration of basic research training will pay 
dividends in sustained productivity in applied medical and biological 
research. 

The health research facilities program had awarded $60 million 
by June 80 of this second fiscal year of operation. Since the grantees 
matched an average of $2 for every $1 received from the Govern- 
ment, the total outlay for federaJly supported research construction 
amounted to approximately $180 million. 


94 Department of Health, Education, and Welfare, 1958 — 


Central Services 


The Division of Business Operations furnishes NIH scientists with 
auxiliary management services. Emphasis during the year was on 
the programing of payroll, financial, personnel, and stock-control 
data for a giant electronic computer installed in March 1958. 

The Division of Research Services provides a wide range of tech- 
nical, scientific, and engineering skills in support of research at NIH. 
Major emphasis in 1958 was again given to new construction author- 
ized by Congress. A plant for chemical waste disposal, five animal 
wings, and special facilities for the production and care of germ-free 
animals were completed during the year, and construction was be- 
gun on a laboratory for biologics control. Planning and design work 
progressed on a surgical wing for the Clinical Center, a permanent 
office building, and laboratories for the National Institute of Dental 
Research. Other developments included the expansion of the Russian 
scientific translation program. 


Institute of Allergy and Infectious Diseases 


The microbiological approach is basic to most research by NIAID. 
Many of this Institute’s advances help to answer basic questions for 
more specialized institutions. The Institute is also exploring new 
specialties and frontiers. Virology, for example, is opening the way 
to a more comprehensive understanding of the role of microbial 
agents in degenerative as well as infectious diseases. 

Allergic and infectious diseases are tremendously costly in terms 
of dollars or human distress. The specter of outbreaks such as the 
influenza epidemic of 1918, which took millions of lives, gives impetus 
to influenza research during inter-epidemic periods. In geographic 
areas linked politically and economically with the United States, 
diseases such as malaria, schistosomiasis, and filariasis are paramount 
killers and cripplers. The Institute is a world center for research on 
such problems. 

Institute scientists, active on many fronts during the 1957 epidemic 
of Asian influenza, evaluated vaccine efficacy in infected volunteers. 
They also developed a more rapid laboratory method of influenza 
diagnosis. This led to uncovering previously unknown agents, the 
hemadsorption viruses, apparently prevalent in young children. 

The Institute’s Rocky Mountain Laboratory at Hamilton, Mont., 
has developed a new method for purifying viruses, with a view to 
aiding research directed toward new or improved vaccines. The 
method employs a filtering column of adsorbent chemicals. Also at 
this Laboratory, a new vaccine against the virus of Colorado tick 
fever has been developed to the stage of clinical trials. 


Public Health Service 95 


The causative agent of toxoplasmosis was demonstrated for the 
first time in pork muscle. Institute scientists also showed that latent 
toxoplasmosis organisms can be transmitted by chronically infected 
rats to their offspring, suggesting the possibility of similar mech- 
anisms in human infection. 

Clinicians of the Institute found that intravenous amphotericin 
brought cure or improvement to several patients with systemic fungal 
diseases such as histoplasmosis—a significant experimental finding in 
the absence of other chemotherapy for such infections. 


GRANT-SUPPORTED RESEARCH 


Allergic (anaphylactic) shock is a hazard to hypersensitive persons 
recelving drug injections or blood transfusions. Institute grantees 
at Columbia University have found that certain steroids and tran- 
quilizing drugs protect mice from shock. The investigators are seek- 
ing the pharmacologic basis of this protective action. 

In grant-supported studies at Louisiana State University, single 
or multiple infections by whipworm, threadworm, roundworm, and 
pinworm were effectively treated with a single drug, dithiazanine. 
This work is particularly promising for the care of patients in insti- 
tutions where conditions may favor the spread of these intestinal 
parasites. 

Scientists at Children’s Hospital in Detroit employed grant funds 


| to develop a method for identifying causative agents in nursery epli- 


demics of infant diarrhea. Fluorescent antibodies in a preprepared 
solution “spotlight” their corresponding antigens, or disease agents, 
and rapidly give definitive information upon which treatment can 
be based. 

Heightening concern over staphylococcal infections that resist 
treatment underscores the importance of studies supported at Har- 
vard University and Boston City Hospital. Erythromycin is sug- 
gested as the antibiotic of choice in the clinical trials. 


Institute of Arthritis and Metabolic Diseases 


During the year, the Institute strengthened its basic research at- 
tack on arthritis and other rheumatic diseases, and on the metabolic 
diseases such as diabetes and gout. In addition, research and train- 
ing activity was expanded into two new research areas: gastroenter- 
ology—the medical specialty dealing with such disorders as peptic 
ulcer, ulcerative colitis, and regional ileitis—and the new science of 
physical biology. In the latter field, the techniques of modern phys- 
ics are helping to solve basic biological problems. 

Arthritis and the rheumatic diseases continue to afflict more than 
10 million people in the United States. Although the basic cause of 
arthritis is still unknown, continuing research has led to better forms 


96 Department of Health, Education, and Welfare, 1958 | 


of treatment and a more complete understanding of the underlying 
disease process. 

Since cortisone’s antirheumatic properties were first discovered in 
1949, other steroids—hydrocortisone, prednisone, prednisolone, 
methylprednisone, triamcinolone—have been developed for the treat- 
ment of rheumatoid arthritis. Clinical investigators at the Institute 
recently completed preliminary studies of still another new steroid, 
which appears to be even better than its predecessors. Known as 
dexamethasone, the drug is 25 times more potent than hydrocorti- 
sone and 6 times more potent than prednisone. It has been found ef- 
fective in relieving the characteristic pain and inflammation of rheu- 
matoid arthritis in patients who have received little or no benefit from 
the other steroids. 

Important basic knowledge about gout recently was uncovered 
by Institute scientists, who found that overproduction of uric acid 
in the body is the effective metabolic defect in this disease. This 
has been a controversial point ever since the high blood levels of uric 
acid were first detected in gout patients. Some scientists believed the 
excess uric acid was due to insufficient destruction of the acid in the 
body, and others thought it due to an inability to excrete proper quan- 
tities of the material. 

Institute clinicians have evaluated a new intravenous preparation of 
colchicine, an age-old drug for the relief of gout attacks. They 
found that, by injecting the drug, the attacks could be relieved more 
promptly and without the distressing gastrointestinal disturbances 
that often accompany colchicine when taken by mouth. 

A few highlights of basic research in the Institute were the de- 
termination of how thrombin, the body’s essential blood-clotting 
enzyme, does its work; the recognition of selenium as an important 
trace element in the diet to prevent dietary liver necrosis in experi- 


mental animals; and the discovery that the bones of the human skele- — 


ton wear out and are replaced by new bone growth to a much greater 
degree than previously supposed. 
GRANTS AND AWARDS 
Diabetes research is one of the primary areas of interest to the Insti- 
tute. The year’s most noteworthy development in this field was 
the widespread use of the new oral antidiabetic drug tolbutamide. 
After extensive clinical trials by Institute grantees and other physi- 
cians throughout the country, the drug went on the market in June 
1957. Today it is used by over 300,000 Americans with diabetes. 
The new drug, though not chemically related to insulin, does have 
the ability to bring about one of insulin’s major effects in the body— 
that of lowering the high level of blood sugar found in diabetes. 


Public Health Service 97 


Studies by Institute grantees indicate that the drug acts in part by 
stimulating the body’s own insulin-secreting cells in the pancreas. 

Other Institute-supported studies have shown that postoperative 
patients recover more rapidly if the long-accepted semi-starvation 
method of feeding is replaced by one supplying adequate nutrition. 
The nitrogen losses that were formerly thought to be the result of 
operative injury or stress were found to be almost entirely the result 
of poor nutritional intake. The investigators prevented these losses 
in their surgical patients by administering intravenous solutions with 
a high protein and calorie content. 


Cancer Institute 


Studies in virology, exfoliative cytology, and chemotherapy pro- 
duced some of the most encouraging advances in the field of cancer ever 
achieved in a single year. 

The relationship between viruses and cancer has become one of the 
more promising areas of investigation. In one study, laboratory 
animals developed multiple tumors affecting nearly every organ and 
tissue after receiving a single injection of an agent that has the proper: 
ties of a virus. This observation, together with similar ones in the 
recent past, has stimulated a search for additional viral agents with 
cancer-producing properties. 

Research during the year reaffirmed the importance of exfoliative 
cytology as a technique for the detection of uterine cervical cancer in 
its early, unsuspected, and most curable stages. Analysis of the data 
gathered in a cytologic study of more than 100,000 women showed that 
invasive uterine cervical cancer may produce no symptoms for 2 to 3 
years, but that it can be detected during that time by cytologic 
examination. 

Studies are continuing in an effort to adapt the cytologic technique 
to the detection of cancer of other body sites, such as the lung, large 
intestine, bladder, and prostate gland. A quantitative method has 
been developed which permits the detection and estimation of the 
number of cancer cells in the circulating blood of cancer patients. 
This permits completely new approaches to the study of the biological 
characteristics of clinical cancers. 

Research in chemotherapy was directed principally at producing 
new and more effective anticancer agents and improving procedures 
for administering drugs to patients. In a laboratory study, adminis- 
tration of dichloroamethopterin produced a marked increase in the 
survival time of mice with advanced leukemia. This agent is closely 
related to methotrexate, which continued to produce encouraging re- 
sults in the treatment of choriocarcinoma, a rare type of uterine tumor 
that occurs in women during or after pregnancy. One choriocarci- 


98 Department of Health, Education, and Welfare, 1958 
anaes a 


noma patient treated with methotrexate has remained apparently free 
of cancer for more than 30 months. 

The adoption of a new Departmental patent policy encouraged a 
substantial increase in industry’s participation in chemotherapy re- 
search. The Cancer Chemotherapy National Service Center, at the 
National Cancer Institute in Bethesda, Md., is coordinating the re- 
sources of the Nation’s leading research institutions, colleges, and the 
pharmaceutical industry in an intensive effort to find more effective 
anticancer drugs. Chemicals, fermentation liquors, hormonal agents, 
and other materials are being studied at the rate of 40,000 per year in 
the Chemotherapy Service Center’s screening program. 

Important advances were also made in fundamental research into 
the nature of normal and malignant cells, the carcinogenic process, and 
intricate host-tumor relationships. 


INSTITUTE RESEARCH 


In collaboration with the Division of Biologics Standards, Institute 
scientists produced multiple tumors in mice and hamsters by in- 
jecting them with cell-free tissue culture preparations obtained from 
certain mouse tumors. The following observations suggest that the 
tumor-inducing agent used in these studies is a virus. It grows in 
tissue culture; is destroyed by heat, but not by storage at freezing 
temperatures; is in the virus size range, as indicated by the filter 
through which it passes; is not destroyed by antibiotics, which kill 
bacteria but not viruses; and produces neutralizing antibodies in 
rabbits. 

Within the year a group of Institute scientists reported the results 
of laboratory studies on the problem of tumor metastasis. Experi- 
ments with mice showed that a primary tumor may exert an inhibitory 
effect on the growth of distant metastases, and that removal of the 
tumor acts as a stimulus on the metastatic deposit. Another phase of 
the investigation showed that neither anesthesia nor cortisone admin- 
istration, nor operative procedure in which the primary tumor was 
not removed, had any effect on the number of lung metastases. The 
_ third study in the series demonstrated that the anticancer drug TSPA 
was effective in reducing the number of lung metastases when admin- 
istered several hours after removal of the primary tumor. Metastases 
were completely prevented in some mice. 

Biostatistical studies on nearly 200,000 United States veterans re- 
vealed that the death rate for smokers exceeded that for nonsmokers 
by 82 percent. Mortality was 58 percent higher among cigarette 
smokers than among nonsmokers, and the smokers showed a death rate 
from lung cancer 10 times higher than did the nonsmokers. 

NCI continued its comprehensive study in Washington County, 
Md., of the relationship between environmental factors and cancer. 


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Public Health Service 99 


GRANT-SUPPORTED RESEARCH 

A National Cancer Institute grantee reported that administration 
of large amounts of the compounds prednisone and prednisolone pro- 
duced complete or partial remissions in several patients with acute 
leukemia. The drugs are newly synthesized hormones closely related 
to cortisone, which is also useful in treating this disease. 

Promising results have been achieved in the treatment of tumor- 
bearing mice with a new anticancer drug, azauridine. The drug is 
chemically related to 6-azauracil, which has been used with encourag- 
ing results in the treatment of some cancer patients. The synthesis 
of azauridine was undertaken as part of a research plan to produce 
and study compounds that might interfere with the metabolism of 
tumor cells. The scientists reasoned that compounds that hinder the 
formation or utilization of uracil might prove useful as anticancer 
agents. This led to the synthesis and testing of 6-azauracil and later 
to the synthesis of azauridine. The results of studies in mice indicated 
that azauridine was significantly more effective than 6-azauracil in 
inhibiting the growth of transplanted mouse tumors. 

In another study the use of chemotherapeutic agents in tumor- 
bearing mice made X-ray therapy more effective. More tumors re- 
gressed completely in a group of mice receiving both drugs and 
radiation than in groups treated by either chemicals or X-rays alone. 

A study in animals showed that radioactive sulfur selectively 
damages cartilage cells. This indicates that radioactive sulfur may 
also be effective in the treatment of cartilaginous tumors in man. 


Institute of Dental Research 


The program of the National Institute of Dental Research is di- 
rected toward both the prevention and treatment of oral diseases. 
Thus, research is emphasized which increases basic knowledge of 
oral biological systems and their relationship to the whole body. 

The most important problem in studies of both calcified and soft 
tissues of the mouth is the magnitude and complexity of the oral 
microbial flora. Even under normal conditions, saliva contains no 
less than 500,000,000 microorganisms per cc. Upward of 50 species 
of organisms have been isolated in saliva to date. 

In recognition of the inestimable value of germ-free animals in oral 
bacteriologic studies, the National Institute of Dental Research under- 
took in 1958 to study the etiology and mechanism of caries, calculus 
formation, periodontal disease, and wound healing. Among pre- 
liminary findings is the confirmation that caries does not occur in 
germ-free animals. It may, however, be induced in rats infected 
orally with a single pure strain of certain streptococci organisms. 

The expansion of epidemiologic and biometric studies in 1958 to in- 
clude selected population groups in India and Alaska is contributing 


100 Department of Health, Education, and Welfare, 1958 


not only to a better understanding of oral disease patterns among 
these groups, but also to the further development of methods of assess- 
ing periodontal diseases. Parallelling this work is the continuing 
genetic study of a racially isolated group in Southern Maryland and 
a new survey of hereditary oral defects in some 5,000 offspring of 
first-cousin marriages in Hiroshima and Nagasaki, Japan. 

In the area of biochemistry, nutritional studies of oral disease are 
being continued. These suggest that certain proteins and mineral 
phosphates effect a marked reduction in dental caries. Other investi- 
gations in the biochemical field relate to a better understanding of the 
organic and inorganic composition of saliva, dentin, enamel, and 
other oral tissues. 

Pioneer work in the use of electron and X-ray microscopy in mor- 
phologic studies of heretofore unseen crystallites and the supporting 
organic framework of enamel and dentin is contributing new and 
significant knowledge. Other investigators are applying new histo- 
chemical methods in a study of protein and enzyme components of 
oral tissues. 

In the field of clinical research, more effective means are sought for 
minimizing the danger of bacteremias subsequent to oral surgery on 
theart patients. Still other areas of investigation include dental 
anesthesiology, oral and facial abnormalities, and periodontal disease. 
GRANTS AND AWARDS 

The Institute increased its support of dental research projects in 
institutions throughout the country. In the training area, the Na- 
tional Advisory Dental Research Council granted approval for the 
establishment of a permanent Training Grant Committee to advise 
on needed expansion and programming to meet rapidly increasing 
needs for scientific manpower. 


Heart Institute 


Basic and clinical research was strengthened during 1958 both in the 
National Heart Institute’s laboratories and in those of institutions 
recelving grants. Training programs were enlarged to increase the 
supply of much-needed scientific manpower. Activities designed to 
assist in the application of rapidly developing knowledge from re- 
search progressed. Through these primary means, steady gains were 
made in the effort against diseases of the heart and blood vessels, 
which now claim more than 800,000 lives a year. 

Atherosclerosis, a disease in which fatty deposits on the walls of 
blood vessels can progressively restrict blood supply to vital centers, 
is a major cause of death in this country. When it affects the blood 
vessels supplying the heart, it leads to myocardial infarction, the 
common form of heart attack. The disease is associated with eleva- 


Public Health Service 101 


tion of the concentrations of fats in the blood, a subject of intensive 
research at NHI. . 

Studies of the effects of adrenalin on fat metabolism have been 
undertaken, in view of the long-suspected relation between emotional 
factors and heart disease. Adrenalin, the hormone produced by the 
adrenal gland during emotional excitement or anger, has been shown 
to cause a marked increase in the cholesterol content of the blood. 
The mechanism by which this occurs is not yet clearly understood, but 
the implications with respect to heart disease may be important. An- 
other kind of adrenalin effect has been shown—namely, a stimulation 
of the release of fatty acids from depots of fat tissue. Taken to- 
gether, these findings indicate a central role for adrenalin in the con- 
trol of fat metabolism and blood-fat concentrations. 

It is now well established that the ingestion of large quantities of 
unsaturated fats can lower blood-fat concentrations quite signifi- 
cantly, but it is not yet known how this comes about. At the Clinical 
Center, patients with high blood-cholesterol levels are being treated 
with liquid formula diets containing large quantities of unsaturated 
fat, and their cholesterol metabolism is being studied with the aid of 
radioactive-tagged cholesterol molecules. It has been found, contrary 
to previous notions, that most of the cholesterol excreted is still in its 
original form and that only a small percentage has been converted to 
oxidized products (bile acids). In some patients, unsaturated fats 
increase the amount of cholesterol and of bile acids excreted. Further 
studies are in progress to clarify the mechanism involved in this prom- 
ising dietary approach to treatment of high blood-cholesterol levels. 

Another approach being explored is the use of inhibitory sub- 
stances that will decrease the rate at which the body manufactures 
cholesterol. A number of compounds have been shown effective in 
suppressing cholesterol production, and one of these, delta-4-choles- 
tenone, proved to have a very interesting side effect. Given in large 
doses, it suppressed the production of the adrenal hormones. It has 
been known for some time that cholesterol could be converted to 
adrenal steroid hormones. The present findings strongly suggest that 
cholesterol is necessary for their production. 

Fats in the diet are absorbed from the intestine and initially 
shunted to the blood stream in the form of large particles, the chylo- 
microns. Recent studies demonstrate that the protein contained in 
chylomicrons is of three kinds, one of which appears to be identical 
with another protein associated with the fats that are always circu- 
lating in the blood. The finding may have significance in relation 
to the mechanisms by which the body clears the blood stream of newly 
absorbed fats. Further studies of the chylomicrons show that their 
removal is probably not piecemeal, but that the entire particle is 


102 Department of Health, Education, and Welfare, 1958 


removed as a unit and that the tissues responsible for the major 
uptake will vary with the nutritional state of the animal. 

The problem of high blood pressure is being approached in sev- 
eral ways. Substances that inhibit the enzyme monamine oxidase 
give promise of value in treatment of hypertension. A new diagnos- 
tic test of the efficacy of such compounds has been developed which 
can be safely used in patients. Availability of this test should permit 
effective screening of potential therapeutic agents. A protein present 
in human urine and possessing potent activity against high blood 
pressure has been considerably purified. This material has the capac- 
ity to break down other protein molecules. Since it is a naturally 
occuring compound, it may play a role in regulating blood pressure. 

When the heart fails, one of the major effects is an accumulation of 
water in the tissues. Evidence is strong that malfunction of the 
kidneys plays an important part in this process and that a number 
of hormones contribute to the over-all effects. In NHI studies of 
normal and abnormal kidney function pursued during the past year, 
an important new theory regarding the way in which the kidney 
controls its output of water has been developed. Also of importance 
was the finding that one of the classes of drugs used in the treatment 
of heart failure has, in addition to its direct effects on the heart, a 
direct effect on kidney function as well. 

The keystone to successful surgical repair of cardiac defects is 
accurate preoperative diagnosis. The past year has seen the develop- 
ment in the Heart Institute of several new procedures that give the 
surgeon an accurate indication of the location and size of cardiac 
defects prior to surgery. These include the application of a radio- 
active gas, krypton®, which the patient inhales for a brief period 
while blood samples are drawn from the circulation at several points. 
Nitrous oxide gas has been used in the same way. These procedures 
tell the surgeon how much blood is passing through an abnormal 
connection between the two sides of the heart so that the desirability 
of surgery can be evaluated. 


GRANT-SUPPORTED RESEARCH 


Efforts to unravel the interrelations of diet, hormones, and ather- 
osclerotic disease continued at many institutions. It is not yet estab- 
lished whether the tendency to atherosclerosis is attributable to an 
excess of total fat, too high a fat-protein ratio, an imbalance among 
chemicals in the body such as_ cholesterol-phospholipid-fatty- 
acid triglyceride, too much saturated fat, too little unsaturated fat, 
a lack of essential fatty acids, or some other dietary factor or 
deficiency. Use of the technique of gas-liquid chromatographic sep- 
aration of lipids to attack parts of the problem was extended and 
should lead to important new data. 


Public Health Service 103 


Studies of the role of the endocrine system—particularly the thy- 
roid, the pituitary-adrenal axis, and the sex glands—in regulating 
lipid metabolism, were pursued. Trials of estrogens in patients with 
coronary artery disease gave promising results, and the search con- 
tinued for new estrogen-like substances that may be used without 
producing feminization in males or uterine bleeding in females. 

An important achievement in hypertension research was the syn- 
thesis of angiotensin, a natural blood-pressure raising substance. 
Availability of angiotensin has opened new approaches to the study 
of renal pressor mechanisms in high blood pressure. 

A new oral diuretic drug, chlorothiazide, has been found effective 
not only in edema but in high blood pressure. Combined use of this 
drug with other antihypertensive agents has reduced the blood pres- 
sure of some patients formerly refractory to treatment. 


Mental Health Institute 


Significant progress was made during the year in mental health 
research, training of needed personnel, and the development of mental 
health services. 

The ultimate goals of investigators in the mental health field are 
to discover and clarify the mechanisms of psychological development 
and to determine the origins of human behavior. Important work 
toward achieving these goals is being done by scientists and grantees 
of the National Institute of Mental Health. We have learned, for 
example, that there is no single inherited or environmental determi- 
nant of behavior or of psychological functioning, but that behavior 
results from the complex interplay of a great number of inherited, 
constitutional, and environmental forces. 


RESEARCH PROJECTS GRANTS 


The relations among all these forces may be clarified by an NIMH 
grantee who is studying “imprinting,” an extremely rapid form of 
learning that takes place for a brief period in the early life of 
many organisms. During this period, both the timing and effective- 
ness of the process can be altered by changing the environment of the 
animal—presenting physical or emotional obstacles, administering 
drugs, etc. Since human development may include stages analogous 
to the imprinting stage in lower animals, these studies may well 
clarify some of the effects of early childhood experience on learning 
and later social behavior. 

Another Institute-supported study is concerned with the effects on 
learning of pre- and postnatal X-irradiation. This study will permit 
better understanding of the physical and behavioral consequences of 
irradiation and more precise determination of the times of maximum 
vulnerability of the growing organism to X-rays. . 


104 Department of Health, Education, and Welfare, 1958 


While behavior is profoundly affected by environmental condi- 
tions, it appears to have its physiological correlates as well. Pre- 
liminary results of one grant-supported study, for example, indicate 
that adaptive behavior in the rat can be correlated with the level of 
the enzyme cholinesterase in the animal’s nervous system. 

Other studies by NIMH investigators and grantees are concerned 
with the physiological and psychological roles of a variety of chemical 
agents in the body. It may well be that disturbances in the metabo- 
lism of epinephrine, serotonin, certain amino acids, carbohydrates, or 
other substances may be responsible for abnormalities in psychological 
functioning. Credence for this view is found in two recently analyzed 
forms of mental retardation rooted in abnormal biochemical activity 
in the body—phenylketonuria and galactosemia. 


DIRECT RESEARCH 


Recognition of abnormal functioning is dependent upon knowledge 
of the normal. A significant advance during the year was the dis- 
covery of an enzyme which is responsible for the normal metabolism 
of 70 percent of the epinephrine in the body of the rat. This discovery 
revealed a hitherto unknown pathway for the transformation of a 
variety of body metabolites, and will undoubtedly elucidate a number 
of still unknown biochemical processes. The study is part of a broad 
program of investigation of the biological aspects of schizophrenia, 
in which an effort 1s being made to distinguish between the physiolog1- 
cal functioning of schizophrenic patients and normal controls and to 
contribute knowledge of the biochemical abnormalities, if any, which 
underlie the schizophrenic process. 

Differences in the reaction of the mentally ill and of normal people 
to various drugs are also being studied by Institute scientists. The re- 
sults may help clarify the mechanism of action of the tranquilizing 
and energizing drugs. The Institute’s Psychopharmacology Service 
Center is continuing to stimulate and support research concerned with 
the synthesis and evaluation of a wide range of psychoactive drugs. 
Other studies at the Addiction Research Center in Lexington, Ken- 
tucky, include evaluations of addicting drugs and attempts to find 
a nonaddicting analgesic. 


COMMUNITY SERVICES 


State activities in developing community mental health programs, 
stimulated by Federal grants-in-aid, have expanded considerably. A 
total of $54 million, an all-time high, was appropriated from all 
sources for these purposes during the past year. NIMH funds con- 
stituted only 7.4 percent of this sum. Four States—California, Min- 
nesota, New Jersey, and Vermont—enacted legislation providing for 
State grants-in-aid to localities for community mental health services. 


Public Health Service 105 


In September 1957, funds became available, under the provisions 
of Title V of P. L. 911, for the support of demonstrations and studies 
designed to improve the care, treatment, and rehabilitation of the 
mentally ill. By the end of the fiscal year, 65 of these special projects 
had been approved and were under way. 


TRAINING AND BIOMETRICS 


A review and report of the Institute’s training program at the 
end of its first decade of operation, conducted at the request of Con- 
gress, revealed that mental health training has improved both in 
quantity and quality during this period and that the program is ac- 
complishing its objectives. One measure of this success is that more 
than 70 percent of former trainees and research fellows are now doing 
mental health work in public agencies or as researchers or teachers. 

In line with the Institute’s forecast that the immediate future need 
is for increased research training, two new types of doctoral-level 
training awards were developed for initiation as of July 1,1958. One 
is for training research personnel in several areas of psychology. The 
other is to provide training of psychologists for research and service 
roles in mental health areas of acute personnel shortage, such as men- 
tal retardation, delinquency, geriatrics, and alcoholism. 

The collection and analysis of mental health data continue to 

broaden understanding of the epidemiology of mental diseases. Dur- 
ing the year the cooperative program undertaken with the States for 
collecting statistical data on mental hospital patients was strengthened. 
Two more States, Connecticut and Kentucky, joined the model report- 
ing area, bringing the total to 20 States. 


Institute of Neurological Diseases and Blindness 


Neurological and sensory disorders, as a group, are the main cause 
of permanent crippling in the United States. These disorders are the 
result of damage to the brain, spinal cord, and peripheral nerves, ° 
and thus affect the entire body. Collaborative efforts of many scientists 
have provided fresh leads to a number of these serious health 
problems. 

Although there is no known cure for multiple sclerosis, Institute 
scientists made a discovery this past year which may hasten its con- 
quest. Myelin is the fatty sheath insulating the nerve fiber tracts of 
the brain and spinal cord. In multiple sclerosis and related dis- 
orders, myelin deteriorates—demyelination—and fails to regenerate. 
An essential compound in the fats of myelin is sphingosine. Institute 
scientists have discovered the specific manner in which sphingosine 
is formed in the body, and have synthesized it in the laboratory. This 
new understanding of sphingosine may lead to additional knowledge 

487270—59-8 


106 Department of Health, Education, and Welfare, 1958 
ee a 


concerning the disappearance of myelin and the possible reversal of 
the process. 

Structural regeneration of central nervous tissue in animals is now 
known to be possible. The regeneration has been aided by cellulose 
acetate plastic shields, which prevent the growth of scar tissue and 
permit a free exchange of nutrient materials. To date, however, there 
has been no significant functional restoration. 

Various recent basic research studies have developed new informa- 
tion concerning the cellular structure of the brain. It has been 
thought that the function of neuroglia, which make up 80 to 90 per- 
cent of the cells of the central nervous system, is primarily to support 
nerve cells and fibers and to repair damage following injury. Re- 
cent studies of neuroglia in tissue culture and under the electron 
microscope reveal that they play more than a supporting role. They 
may act as a filter or manufacturer of the fluids which nourish the 
nerve cells of the brain. Electrical activity of neuroglia has been 
recorded. They have been found to have synaptic relations with 
nerve cells and may respond to nerve impulses. Research also indi- 
cates that they play an important role in the formation and main- 
tenance of myelin. 

Among the most difficult blinding diseases to diagnose are those 
in the general category of retinal disorders. Through electroretino- 
graphic research techniques, Institute scientists developed new leads 
of diagnostic value which may help elucidate retinal mechanisms. 

Neuromuscular diseases, including muscular dystrophy and myas- 
thenia gravis, have presented many perplexing problems for medical 
research. Widely acclaimed both in this country and abroad is the 
Atlas of Muscle Pathology in Neuromuscular Diseases, prepared by 
Institute scientists. It is an aid to the diagnosis of these diseases and 
to basic investigation. 


GRANT-SUPPORTED RESEARCH 


Significant among the research accomplishments of grantees during 
1958 is the collaborative investigation of brain damage during preg- 
nancy and early childhood, the completion of a classification of cere- 
brovascular diseases, and the coordination of international advances 
in the understanding of allergic encephalomyelitis and its possible 
relation to demyelinating disorders. 

Fifteen universities and hospitals are now collaborating with 
NINDB in an extensive investigation of adverse factors causing brain 
damage during pregnancy, at the time of birth, and in the early 
years of childhood. The groundwork has been laid for the study of 
40,000 mothers and babies over a 5-year period, in order to increase 
the understanding of the nature and causes of cerebral palsy, mental 
retardation, epilepsy, and related neurological disorders. 


Public Health Service 7 107 


For the first time, all known types of brain strokes have been de- 
fined and classified by a committee of leading neurologists and in- 
ternists, appointed by NINDB’s Advisory Committee. The comple- 
tion of this 2-year study provides a common language for the ex- 
change of information among researchers throughout the Nation and 
offers a useful tool to practicing physicians. 

A large mass of data on “allergic” encephalomyelitis has been de- 
veloped in recent years in the United States as well as in many other 
countries. In an attempt to assemble this material in a uniform 
manner and to evaluate new developments, a symposium of scientists 
from the United States, Canada, England, Germany, France, Italy, 
and Japan was sponsored by NINDB’s Advisory Council in the fall 
of 1957. Further work is necessary to determine the extent to which 
allergy is a factor in diseases of the nervous system. Among other 
efforts are studies to determine the sites of the earliest neurological 
damage in such conditions. 


Bureau of Medical Services 


The Bureau of Medical Services is responsible for the programs 
of the Public Health Service related to care and protection of the in-. 
dividual. It operates hospitals and outpatient clinics; the foreign 


| quarantine activities; the health program for American Indians and 


Alaska Natives; aids in construction of community hospitals and 
health facilities and in the development of the Nation’s dental and 
nursing resources. 

Research is carried on in hospital design and management, epidemi- 
ology and treatment of tuberculosis and other infectious diseases com- 
mon among American Indians and Alaska Natives, control of yellow 
fever and the mosquitoes that transmit it, measurement of dental 
malocclusion, and many phases of nursing practice. National, re- 
gional, and State studies are made of present and future supply and 
demand for dentists and nurses. The PHS hospitals conduct clinical 
investigations in the treatment of leprosy and of narcotic addiction, 
as well as in many aspects of modern medical practice. They are 
among the Nation’s primary resources for ate training of physicians, 
nurses and other health personnel. 


Hospitals and Outpatient Facilities 


The Division of Hospitals operates the medical care program for 
legal beneficiaries of the Public Health Service. Besides American 
seamen, these patients include officers and enlisted men of the Coast 
Guard, officers and crew members of the Coast and Geodetic Survey, 
commissioned officers of the Public Health Service, civil service em- 


108 Department of Health, Education, and Welfare, 1958 
acento 


ployees of the Federal Government injured in performing their work, 
active duty and retired members of the Uniformed Services and their 
dependents, and several other groups. 

In 1958, the Division maintained 16 hospitals, 26 outpatient clinics 
and 99 outpatient offices. Twelve of the hospitals provide general 
medical and surgical services, one is exclusively for patients with 
tuberculosis, two are for the treatment of narcotic addiction and other 
neuropsychiatric disorders and one provides care for persons with 
leprosy. The general hospitals are in major port cities—Boston, New 
York, Baltimore, New Orleans, Chicago, Detroit, San Francisco, and 
Seattle. In certain other places, depending upon the concentration 
of beneficiaries, outpatient clinics and outpatient offices have been 
established. Staffed by full-time personnel, the former provide com- 
prehensive medical, dental and allied health services. Local physi- 
cians conduct the outpatient offices in their private facilities on a 
part-time basis as needed. 


VOLUME OF SERVICES 


Inpatient admissions in all of the Public Health Service hospitals 
during 1958 totaled 49,501—about the same as the previous year. 
The average daily census at 5,295 was decreased 1 percent. The 
number of outpatient visits increased to 1,098,278—nearly 714 percent. 

General hospitals—The general hospitals admitted 44,410 patients 
in 1958 as compared with 44,584 in 1957. The average daily patient 
load remained substantially the same at 2,756. Days per admission 
at the general hospitals in 1958 averaged 22.7, as compared with 22.6 
Im L957. 

Tuberculosis —The Division’s tuberculosis hospital, the U. S. Pub- 
lic Health Service Hospital, Manhattan Beach, Brooklyn, New 
York, admitted 377 patients in 1958, a decrease of 11 percent. The 
average daily census dropped 8 percent, reflecting the current nation- 
wide trend in pulmonary tuberculosis management. 

All the accepted newer drugs in the treatment of pulmonary tuber- 
culosis are used at the hospital, and the staff keeps abreast of the 
status of experimental drugs and of therapeutic and surgical pro- 
cedures for diseases of the chest. The hospital maintains a modern 
pulmonary function laboratory for cardiopulmonary function studies 
and receives laboratory and consultant services from an outstanding 
community hospital. 

Leprosy.—The U.S. Public Health Service Hospital at Carville is 
the only hospital in the continental United States devoted exclu- 
sively to the treatment and rehabilitation of patients with leprosy. 
It is located on the eastern shore of the Mississippi—75 miles north 
of New Orleans. 


q 


Public Health Service 109 


Anyone in the United States may be admitted as a patient in this 
hospital after the diagnosis of leprosy has been confirmed and he 
has signed a statement of willingness to be treated there. Services 
include complete medical, surgical and dental care as well as the 
specialized treatment to combat leprosy. Outstanding specialists 
from medical centers in New Orleans, notably those of Tulane Uni- 
versity and the University of Louisiana augment the resident staff. 
Besides its clinical services, the hospital offers a range of community 
activities with manifold opportunities to participate in religious, 
recreational and occupational endeavors. 

The sulfone drugs were first introduced at Carville in 1941. Most 
leprosy patients treated with these drugs experience improved gen- 
eral health. In many cases, disabling damage can be avoided if 
treatment is started when the disease is in its early stages. 

Admissions at Carville totaled 73 in 1958, compared with 61 the 
year before, while the average daily census decreased from 315 to 296. 

Narcotic addiction—The U.S. Public Health Service hospitals at 
Lexington, Ky. and Fort Worth, Tex. are operated for the treatment 
of narcotic addicts as defined by Federal law. Mentally ill patients 
entitled to care as beneficiaries of the Federal Government are also 
admitted. 

In 1958, these hospitals admitted 4,641 patients, a 1 percent increase 
over 1957. Addict admissions were up 3 percent; prisoner and pro- 
bationer patients each by 5 percent; voluntary patients by 2 percent. 
The average daily census of addict patients declined 2 percent from 
1,390 in 1957 to 1,367 in 1958. Voluntary patients account for the 
major portion—87 percent—of the admissions, but for less than half— 
42 percent—of the average daily census, reflecting the addicts’ weak- 
ened self control toward narcotics. 


MEDICARE 


The Dependents Medical Care Act, which became effective Decem- 
ber 7, 1956, authorized the Division’s hospitals and clinics to admit 
active duty and retired members of Federal uniformed services and 
their dependents and the dependents of deceased members of these 
services. Known as Medicare, this program resulted in increased 
utilization of Service facilities during the year. For example, admis- 
sions of uniformed service personnel and dependents in June 1958 
totaled 1,126, a 1214 percent increase over June 1957; the number of 
outpatient visits in June 1958—29,097—was 18.9 percent greater. The 
June 1958 average daily census of 214 Department of Defense bene- 
ficiaries in PHS hospitals was 128 more than the PHS beneficiary 
load of 86 in Army, Navy, and Air Force hospitals. 


110 Department of Health, Education, and Welfare, 1958 
janine aE UR eae MDC nie UN eet aN i 


TRAINING 

More than 275 physicians, dentists, pharmacists and dietitians 
served internships and residencies at PHS hospitals. Ten of the 
hospitals had approval for the post-graduate training of physicians 
granted by the American Medical Association, Council on Medical 
Education and Hospitals. Eight hospitals were approved by the 
American Dental Association for dental internships. Dental resi- 
dency training programs in oral surgery and prosthodontia were being 
conducted at the Service hospitals at Staten Island and Seattle, 
respectively. 

Affiliations with colleges and technical schools afforded practical 
experience and hospital instruction to approximately 100 undergrad- 
uates in physical therapy, occupational therapy, vocational therapy, 
social service and medical technology. The hospital in Baltimore, Md, 
conducted an approved course for medical record librarians and the 
hospital at Staten Island, N.Y., provided the clinical nursing portion 
of the hospital corpsmen course given by the Coast Guard. 

Between 1947 and 1958, a total of 394 physicians completed ap- 
proved residencies in Division of Hospitals facilities. Throughout 
the history of the Service training and clinical experience gained in 
these hospitals have contributed importantly to many distinguished 
careers in health fields separate from direct care of patients. 


CLINICAL INVESTIGATIONS 


The hospital in New Orleans, in cooperation with Tulane Univer- 
sity, is conducting tests with various chemicals in the treatment of 
cancer by a closed perfusion method. The hospitals at Staten Island 
and Baltimore are conducting studies in cardiopulmonary hemo- 
dynamics. At the San Francisco hospital, research studies are being 
made on liver function and on the anatomy of the male breast. 

These are a few of the 39 research projects supported by the Divi- 
sion of Hospitals during the past year in 8 hospitals. 

At the hospital for leprosy, Carville, Louisiana, the Second Con- 
ference on Progress and Potentials in Leprosy Investigations was 
held in March 1958. More than 75 physicians and scientists were 
present to discuss furthering research in this disease. Basic research 
disciplines represented included anatomy, nutrition, bacteriology, 
pharmacology, virology and epidemiology. 


FEDERAL EMPLOYEE HEALTH SERVICES 


The Public Health Service helps Federal agencies to establish and 
maintain health services for Federal employees. Twenty-five health 
units in various Federal agencies are staffed and supervised by the 
Federal Employee Health Branch of the Division of Hospitals on a 
reimbursable contract basis. In fiscal year 1958, health services were 


Public Health Service 111 


provided for about 46,500 Federal employees in the Washington, D.C., 
Denver, New York, and Boston areas through these units. 

The Department of Health, Education, and Welfare and several 
other Federal agencies last year inaugurated, through these units, 
health maintenance programs for key personnel. The programs in- 
clude physical examinations and complete medical history, plus all 
necessary routine laboratory procedures. 


FREEDMEN’S HOSPITAL 


There was a record total of 3,227 births, without a single maternal 
death, during the fiscal year 1958 at Freedmen’s Hospital. There 
were 14,083 inpatients admitted, an increase over the 13,715 reported 
for 1957. The daily average census remained unchanged at 361. 

Freedmen’s Hospital is a general medical and surgical hospital 
with facilities for treating chronic chest diseases. It also provides 
clinical instruction and experience for students of Howard Univer- 
sity, College of Medicine, and conducts approved teaching programs 
in nursing, dietetics, medical technology, pharmacy, social service, 
and hospital administration. The Hospital has a capacity of 320 
general medical and surgical beds, 50 bassinets and 150 beds in a sep- 
arate annex for chronic chest diseases. Due to budget restrictions 
_ only 52 of the latter beds were in use at the year end. 

The outpatient service, consisting of 34 organized clinics and the 
emergency room, received 95,218 visits, compared with 91,022 in 1957. 

Approximately 38 clinical research projects were under study dur- 
ing the year, notably a series on various aspects of sickle cell anemia. 

Graduate medical and dental training was provided for 47 medical 
residents, 18 medical interns, 9 medical externs, 2 dental interns, and 
8 clinical research fellows. The hospital serves also as a training 
facility for junior and senior medical students. The School of Nurs- 
ing had an enrollment of 114 students, 56 in the graduating class. 
Ten dietitians completed the internship offered by the hospital and 
approved by the American Dietetic Association. 

The Hospital continued its cooperation with the teaching program 
leading to a master’s degree in hospital administration, offering a 
l-year residency in this specialty. Conducted on a preceptorship 
basis, this program meets standards acceptable to the American Hos- 
pital Association, the American College of Hospital Administrators, 
and the Association of University Programs in Hospital Adminis- 
tration. 

Two pharmacy graduates successfully completed internships during 
the year and one student from Howard University School of Social 
Work was accepted for field work training in medical social work. 


112 Department of Health, Education, and Welfare, 1958 


Foreign Quarantine 


No quarantinable diseases were introduced into the United States 
through international traffic this year. Yet, the tremendous increase 
in such traffic has created health threats to this country. In today’s 
world, time and distance, which formerly served as a protective barrier 
for the United States, have been greatly compressed. Thus, protecting 
the Nation against the importation of diseases remains a gre re- 
sponsibility of the Public Health Service. 

Smallpox and yellow fever continued to occur along routes of 
international traffic to such an extent as to constitute serious threats 
to this country throughout the year. The requirement of smallpox 
vaccination for persons coming from abroad, citizens and aliens alike, 
iS @ Major measure in protection of the United States against this 
disease of worldwide prevalence. For the fifth consecutive year 
the Nation was free from smallpox. 

The northward march of yellow fever through the jungles to the 
northern border of Guatemala necessitated further strengthening of 
measures to protect this country against the disease. The entomol- 
ogy program of the Division of Foreign Quarantine was developed 
further to carry on more intensive yellow fever mosquito survey and 
control activities in airports and dock areas in the yellow fever re- 
ceptive area of the United States around the Gulf of Mexico. The 
yellow fever mosquito, Aedes aegypti, was detected in a number of 
areas, from Florida to Texas. 

Plague, typhus, and louse-borne relapsing fever occurred only in 
localized areas of the world where they are traditionally endemic. 
Cholera occurred in rather explosive epidemics in the Orient, but did 
not invade Western Europe, the Pacific Ocean area, or the Americas. 


INTERNATIONAL TRAFFIC VOLUME 


Airplanes inspected for quarantine or immigration-medical pur- 
poses again showed a significant increase, from 61,892 in 1957 to 
68,703 this year. The number of ships inspected remained nearly 
the same, 34,120 this year compared with 34,779 last year. Arriving 
persons subject to foreign quarantine regulations from overseas and 
interior Mexico increased from 5,061,621 to 5,217,627. Smallpox 
vaccinations by quarantine officers decreased from 541,891 to 418,292. 
The number of persons released subject to further medical examina- 
tion at destination increased from 23,173 to 58,083; persons detained 
in isolation at ports increased from 37 to 124. 

Pursuant to Public Law 85-58 of June 21, 1957, a total of 8,305 
ship quarantine inspections were provided on overtime. To avoid 
costly delays to international commerce this law provides for inspec- 
tions to be made outside regular hours, with expenses paid in most 


Public Health Service 113 


cases by transportation companies requesting the special service. 
Aircraft inspections on overtime numbered 5,140. 


MEDICAL EXAMINATIONS 


General program.—The number of aliens examined abroad by 
Public Health Service officers decreased from 206,754 in 1957 to 
190,526 this year; most of these were prospective immigrants. Those 
examined in this country increased from 2,598,741 to 2,870,292; these 
were chiefly crew members of ships and planes and temporary visi- 
tors. (Figures for this year include 3,474 refugees abroad and 4,835 
in this country. In 1957 refugees came under special programs, 
and are not included here.) Among the persons examined abroad 
and in the United States, 5,403 were found to have diseases exclud- 
able under the immigration law. The categories were as follows: 
mental diseases and defects 302 cases abroad, 161 in this country; 
tuberculosis 2,977 abroad, 1,515 in this country (see following sec- 
tion) ; dangerous contagious diseases 108 abroad, 340 in this country ; 
other physical conditions that may have caused exclusion or required 
the posting of a bond 16,725 abroad, 16,941 in this country. 

Immigration of certain aliens with tuberculosis—Under a provi- 
sion of Public Law 85-316 effective till June 30, 1959, the exclusion 
provisions of the Immigration and Nationality Act are modified to 
permit an immediate family member of an American citizen or of a 
resident alien to immigrate to this country although afflicted with 
tuberculosis. The public health is protected through immigration 
regulations, prepared on the advice of the Division in consultation 
with the Tuberculosis Program, requiring these aliens to go promptly 
to a hospital for examination. The New York Quarantine Station 
checks on compliance and receives a medical evaluation, necessary 
X-ray films, and a report of final disposal of each case. A specified 
health officer or physician of a recognized tuberculosis hospital is 
responsible for supplying necessary care, in conformity with accepted 
local standards of medical practice. 

During the year 576 aliens with confirmed or suspected tubercu- 
losis were examined abroad by the Division of Foreign Quarantine 
under these provisions, and 455 at United States ports. (Aliens 
certified under these provisions are included in figures for “exclud- 
able” diseases in preceding section.) 

Farm placement.—In the seventh year of the farm placement pro- 
gram of recruiting agricultural workers from Mexico, 406,353 labor- 
ers were examined, with 11,634 rejections, at 3 migratory centers in 
Mexico; 424,477 examinations were made, with 4,886 rejections, at 
5 reception centers in California, Arizona, and Texas. 

Plans were completed to conduct routine serologic testing for 
syphilis at the reception centers. This was made feasible by a new 


114 Department of Health, Education, and Welfare, 1958 


rapid plasma reagin test developed by the Communicable Disease 
Center, that permits a report of results within minutes. Trial of 
this test at the El] Centro, California, reception center indicated that 
its general application to Mexican laborers would reveal a significant 
amount of syphilis which would be missed by physical inspection. 


OTHER QUARANTINE ACTIVITIES 


Foreign Quarantine Regulations were amended to strengthen and 
modernize provisions on yellow fever prevention, control of insects 
on ships and aircraft, and importation of dogs, cats, and monkeys. 
The changes recognize yellow fever provisions in amendments to 
International Sanitary Regulations issued by the World Health 
Organization and the longer effective periods of recently developed 
rabies vaccines for dogs. 

Entomological investigations on the Mexican border, in connection 
with medical examination of imported farm laborers, revealed fur- 
ther and conclusive evidence of resistance of body lice to certain 
insecticides. Plans were made to study this important resistance 
problem in more detail to determine its actual nature and extent 
and to search for more effective control measures. 

A revision of “Sanitary Measures for Travel of Aliens with Tuber- 
culosis” was published, chiefly to simplify and improve procedures 
for preventing the spread of infection. The measures apply to travel 
of aliens admitted to the United States as immigrants under special 
legislation or as nonimmigrants for treatment. Changes included — 
clear-cut classification of cases as communicable or noncommunicable 
and provisions to help airlines avoid accepting passengers with 
tuberculosis in communicable form. 


Health Services for Indians 


More health services than ever before were made available during 
1958 to the Indians and Alaska Natives through the Federal Govern- 
ment’s Indian health program. A new record was established in the 
numbers of persons served despite the fact that costs were held essen- 
tially to the 1957 level of expenditure during the third year of the 
program’s operation by the Public Health Service. 

Hospital admissions increased for the third successive year to a total 
of 71,000, including 15,000 in contract facilities. This increase oc- 
curred in spite of a dramatic reduction in tuberculosis morbidity and 
in spite of the fact that fewer tuberculosis patients required bed care 
in hospitals. The greater number of hospital admissions is attribut- 
able to increased care provided general patients. It also reflects a 
growing demand by beneficiaries for more medical services. 

This heavy hospital load points up the need for intensive efforts to 
reduce the increasing need for hospital care at the source by effective 


Public Health Service 115 


disease prevention. The excessive tolls which preventable diseases 
still take in human life among Indians and Alaska Natives make it 
clear that prevention is the key to the greatest improvements attainable 
in their levels of health. 

Prevention of disease and health promotion received greater empha- 
sis during 1958. In extending preventive activities on reservations 
and in Indian communities, the field sanitation personnel alone made 
nearly 40,000 visits to Indian homes and institutions. Public health 
nurses intensified their efforts in Indian homes and communities. 

The Public Health Service operates 55 hospitals and provides serv- 
ices at more than 270 non-Federal hospitals on a reimbursable basis 
or through contracts. Preventive health services as well as thera- 
peutic care for ambulatory patients are provided by the Public Health 
Service at health centers, dispensaries in Indian boarding schools, field 
health stations, hospital outpatient clinics, and other locations totaling 
about 300. Approximately 160 private physicians and dentists, and 
30 agencies of State health departments also provide services to Indians 
and Alaska Natives under contractual arrangements with the Public 
Health Service. 

The beneficiaries of the Indian health program number about 347,500 
Indians (excluding those in Alaska) and about 37,500 Alaska Natives 
(including Indians, Aleuts, and Eskimos), or a total of 385,000. Most 
of the Indians live in 24 States, and are scattered over about 250 reser- 
vations. ‘These populations depend primarily upon the Public Health 
Service not only for the preventive services commonly provided by 
local health departments but also for a full range of medical, nursing, 
and dental care. 

The health problems of the Indians and Alaska Natives and the 
difficulties in reaching them with health services are unique. Nearly 
a fifth of all deaths among these groups result from infectious diseases 
which long have been under control in the general population. Their 
deaths from such preventable diseases as tuberculosis, gastroenteritis, 
influenza, and pneumonia are 3 to 6 times higher than in the population 
as a whole. Life expectancy among Indians and Alaska Natives is 
10 years shorter than the 70-year life span which prevails generally. 

Whereas the average age at time of death in the general population 
is 62, among the Indians it is only 40. This early average age at 
death results largely from the excessive infant death rate among 
Indians. Twenty-two percent of all Indian deaths occur among in- 
fants, compared with a national average of only 7 percent. 


THERAPEUTIC SERVICES 


The 71,000 hospital admissions in 1958 represent an increase of 6 
percent over last year. Reflecting successes in combating tuberculosis, 
the average daily census in Indian hospitals (not including contract 


116 Department of Health, Education, and Welfare, 1958 


facilities) decreased slightly to 2,600. The census of general pa- 
tients increased by 2.4 percent during the year. Visits for treatment 
and preventive services provided by hospital clinic staffs totaled 
nearly 575,000. 

Reflecting improvements in the operation of Indian hospitals, one 
additional hospital was accredited, bringing the total to 12 out of 
55 now in operation. One small hospital at Cloquet, Minn., was 
closed and its services replaced by a modern community hospital 
which has a contract with the Public Health Service. 

Pharmacies were established in four additional hospitals. This 
expansion provides services for an additional 164 hospital patients 
and 38,000 outpatients. There now are 20 hospitals in the program 
which have pharmacies. Smaller facilities are provided with phar- 
macy services from central pharmacies. Prescriptions filled during 
the year totaled 255,000 for 249,000 outpatients. 

Both qualitative and quantitative improvements were made in 
treatment services rendered outside hospitals. Eleven Public Health 
Service physicians were added to provide such treatment, bringing 
the number serving at field health installations to 54 out of a total 
of 230. Use of contract physicians and dentists was increased, per- 
mitting more beneficiaries to recelve services nearer to their homes. 
Total expenditures for contract care, both in hospitals and by private 
practitioners outside hospitals, amounted to $7,679,000. 


PREVENTIVE HEALTH SERVICES 


Qualitative improvement in public health nursing and health edu- 
cation services was achieved by means of increased staff training 
and professional development through institutes, scholarships, and 
accelerated training on the job. An audiovisual service was estab- 
lished in the field to develop health education materials for specific 
tribal groups. For the first time, it was possible to provide limited 
psychiatric services for disturbed school children. 

In response to the need to improve nutritional health among 
Indians, organized nutrition services were expanded to 2 of the pro- 
gram’s 7 geographic areas. Nutrition and dietetic services, still new 
to the Indian health program, now are available to 7.3 percent of the 
beneficiaries. 

A prime factor in the excessive incidence of enteric and other in- 
fectious diseases among Indians and Alaska Natives is the gross in- 
sanitary environment prevailing on reservations and in communities 
where the beneficiaries live. Use of polluted water hauled from remote 
sources, contamination of food, insect and rodent infestations, and 
dangerously overcrowded and inadequate housing are common among 
these peoples. Environmental sanitation activities of the Indian 
health program are designed to correct these conditions and practices. 


Public Health Service J 117 


The addition of 19 sanitarian aides, most of whom are Indians trained 
by the Service to work under the direction of sanitary engineers, per- 
mitted some expansion of sanitation services during the year. 

Sanitation surveys were completed for 4,000 water sources, nearly 
20,000 waste disposal facilities, 192 Indian schools, and various other 
facilities. Technical assistance provided for the beneficiaries made it 
possible for them to improve or build at their own expense hundreds 
of safe water sources, nearly 1,000 sanitary privies, and nearly 3,000 
refuse disposal facilities. However, the sanitary deficiencies on reser- 
vations and in native communities in Alaska are far too great to be 
overcome by the beneficiaries with their own limited resources. 

Under the terms of Public Law 85-187, enacted in August 1957, 
the Public Health Service built sewer and water facilities to serve the 
Indian colony at Elko, Nev. This project, carried out in cooperation 
with the Indians concerned and the city of Elko, was completed in 
February 1958 and turned over to the city government for continued 
operation and maintenance. 


TUBERCULOSIS CONTROL 


Between July 1955 and the end of the 1958 fiscal year, new tubercu- 
losis cases dropped 25 percent. The tuberculosis death rate among 
beneficiaries outside Alaska also declined 25 percent. Among Alaska 
Natives, the tuberculosis death rate dropped 57 percent. In spite of 
these spectacular gains in a relatively short space of time, the tubercu- 
losis death rate among Indians outside Alaska is still 4.4 times greater 
than the rate of 8.4 deaths per 100,000 annually among the Nation’s 
population as a whole. Among Alaska Natives, the tuberculosis death 
rate is more than 10 times this national average. 

In contrast with the situation 3 years ago, when there was a waiting 
list of tuberculosis patients who could not receive needed hospital care 
because of limitations in the Indian health program, there now is 
actually a small surplus of beds for such patients. Some hospital 
beds formerly required for tuberculosis patients now are being con- 
verted for general patients. It also has been possible to terminate 
some contracts with non-Federal sanatoria because of the elimination 
of the backlog of cases in need of hospital care and the reduction in 
the incidence of the disease in beneficiary populations. 

Continued progress in controlling tuberculosis will depend largely 
upon the adequacy of case finding, epidemiological investigations, and 
supervision of the increasing number of ambulatory patients receiving 
outpatient treatment with modern drugs. To facilitate case finding 
and followup of patients, an improved tuberculosis record system 
was extended to several additional field health installations. 


118 Department of Health, Education, and Welfare, 1958 


ORAL HEALTH SERVICES 


Clinical observations of oral health conditions among Indians and 
Alaska Natives indicate that the vast majority is in need of dental care. 
Defects ranged from rampant tooth decay to gross periodontal dis- 
ease. The 73,000 patients examined during the year required nearly 
270,000 restorations, 114,000 extractions, and 24,000 prosthetic 
appliances. 

Visits to Indian health dental clinics increased by 18,500 and indi- 
vidual treatments increased by 33,000 over 1957. Contract dental care 
services were begun during the year to reach beneficiaries who had 
received little or no dental services in the past. Despite these gains, 
less than one-fifth of the beneficiary population received dental care 
during the year, and even the patients who were treated required 
307,000 more individual treatments than could be provided. Because 
of the inability to provide dental care for all who need it, services are 
available primarily to school children. 


SERVICES TO MOTHERS AND CHILDREN 


Services to mothers and children, including prenatal care and well- 
baby supervision, were increased substantially. Nearly 18,000 prenatal 
eXaminations were given in 1958, compared with 13,000 in 1957. At 
the 16 school health centers outside of Alaska, visits to physicians in- 
creased 31 percent and visits to nurses increased 7 percent. 

During 1957, examinations in the field disclosed that trachoma, a 
virulent eye disease, was recurring among Indians in the Northwest 
and the Southwest. Inasmuch as this disease is relatively rare in the 
general population, very little in the way of professional literature 
was available for guidance of physicians who must diagnose and treat 
the condition among Indians. Accordingly, the Public Health Service 
commissioned its consultant in ophthalmology, a leading authority on 
trachoma, to write a medical text to meet this urgent need—the 
Trachoma Manual and Atlas. This text has also been made available 
for use in other parts of the world where trachoma is a serious health 
problem. Trachoma among Indians is being brought under control. 

The excessively high death rate among Indian children remains one 
of the most serious problems facing the Service’s Division of Indian 
Health. Of every 1,000 Indian infants born alive in 1956—the latest 
year for which figures are available—56 died within the first year. In 
the general population, only 26 out of each 1,000 infants born alive fail 
to survive beyond the first year. 

Encouraging progress is being made in reducing the Indian infant 
death rate. This death rate has dropped 15 percent since the Public 
Health Service assumed its present responsibilities for Indian health. 


Public Health Service : 119 


TRAINING OF INDIANS 

Approximately 100 Indians and Alaska Natives received training 
in health occupations during 1958 through the Division of Indian 
Health. Slightly more than half of these are practical nurses who 
were trained in the two accredited schools which the Service operates 
to provide practical nurses in its Indian hospitals. 

Others who received training to qualify them for employment in 
the Indian health program included sanitarian aides and dental as- 
sistants. In-service training also is provided for personnel in each of 
these categories, and for community workers (health) who are trained 
on the job under contract by faculties from the Schools of Public 
Health of the Universities of California and North Carolina. More 
than half of the employees of the Division of Indian Health are of 
Indian descent. 


CONSTRUCTION 


The Congress has authorized construction of 4 new hospitals, 15 
field health facilities, and more than 70 new staff quarters. The new 
hospital at Shiprock, N. Mex., now is under construction, and those 
at Gallup, N. Mex., and Kotzebue, Alaska, will be under way in fiscal 
year 1959. Planning for the new hospital at Sells, Ariz., will be 
completed in 1959. 

All 15 of the new field health facilities are under construction, and 
48 of the new housing units have been started. Five old hospitals 
are to be remodeled, and extensive repairs are being carried out on a 
number of other hospitals and health facilities. 

Procedures for participation by the Public Health Service in the 
construction of community hospitals to be used jointly by Indian 
beneficiaries and non-Indians were developed and approved. Such 
projects are to be carried out under the terms of Public Law 85-151, 
approved in August 1957. 


Health Facilities Construction Program 


Since the beginning of the hospital construction program in 1948, 
substantial gains have been made in meeting the need for general 
hospitals, and some gain in facilities for mental and chronic disease 
care. During the past decade new construction has been offset 
materially by increases in population, by obsolescence, and by the 
abandonment of old facilities as new facilities are constructed. 

Amendments to the original legislation have expanded the program 
until now nearly all types of facilities are eligible for aid, except 
offices of physicians and dentists. A program of research is helping to 
develop the most effective use of hospital facilities, services and 
resources. 


io 


120 Department of Health, Education, and Welfare, 1958 


CHANGING NEEDS AND EMPHASIS 

Seventy-five percent of the need for general hospitals has now been 
met, according to inventories and statewide programs furnished by 
the States, as compared with 59 percent in 1948. Mental hospitals 
have fewer beds today in proportion to requirements than was reported 
in 1948—53 percent as compared with 55 percent. ‘Tuberculosis fa- 
cilities are decreasing in number and capacity because of declining in- 
cidence of new cases. The Nation now has 70 percent of its total 
tuberculosis hospital need. Chronic care hospitals now provide only 
14 percent of the beds needed for such care. 

The State plans on record January 1, 1958, show a remaining need 
of 888,000 additional beds for all types of hospitals. Besides this, 
323,000 additional nursing home beds are needed for skilled nursing 
care, or three-fourths of the total requirements in this field. 

In 1958 the record shows a continued trend toward providing fa- 
cilities for long-term care, within the program of federally aided con- 
struction. This trend is evident in national totals, but it is most 
pronounced in the States which now have the largest proportion of 
need met for general hospitals. The top 13 States in this respect (first 
quartile) in 1958 assigned to general hospitals 44 percent of the new 
hospital bed program which received Federal aid and assigned 39 
percent to chronic care hospitals and nursing homes. ‘These States 
each have more than 80 percent of general hospital needs available. 


RESEARCH IN HOSPITAL MANAGEMENT 


Hospital research is also receiving added attention through in- 
creasing requests for grants available to universities, hospitals, and 
State and local governments. Direct intramural research is also 
conducted under this program. The statutory ceiling on research 
funds is $1,200,000 annually. 

As an example of intramural research, the better organization of 
hospital services around the medical and nursing needs of the patient 
was studied intensively by the Public Health Service in 1958. A 
pattern of services is being evolved which is known as “progressive 
patient care.” This pattern makes possible a high level of service, 
with the best use of medical and nursing personnel and a type of 
facility most suited to the patient’s need. It includes intensive care 
for critically ill patients, intermediate care for those requiring moder- 
ate amount of service, self care in a hotel type of setting for ambula- 
tory patients, and long-term care in a homelike atmosphere with a 
periodic evaluation of patient progress and with rehabilitation. These 
types of hospital care are supplemented by home care under medical 
direction, with opportunity for preventive services. Specific studies 
in this field are in progress at the Manchester Memorial es = 
Manchester, Conn. 


Public Health Service ; 121 


SCALE OF OPERATIONS 


The annual amount of Federal construction grants has varied, since 
the initial appropriation in 1948, from $65 million to $150 million. 
The 11-year average, 1948-58, is $96 million annually. The total 
cost of projects assisted has averaged about three times the Federal 
contribution. 

The current active program on June 30, 1958, includes 1,330 projects 
in the construction or preliminary planning stages. These projects 
will provide 53,362 beds for inpatient care and 418 health units for 
outpatient care. Such units include public health centers, State health 
laboratories, diagnostic and treatment centers and rehabilitation 
facilities. The estimated cost of this active program is $1,828 million. 
This level of activity is higher than in any previous year. Likewise, 
the national volume of all new construction started, for health facil- 
ities, 1s rising and has nearly reached the postwar peak attained in 
1951. The volume of all work placed in the fiscal year 1958 amounts 
to $921 million, a 25-percent increase over 1957. The volume of 
federally aided work placed in 1958 is $320 million, as compared 
with $170 million in 1957. 

LEGISLATION 

New legislation enacted in 1958 includes an amendment to Title VI 
of the Public Health Service Act, making available loans for hospital 
construction, in lieu of grants, from the funds appropriated for 
grants. Also, the statutory term of the Federal program for hospital 
construction aid was extended for a period of 5 years after the fiscal 
year 1959, by a measure signed by the President August 14, 1958. 


Dental Resources 


Activities of the Division of Dental Resources are directed toward 
the goal of more and better dental care for a larger, more health- 
conscious population, in the face of an increasingly serious shortage of 
dentists. The Division has pioneered studies in long-range manpower 
requirements, educational experiments to help in training dentists to 
work with chairside assistants, and analyses of prepaid dental-care 
plans and their effect on demands for service. 

The Division also conducts technical research in malocclusion. An 
epidemiological measure of this condition developed by the Division 
was tested successfully in five field studies. The purpose is to devise 
a reliable method of assessing prevalence and incidence of malocculu- 
sion, so that preventive programs can be developed. 


SERIOUS MANPOWER SHORTAGE 
Because of inadequate dental school facilities, the Nation is not 
eraduating enough dentists to pace population growth. This, plus 
487270—59 9 


122 Department of Health, Education, and Welfare, 1958 


increased demands for service, is producing a critical manpower 
shortage. To determine how many more schools are needed, and 
where, the Division added a survey of New England to its series of 
regional manpower studies and began another for the Great Lakes 
States. The New England survey, prepared at the request of the New 
England Board of Higher Education, indicated that the most serious 
shortages in the region are developing in Connecticut and Massa- 
chusetts. Previous studies of the Southern and Western States, where 
shortages also exist, are being used as guides in expansion of 
training facilities. 

Other Division activities were designed to insure effective utiliza- 
tion of available manpower. Although chairside assistants enable a 
dentist to treat more patients, they are not universally employed be- 
cause most dentists were not taught to use them. In a project begun 
in 1957, six dental schools are cooperating with the Division in 
developing ways of training undergraduates to work effectively with 
assistants; definite improvement has been shown both in quality and 
quantity of work of students using assistants. Other findings are 
expected to affect length and type of schooling given chairside as- 
sistants, timing of clinical and research training in dental schools, 
and contemplated modernization of undergraduate curriculum. 


STUDIES OF PREPAYMENT PLANS 


One of the most potentially important developments in dentistry 
is the current growth in number and size of prepaid dental care plans. 
Cost is generally considered the greatest single deterrent to purchase 
of dental care. Prepaid plans, which provide services at a planned 
expense to the member, may therefore make comprehensive care pos- 
sible for millions who have never had it. 

The Division conducted research in all phases of dental prepay- 
ment. Two reports, one of a study of the organization and operation 
of the nonprofit Washington State Dental Service Corporation and 
the other a digest of all known prepaid dental-care plans in the 
United States, were published. A third, a glossary of terms used in 
prepayment literature, was begun. Other studies undertaken were 
an analysis of patient utilization of the Nevada State Dental Society’s 
postpayment plan (in which dental care is financed through short- 
term loans) and a description of the operation of a dental care plan 
for public assistance beneficiaries in the State of Washington. 

Nearing completion were two studies that will show the variations 
in utilization patterns among different population groups. The first 
is a study of treatment sought by a group of persons of relatively 
low income served by the St. Louis Labor Health Institute. The 
second covers the use of clinic services by Public Health Service and 
Coast Guard beneficiaries. 


ee 


Public Health Service 123 


Nursing Resources 


In Autumn, 1957, a group of nurse educators met at the University 
of Colorado to discuss how to interest graduate ‘nursing students in 
nursing research. Early in 1958, nurse leaders and social scientists 
met at the University of California to find ways of directing more 
nursing research toward patient care, ways to improve family health. 
Later in the year, in Seattle, the Western Institutions for Higher 
Education in Nursing held a conference for the exchange of informa- 
tion on research projects in nursing. Another conference was planned 
in mid-summer to evaluate what has been accomplished in nursing 
research, and what still needs to be done. Al of these conferences 
were sponsored and supported by the Division of Nursing Resources. 

The ground is slowly, surely and carefully being prepared for the 
growth and development of strongly patient-centered studies which 
may explain some of the mystifying and perplexing anomalies in 
nursing: Why is there not enough nursing when there are more 
nurses than ever? What is nursing? Who should nurse the patient? 
What are we educating nurses to do? 

Improving the supply of nursing which reaches patients, through 
study and application of knowledge, is one of the major responsibili- 
ties of the Division of Nursing Resources. This year, most of its 
efforts were applied to stimulating investigation of basic nursing 
problems affecting care of patients, conducting an intramural re- 
search program, and offering consultation to hospitals, States, and 
others serving community health needs. 

The chief of the Division conducted the first Inter-American Con- 
ference (Brazil) on improving nursing resources through studies of 
supply and demand based on techniques developed by the Division 
of Nursing Resources for use in the United States. 


NURSING AND PATIENT WELFARE 


Premature infants have been the object of considerable study, but 
now for the first time their behavior is being observed in an effort 
to establish some fundamental facts about the impact of nursing 
care on patient response to treatment. 

At Bellevue Hospital, New York, the Division is observing 100 
premature infants to see what differences occur in weight gain, feeding 
ability, and infant behavior of babies receiving routine care compared 
to a study group for whom one simple additional nursing procedure 
has been added—an “artificial” back support. — 

Infants in a control group, and infants with the supports, are being 
observed 42 days each. Premature infants, more than all other 
patients, are free to respond to stimuli without undue influence of 
remembered experiences. If the infants with the supports differ from 


124 Department of Health, Education, and Welfare, 1958 


the control group in weight gain, fretfulness, crying, or vomiting, the 
study may be able to establish a significant relationship between a 
specific nursing procedure and survival, or rate of growth. In any 
case, tools to further test such relationships will have been developed. 
A concurrent result of the study will be a wealth of new information 
on premature infant behavior for nurses, pediatricians, and 
psychologists. 


DO NURSES “KNOW” THEIR PATIENTS? 


The kind of care a nurse provides may be influenced by her ca- 
pacity to know and to understand her patients—and, from this un- 
derstanding, to perceive their emotional as well as physiological needs. 
Although empathy may not be a hard and fast requirement in nursing 
care, recognition of needs unquestionably is. 

For the past 2 years, the Division has been investigating student- 
nurse perception ability in 9 hospitals and 7 schools of nursing. A1- 
most 400 students were interviewed to find out whether their own views 
differed from those of the patients. 

Preliminary findings indicate that (1) students believe that they 
do not have adequate chance to know patients; (2) students often 
misjudge the importance of certain items which are important to 
patients; (3) students may “know best” the patients who present the 
fewest nursing problems; (4) patients are well aware that the nurse 
is “busy ;” they also have had impressed on them, they say, that their 
needs “are not to interfere with the nurses’ schedules and hospital 
routines.” 

While these findings are by no means conclusive, they suggest that 
the completed study may explain why many patients believe there are 
too few nurses. Quite possibly the results may also suggest that nurs- 
ing education could profit by some changes in the curriculum of the 
undergraduate program. ‘These changes would be in the direction 
of helping faculties to recognize that nursing service practice in- 
fluences student nurse behavior more than theory. 


PROFESSIONAL NURSE TRAINEESHIPS 


During fiscal year 1958, $3 million was awarded to colleges and 
universities for grants to qualified registered nurses desiring advanced 
preparation in administration, supervision, and teaching. This pro- 
gram enabled 1130 registered nurses to enroll in 60 degree granting 
institutions. About half of these nurses had not previously been able 
to enroll in graduate programs in these specialties; the remainder had. 
been enrolled only part-time or intermittently. 

Purpose of the professional nurse traineeship program is to in- 
crease the pace at which professional nurses may be prepared for lead- 
ership positions in hospitals, community health programs, and in 


Public Health Service * : 125 


schools of nursing. Good patient care, it was felt, depends upon not 
only the Judgment and skill of the nurse at the bedside but also upon 
the assignment of nursing personnel according to the individual re- 
quirements of patients of all kinds. The quality of the “product” of 
the undergraduate nursing schools is determined largely by the prepa- 
ration of nurse faculties. Similarly, the correct assignment of person- 
nel assumes knowledge of management and personnel practices in re- 
lation to the needs of the sick. Advanced preparation in the special- 
ties of administration, supervision, and teaching, therefore, seems to 
offer the most economical and rapid approach to the improvement of 
nursing services. 


RESEARCH GRANTS AND FELLOWSHIPS 


The Division of Nursing Resources also administers a program of 
research grants and awards in the field of nursing. In 1958, 30 nurs- 
ing research grants were awarded under an appropriation of $725,000. 
Most of the grants were for investigations of nursing care of patients. 
Also studied were recruiting practices, attrition rates in nursing 
schools, and screening and selection of students. All projects include 
nurses as investigators or consultants; more and more are attracting 
social and behavioral scientists as members of the research team. 

The fellowship awards offer nurses the opportunity to prepare them- 
selves for research careers. During the year, 25 full-time fellowships, 
amounting to $71,400, were awarded; 47 units ($30,450) were also 
made available for part-time study. 


Medical Services for Federal Agencies 


The medical care programs of the Federal prisons, the Coast Guard, 
the Maritime Administration, and the Bureau of Employees’ Compen- 
sation were carried on by Public Health Service officers who are as- 
signed to these agencies on a reimbursable basis. 


UNITED STATES COAST GUARD, TREASURY DEPARTMENT 


Medical services were provided the Coast Guard’s ocean weather 
stations in the Atlantic and Pacific, the ships going to the Arctic 
and Antarctic, the Voice of America ship Courier, and other cruise 
vessels as needed. 

Both a doctor and a dentist went on the Bering Sea Patrol, often 
working as long as 16 hours a day. At the 26 Alaskan villages the 
ship visited, they examined Alaska Natives in family groups at health 
clinics in the school house. All the children were given eye, nose, 
throat, and chest examinations. A record number of 56 patients 
received medical treatment in one single day. During the entire 
patrol, the medical officer examined 3,741 persons, gave 1,027 X-rays, 
and treated 816 patients. 


126 Department of Health, Education, and Welfare; 1958 


The dental officer examined 976 patients and gave 2,856 treatments 
including 926 extractions, 23 restorations, and 49 X-rays. More than 
800 of the patients received anesthesia. 

In all, 92 officers of the Public Health Service were on duty with the 
Coast Guard, including 32 physicians, 46 dentists, and 11 nurses. 


MARITIME ADMINISTRATION, DEPARTMENT OF COMMERCE 


Medical and dental care for the 720 cadet midshipmen and the 275 
faculty and staff members of the U. S. Merchant Marine Academy, 
Kings Point, N. Y., was provided by the Public Health Service officers 
assigned to the Maritime Administration. 

There were 803 admissions to the academy’s Patten Hospital, or an 
average of 73 for each month of the school year. Outpatient treat- 
ments and services, including physical examinations and inoculations 
of cadets going on sea cruises, totaled 27,822. More than 11,000 dental 
treatments also were given. 

At Washington headquarters, the physician serving as chief medical 
officer of the Maritime Administration gave professional counsel to the 
Office of Seamen’s Services and the legal insurance department. 


BUREAU OF PRISONS, DEPARTMENT OF JUSTICE 


The Public Health Service continued to provide medical care to 
prisoners in the 30 institutions of the Federal prison system. The 
prison hospitals provided 431,353 hospital days of care, and their 
staffs performed 974 major and 5,674 minor operations. Outpatient 
departments gave 785,368 treatments and 30,989 physical examina- 
tions. Thirty babies were born and 48 prisoners died. 

Medical research was carried on in several institutions. A study of 
effects of d-lysergic acid was continued at the penitentiary in Atlanta, 


Ga., under guidance of Emory University staff members, and a project 


concerned with storage and excretion rates of DDT in human volun- 
teers went into its third year in Atlanta. A survey of incidence of 
histoplasmosis among prisoner patients at the Medical Center, Spring- 
field, Mo., was made; 39 percent of the patients were negative to his- 
toplasmin. Research at the National Training School for Boys, 
Washington, D. C. concerning the development of delinquent gangs 
was completed, in cooperation with the Catholic University. 

Prisoners in 22 institutions donated 8,828 pints of blood to Red 
Cross Blood Banks and to local hospitals. 

The medical staff provided psychiatric diagnostic studies of per- 
sons charged with criminal offenses about whom questions of mental 
competency are raised. Because of increasing public interest in de- 
termining criminal responsibility of offenders who have mental illness, 
a comprehensive study was begun by the Medical Section, Bureau of 


Public Health Service : 127 


Prisons, of 500 cases examined in the course of mental competency 
proceedings under sections 4244 and 4246 of the U. S. Code, Title 18. 


BUREAU OF EMPLOYEES’ COMPENSATION, DEPARTMENT OF LABOR 


Beneficiaries of the Federal Employees’ Compensation Act are en- 
titled to medical care, compensation for wage loss, and rehabilitation 
services for injuries in performance of duty and diseases caused by 
their employment. Medical officers of the Public Health Service as- 
signed to the Bureau of Employees’ Compensation administer the 
medical care program for their benefit. Medical facilities of the Serv- 
ice and of other Federal establishments are utilized where available; 
in many areas medical care is provided by private physicians. 

During fiscal 1958 there was a slight overall decrease in the total 
number of work-injury cases reported to the Bureau but a significant 
increase in cost of compensation and of medical care. 

Increased emphasis was given to special study of occupational dis- 
eases of obscure etiology and of conditions said to be caused by occu- 
pation. The Public Health Service hospital in San Francisco pro- 
vided facilities for special study of disability due to mustard-gas ex- 
posure. The Wright-Patterson Air Force Base Hospital, Dayton, 
Ohio, provided facilities for study of various occupational diseases, 
in a new specialty center for occupational medicine. 

More emphasis was also given to early vocational rehabilitation 
of injured employees, through frequent utilization of established re- 
habilitation centers, cooperation with Public Health Service facilities, 
and cooperation with State vocational rehabilitation offices. 


Bureau of State Services 


The Bureau of State Services has primary responsibility for the 


application of new knowledge to community health programs. The 


Bureau provides technical, financial, and consultative services to 
States and communities, and conducts applied research which is de- 
signed to improve health and prevent disease. In addition, the Bureau 
conducts programs which help to strengthen international health 
activities. 


Division of General Health Services 


The programs administered by the Division of General Health 
Services are: the Arctic Health Research Center, the National Office 
of Vital Statistics, program development, public health education, 
State grants, and professional training and traineeships. 


128 Department of Health, Education, and Welfare, 1958 


STATE GRANTS 


For fiscal year 1958, a total of $197,913,000 was available for grants- 
in-aid to States and Territories to conduct public health programs 
and to build hospitals and other health facilities. Because no funds 
were granted for poliomyelitis vaccine (the Poliomyelitis Vaccina- 
tion Assistance Act expired in fiscal 1957) the total amount is less than 
the previous year. However, the grants for general health were in- 
creased by $3 million and those for venereal disease control by 
$900,000. The amounts of actual payment and the purposes for which 
they were made are as follows: 


General health. ‘services. 222 ar Sere eee $14, 934, 646. 00 
Venereal disease special projects____.__________-_--__-__- 11, 675, 964. 37 
Tuberculosis, controlasceds, Joe kee ee 4, 493, 988. 00 
Mental health activities... ee 3, 954, 997. 00 
Cancer. CORLDOl — So ee ee ee ee 2, 214, 028. 00 
Heart ‘diseéase-controlc= 2s 2 7 See ee eee 2, 045, 540. 00 
Medical facilities survey and planning_________________ 124, 408. 85 
Construction of community facilities in defense im- 

pacted,».AreCaSs. eee 13, 352. 00 
Hospital and medical facilities construction____________ 105, 291, 966. 43 
Waste treatment works construction____________________ 16, 884, 274. 88 
Water: pollution «controle: so_1)e creda 2 ise 22.776, 515. 00 


+ Includes supplies and services furnished in lieu of cash. 

2 Includes $248,613.00 paid to interstate agencies. 

Other funds which were used to help strengthen State and local 
public health services were $1,854,000.57 for traineeships for profes- 
sional public health workers and $232,140.30 for training and demon- 
stration projects in air pollution control. 


ARCTIC HEALTH RESEARCH CENTER 


The Arctic Health Research Center cooperates with the Alaska 
Department of Health to improve public health and medical services 
in the area. Research at the Center is focused on solving problems 
associated with life in low temperature areas. One of these projects © 
involves various tests to determine human adaptation to cold. Based 
on results of previous work with arctic animals, this project is being 
carried out in collaboration with investigators from the National 
Science Foundation, the University of Alaska, and foreign countries. 

Another Center project this year was a survey of 52 Alaskan vil- 
lages to determine whether the native population had antibodies 
against the three types of poliomyelitis virus. It was found that 
they had and this indicates that, contrary to previous medical opin- 
ion, Alaskan natives have had considerable poliomyelitis infection 
for many years. 

Serological tests made during the 1957 influenza pandemic showed 
that Asian influenza penetrated to the most remote villages. 

Sanitation studies continued on experimental water supplies, waste 
disposal and housing installations. Five experimental housing units 


Public Health Service : 129 


were completed which offer a radical departure from designs and 
materials used previously. 


NATIONAL OFFICE OF VITAL STATISTICS 


National vital statistics are derived from reports of births, deaths, 
fetal deaths, marriages, divorces, and notifiable diseases that are col- 
lected by registration officials. Such data provide a current basis for 
planning programs in public health, medical and demographic re- 
search, education, social welfare, business, and government. 

An important objective of the National Office of Vital Statistics is 
to secure complete and accurate registrations and to coordinate the 
registration and statistical practices of the States insofar as they af- 
fect interstate and international comparability of data. A signifi- 
cant milestone was the inauguration in January 1958 of the Divorce 
Registration Area with 14 States and 8 Territories, following by 1 
year the inauguration of the Marriage Registration Area. 

The Seventh Revision of the “International Statistical Classifica- 
tion of Diseases, Injuries, and Causes of Death,” adopted by the World 
Health Organization for coding causes of death went into effect on 
January 1, 1958. 

As part of its selected studies series, NOVS issued the following 
reports: the study and recommendations made by the U.S. National 
Committee on Vital and Health Statistics on national vital statistics 
needs; a study on socioeconomic characteristics of recently married 
persons; an evaluation of obstetric and related data recorded on vital 
records and hospital records by the District of Columbia Health De- 
partment; a study of the relation of live births and neonatal deaths to 
birth weight; and a report of a special Advisory Committee on Vital 
Statistics Methods. 


PROGRAM DEVELOPMENT 


The Program Development Branch explored the need for new 
public health programs. It continued to serve as a foca] point for 
work on problems of rural health generally, including the health of 
agricultural migrants. Effort was made to obtain continuity of 
health services to migrants, as they move from place to place. Meth- 
ods by which migrant health services are financed were studied, and 
more accurate information obtained about the migrant population. 


TRAINING 


Training opportunities continued to increase for potential and 
current employees in public health. In 1958, a total of 665 profes- 
sional health personnel was given advanced training under the public 
health traineeship program of the Health Amendments Act of 1956, 
compared with 363 last year. More people were also being trained 


130 Department of Health, Education, and Welfare, 1958 
ice aT Nl Dh hie EAC AR AGN i 


under State and local health departments sponsorship, and schools of 
public health experienced a further increase in enrollment. 


PUBLIC HEALTH EDUCATION 


The Public Health Education Branch worked with State and local 
agencies to develop health education programs which would lead to 
desirable health habits. — 

The Branch provided consultative services in health education tech- 
niques and methods to States and communities, to other units of the 
Public Health Service and the Department, and to voluntary agencies. 
It also conducted a number of research studies in the behavioral 
sciences. 

Prominent among these was a cooperative study in 5 cities on the 
effects of the Asian influenza epidemic on community life. Another 
study, which dealt with children with rheumatic fever, uncovered 
barriers to effective patient management which existed among patients, 
parents, physicians, and others. Other research projects were on: 
psychological factors which may predispose to heart disease; why 
people use or fail to use available free dental services; and the social 
and personal consequences of cleft lip and palate in a sample 
population. 


PUBLIC HEALTH NURSING 


The development of scientific techniques to determine the needs for 
nursing staff of public health agencies, based on the policies and pro- 
grams of the individual agency, was a major accomplishment of the 
Public Health Nursing Branch during the year. 

Studies in work measurement and performance budgeting in pub- 
lic health nursing were conducted in four areas. As a result of 
these projects, health departments are able to plan more accurately 
for modifying and expanding services to patients without jeopardy 
to the ongoing program. 

A “Guide for Class Specifications for Nursing Positions in State 
and Local Public Health Programs” was published and distributed 
through the Division of Merit Systems. States used the Guide widely 
in determining qualification requirements of nursing personnel com- 
mensurate with their responsibilities. 

During the year, the Public Health Nursing Branch assisted various 
units of the Service in planning and evaluating public health nursing 
services. 

An experimental extension course in public health nursing was 
established by the Branch in cooperation with the University of 
Minnesota. It is designed for public health nurses, who are unable to 
leave their homes or work long enough to take all of the required 
public health courses on campus. 


et eee eR 


Me Public Health. Service 131 


| Division of Special Health Services 


The Division of Special Health Services is concerned with the 
problems of personal health maintenance. Emphasis is placed on 
chronic illness control and the health of the aged. Division programs 
are: medical aspects of air pollution and radiological health, accident 
prevention, occupational health, cancer, and control of tuberculosis, 
heart disease, and other chronic diseases. 


ACCIDENT PREVENTION 


The Accident Prevention Program worked to reduce the number 
of deaths and injuries from accidents—in the home, the school, and on 
the highway. 

Forty-five State health departments now conduct some kind of ac- 
cident prevention programs. The majority of those are centered on 
home and farm safety, but there is also a growing interest in motor 
vehicle safety. This interest has been stimulated by participation in 
such activities as the Cornell Automobile Crash Injury Studies, and 
meetings on the medical aspects of motor vehicle operator licensing 
sponsored by the Program. 

There is a total of 124 poison control centers in 40 States. The 
Public Health Service coordinates this activity through the National 
Clearinghouse for Poison Control Centers. During the year, local 
centers were encouraged to provide better emergency treatment facil- 
ities, Including equipment and antidotes for various poisons. The 
Clearinghouse obtained information from manufacturers on formula- 
tion, toxicity, and recommended treatment in the event of accidental 
use of their household products. 

An important epidemiologic study of fires and explosions, with 
particular emphasis on petroleum products, began in Mississippi 
County, Ark., in cooperation with the State health department. An 
investigator 1s working with fire department officials and others to 
identify the causes and circumstances of fires. 

The Cornell] Aeronautical Laboratory was awarded a contract to 
study the feasibility of building a driving simulator—a device for 
studying driver behavior under various conditions. 


CANCER CONTROL 


During the year, a new unit was established to conduct cancer con- 
trol activities. The unit works closely with physicians and health 
agencies to stimulate early detection of cancer. 

Informal 2-day discussions were held during the year in Atlanta, 
New York, and San Francisco to explore possible areas for action. 
These sessions were attended by representatives of professional medi- 
cal societies, State health departments, and voluntary health agencies. 


132 Department of Health, Education, and Welfare, 1958 


Among the recommendations were that health departments initiate the — 
following activities : tumor registries; tumor diagnostic and treatment 


clinics; casefinding, including cervical cytology; patient followup ac- — 


tivities, and lay education. 


CHRONIC DISEASE CONTROL 


The Chronic Disease Program helps States and communities to pre- 
vent the disabling effects of long term illness. In 1958, the Program 
continued to emphasize the early detection of diabetes and glaucoma. 
In promotion of better health for the aging, standards were developed © 
for workers in nursing homes, homes for the aged, chronic disease 
hospitals, and organized home care programs. 

A significant event of the year was the First National Conference 
on Nursing Homes and Homes for the Aged called by the Surgeon 
General to develop recommendations for raising the level of care in 
nursing homes. Basic services, accreditation, financing, and regu- 
lation were among the major areas considered. 

To further glaucoma detection programs, demonstration equip- 
ment was furnished to the National Society for the Prevention of 
Blindness. 

Developmental work leading to an evaluation of the effectiveness 
of medical rehabilitation-restorative services began with a pilot study 
of cerebrovascular accident patients at the D. C. General Hospital, 
where 80 percent of those treated who were ambulatory at discharge, 
remained so after discharge. In another hospital without a medical 
rehabilitation program, only 35 percent were ambulatory at discharge. 

Among activities dealing with nutrition and weight control was 
a cooperative agreement with the Ohio Department of Health to 
provide the program with essential data on the operation of its 
“Meals on Wheels” program. 

A joint project with the Washington State Department of Health 
and the Council on Aging for Seattle and King County was estab- 
lished to study the health benefits from a program of supervised 
activities and counselling in an aged population. 


HEART DISEASE CONTROL 


The Heart Disease Control] Program works with State and local 
health departments to establish and improve control activities. Some 
important current needs are for: rheumatic fever programs; better 
care of cardiac patients in areas unattended by physicians; multi- 
discipline training; epidemiological studies; and professional and 
public education in the application of basic research findings. 

A “Heart of the Home Program,” cosponsored with the Minnesota 
Department of Health, Minnesota Heart Association and the Uni- 


Public Health Service : 133 


versity of Minnesota, was developed to simplify household chores 
and otherwise assist homemakers with a cardiac condition. 

Screening activities included: a multi-phasic screening program 
in two Oklahoma counties using EKG, blood determination and pres- 
sure readings; screening for hypertension among people in Wisconsin 
- who had received mobile chest X-rays; a heart disease screening 
~ project among school children in Meso County, Colo.; and citywide 
screening in Los Angeles to find new heart disease among people 
previously tested. 

A research study of the after-effects of severe heart illness, with 
reference to excessive disability, revealed that an initial emotional 
breakdown was related to better later adjustment or handling of 
emotional problems. 

Data collection began in Georgia among vegetarian and non-vege- 
tarian populations to test hypotheses relating fat intake to serum 
cholesterol levels. 

One hundred obese children and 100 children of average weight 
identified in Hagerstown, Md., in 1936, have been located and re- 
examined to learn to what extent obesity among adults 1s conditioned 
by childhood obesity. Also, an effort will be made to identify socio- 
‘logical factors associated with the inability to lose weight. 


OCCUPATIONAL HEALTH PROGRAM 


Protection against occupational disease and injury and stimulation 
of preventive health services for the working population are important 
functions of the Occupational Health Program. 

Through medical studies of the individual and engineering studies 
of the environment, pathological findings were correlated with ex- 
posure, all of which helped in designing control measures. One such 
study involved the relation of industrial noises to loss of hearing. 
Preliminary findings suggest that noise-induced hearing loss may 
occur earlier than had been expected; and continuous noise 1s more 
injurious than intermittent noise. Work is being done to learn the 
extent of permanent hearing loss under such conditions. 

In study of health hazards in uranium mining and milling, empha- 
sis is being placed on medical considerations, since European exper1- 
ence showed that lung cancer began to appear in uranium miners after 
about 15 years of exposure. Because of high turnover among this 
mining group, annual censuses have been made to learn if medical 
reasons were responsible for some of, the men leaving the industry. 

Silicosis remains the most significant occupational disease in the 
United States in terms of disability and compensation cost. ‘These 
costs are estimated to be about $10 million yearly. A joint PHS-U.S. 
Bureau of Mines study began on the relation of silicosis to occupation, 


134. Department of Health, Education, and Welfare, 1958 
ee ee eee 


length of exposures, dust concentrations, the kind of dust and its 
particle size, and other environmental factors related to the problem. 
A medical phase of the study will seek X-ray evidence of silicosis 
among a sample of currently employed metal miners. 

Completion of a census of professional registered nurses employed 
full time in United States industry on January 1957 showed 16,223 
individuals employed. Since this number represented a 82 percent 
increase over that found in a 1952 census, several universities and 
schools of nursing have expressed a desire to provide more educational 
opportunities for occupational health nurses. 


RADIOLOGICAL HEALTH MEDICAL PROGRAM 


During most of the fiscal year, the medical aspects of radiological 
health were centered in the Division of Special Health Services, and 
the engineering aspects in the Division of Sanitary Engineering Serv- 
ices. In March 1958, these programs were combined in a newly created 
Division—the Division of Radiological Health. 

Medical implications of ionizing radiation are based on the fact 
that effects on health are cumulative and irreversible. All sources 
of exposure must be considered in assessing and controlling the poten- 
tial hazard—fallout from nuclear testing, use of X-rays in medical- 
dental diagnosis and therapy, and occupational sources of exposure, 
among others. The Service recommended, in cooperation with State 
and local health departments, that X-ray equipment be maintained in 
optimum operating condition to reduce all unnecessary exposure, both — 
to operators and the public. 


TUBERCULOSIS CONTROL 


During the year, the use of community chest X-rays to find unknown 
cases of tuberculosis was subjected to intensive review. On the advice 
of a group of experts in this field, the Service recommended that mass 
X-ray surveys be concentrated among groups known to be at high 
risk of tuberculosis infaction. | 

This recommendation was based on changes in the extent of the 
tuberculosis problem and on the problem of low-level exposure to 
radiation. The Service also recommended that State and local au- 
thorities consider using the tuberculin skin test in school health pro- 
grams as the initial means of detecting tuberculosis. 

The Ad Hoc Advisory Committee to the Surgeon General recom- 
mended that large scale BCG vaccination programs are not indicated 
in this country and that its use be limited to groups where risk of — 
exposure is high and other means of control are weak. 

The principal current research efforts of the program are directed 
at development of more effective prophylaxis methods. Studies on 
the effectiveness of isoniazid to prevent meningitis and other compli- 


Pathe Health’ Service 135 


cations of primary tuberculosis in children were continued on 2,750 
individuals in 82 clinics. The efficacy of isoniazid was also being 
tested among 27,000 persons in institutional populations, and house- 
hold and other close contacts of newly reported active cases of 
tuberculosis. 

Evaluation studies of antimicrobial therapy showed streptomycin 
plus pyrazinamide as used in a completed project, produced a more 
rapid reversal of infectiousness than isoniazid plus PAS, the most 
commonly used therapeutic regimen. Although the former regimen 
is more toxic than the latter, the first 12 weeks of treatment were rela- 
tively safe when most of the therapeutic effect was achieved. 

Special emphasis was placed on determining the needs of unhospi- 
talized patients for long term services. A pilot study of active tuber- 
culosis patients who follow medical recommendations, as compared 
with those who lapse from supervision, was made in Minneapolis. 


Division of Sanitary Engineering Services 


The Division of Sanitary Engineering cooperates with State and 
local health departments, industry, and other groups on environmen- 
tal health problems associated with air, water, and food. Division 
programs deal with the engineering aspects of such problems as air 
pollution, water supply and pollution control, milk and food sanita- 
tion, the sanitation of interstate carriers, radiological health, and 
professional training in sanitary engineering. 


ROBERT A. TAFT SANITARY ENGINEERING CENTER 


The Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio, 
is a national laboratory for research, specialized technical assistance, 
and advanced training in the activities of the Division. The Center 


. cooperates with program personnel to develop new and improved 


testing procedures, and with industry and health departments in the 
application of these methods to local problems. Analysis of air pol- 
lution problems is given high priority, as well as a variety of condi- 


tions associated with the expanded use of ionizing radiation by in- 


dustry and others. 
AIR POLLUTION ENGINEERING PROGRAM 


Although research dominates current program activities, long range 
planning is aimed at cooperative action with State and local com- 
munities to help control community air pollution. 

Initial planning began for a National Conference on Air Pollu- 
tion to be held in Washington, D. C. on November 18-20, 1958. 

Research studies were under way in a variety of fields related to air 
pollution. Some of these studies involved cooperative work with other 
Federal agencies. For example, PHS specialists began work with the 


136 Department of Health, Education, and Welfare, 1958 


Department of Agriculture on the use of plants as indicators of air 
pollution. The Tennessee Valley Authority began studies on the 
dispersion of stack gases. 

Automobile exhaust research by the Service was accelerated at the 
request of the National Advisory Committee on Air Pollution and the 
Automobile Manufacturers Association. 

In a study of community air pollution in Nashville, Tenn., data 
were collected in order to determine the health effects of air pollution. 
In addition to possible medical implications, the study should help to 
determine the type and extent of air pollution over a metropolitan 
area. 

The National Air Sampling Network had 112 urban and 45 non- 
urban stations gathering data on the country’s air pollution problem. 
State and local authorities in every State collected and analyzed air 
samplings to define and identify the extent and variety of air pol- 
lutants. In cooperation with the National Cancer Institute, air 
samples were analyzed in eight cities for known carcinogenic and 
other substances. 


ENGINEERING RESOURCES AND TRAINING 


The Division continued to provide training and career development 
opportunities for the sanitary engineering profession. Under the pro- 
visions of Public Law 911, a total of 121 engineering traineeship 
awards was made. 

Special courses were sponsored to meet the increasing demands for 
engineering personnel in radiological programs. To stimulate interest 
in sanitary engineering as a career, material was produced for use 
among secondary school students. 

In cooperation with the National Science Foundation, work contin- 
ued on a roster of sanitary engineering manpower in the United States. 


GENERAL ENGINEERING 


Special citations, which are awarded annually to qualifying inter- 
state carrier companies, went to 12 vessel companies and 5 railroads 
for maintaining high sanitation standards in all operating units. 

Significant developments toward world-wide uniformity of stand- 
ards resulted from staff work with the Expert Committee on Airport 
Sanitation of the World Health Organization. Other international 
activities included cooperation with the Pan American Health Organ- 
ization on sanitation standards for tourist establishments in Central 
and South America. 

An expanded Maritime Service construction program required addi- 
tional inspection of potable water systems, food service categories, 
ratproofing, and general plumbing arrangements. In the airline pro- 
gram, Inspections were made of individual aircraft, servicing areas, 


Public Health Service 137 


and caterers similar to that done for many years on railroads. Since 
buses now carry water, serve food, and maintain restrooms aboard, 
interstate quarantine regulations were applied to all units as well as 
their servicing areas. 

To solve the problems of household waste disposal, a study was ini- 
tiated on individual household aerobic sewage treatment systems to 
develop criteria for evaluation, testing, and conditions for use. 


MILK AND FOOD SANITATION PROGRAM 


A continuing pilot study of milk samples from 10 milksheds of the 
Nation showed radioactivity to be well within the maximum permis- 
sible concentrations published by the National Committee on Radia- 
tion Protection and Measurement. 

Control of the sanitary quality of the aquatic environment was a 
primary activity of the shellfish sanitation program, and cooperative 
action with coastal States supplemented work with shippers and 
distributors. Improved biochemical and assay methods developed at 
SEC to determine paralytic shellfish poisoning showed increased re- 
hability and accuracy during unexpected outbreaks of the poison in 
West Coast shellfish species and certain marine clam beds. 

_A final report on the joint University of California-Public Health 
Service Q fever pasteurization studies was released covering incidence, 
methodology, laboratory thermal inactivation, and commercial equip- 
ment studies. Study of the organism in dairy products other than 
milk is continuing at the University. 

New and potential reservoirs of food-borne infection and contamina- 
tion, including effects of disposal of radioactive wastes, received 
attention. 

Work continued with the States to correct deficiencies in the poultry 
processing industry. Scheduled for completion next year, the poultry 
sanitation demonstration project in Denver, Colo. made substantial 
progress. Other work involved cooperation with States on interstate 
milk shipment problems, and with industry and official health agencies 
on local regulations necessary for the vending of foods and beverages. 


- RADIOLOGICAL HEALTH ENGINEERING PROGRAM 


Increasing use of ionizing radiation resulted in extended Public 
Health Service cooperative action with State and local groups ranging 
from specific technical matters to assistance in developing compre- 
hensive programs for radiation protection. Some of these activities 
included methods of reducing clinical exposure to X-rays; monitoring 
programs to determine the extent of radioactive contamination; and 
determination of the adequacy of proposed radioactive waste treat- 
ment and disposal facilities used in conjunction with reactors and use 
of radioisotopes. 

487270—59 10 


138 Department of Health, Education, and Welfare, 1958 


Cooperative work on radiological health and safety was undertaken 
with the Maritime Administration on its nuclear powered merchant 
ship program, with the Navy on its Nuclear Propulsion Program, and 
with coastal authorities on monitoring of ships entering ports with 
cargoes having a potential radioactive hazard. 

The Service continued to carry out off-site monitoring activities 
at the Atomic Energy Commission Nevada nuclear test site, supple- 
mented by a medical liaison officer network. 

Under an agreement with the Atomic Energy Commission, the 
National Radiation Air and Water Surveillance Network was in- 
creased to 45 stations. This work was expanded to include analysis 
of weekly samples from 50 raw water supplhes. 


WATER SUPPLY AND WATER POLLUTION CONTROL 


To provide a sound basis for pollution abatement programs, ac- 
tivities were directed toward the collection and analysis of data 
on existing water and waste treatment facilities and needs, the 
continuous collection of water quality data over a national network 
of 40 sampling stations, and studies of the economics of water pollu- 
tion. Research at the SEC and other field investigations helped 
measure the complex problems created by the manufacture of new 
chemical and synthetic products. The construction grants program 
and interstate enforcement activities are increasing the rate of con- 
struction of pollution abatement facilities by States and local com- 
munities. 

Inventories of community water supply facilities and municipal 
and industrial waste treatment works were completed. 

At the end of fiscal year 1958, Federal grants under Public Law 660 
amounting to $85.3 million went to 1,038 communities in support of 
sewage treatment work construction totaling $441.8 million. About 97 
percent of these grants went to communities under 125,000 population. 

Some sanitary engineering studies involved small sewage treatment 
plant design in the North Central United States; design and cost of 
constructing sewage stabilization ponds, a less expensive method of 
sewage disposal now receiving greater attention and use by smaller 
communities; and determination of sewage treatment plant inane ng 
problems by public bodies. 

Formal conferences were held to seek abatement of interstate pollu- 
tion involving the Potomac River in the metropolitan Washington 
area; the Missouri River at Kansas City; Mississippi interstate waters 
in the St. Louis area; and the Animas River in the Southwest for 
alleged radioactive and other wastes. 

Analysis continued of the adequacy of State water pollution control 
laws. Nine States requested and received advice on proposed water 


Public Health Service ; 139 


pollution control legislation, and seven States enacted such laws 
during the year. 

Other major projects involved finding more effective treatment 
methods for Lake Michigan water, in cooperation with Northwestern 
University ; a study of the status of pollution in the New York Harbor 
area; water quality effects of economic poisons used in spray programs 
for eradication of the gypsy moth; the effects of hydroelectric plants 
on water quality for other water uses; and the effects of tides and cur- 
rents on pollution. 


Communicable Disease Center 


The Communicable Disease Center operates as a working partner 
of the States in the control of infectious disease. It is located in 
Atlanta, Ga., with laboratories and field stations in various parts of 
the United States. The Center provides technical assistance to the 
States and develops practical tools in the form of knowledge or im- 
proved techniques to enable the States to carry out effective disease 
control programs. During the year, construction was started on new 
headquarters for the Center on 14 acres of land adjoining the Kmory 
University campus. 


EPIDEMIC AND DISASTER AID 


CDC gave epidemic aid in 42 instances. Aid was given in connection 
with the Asian influenza epidemic, staphylococcal and other hospital- 
acquired infections, health problems on Indian reservations, and the 
East Pakistan outbreak of smallpox and cholera. Hurricane Audrey 
and floods in Texas, Louisiana, Arkansas, and Oklahoma accounted for 
11 requests for disaster aid. 

REPRESENTATIVE FIELD AND LABORATORY STUDIES 
Asian Influenza 

Prior interest in respiratory diseases and international responsi- 
bilities in the influenza field prepared CDC to initiate its Influenza 
Surveillance Program in July and to serve as the principal laboratory 
resource during the Asian influenza epidemic. Functioning as strain 
study center and focal point for laboratory information, CDC also 
established contractual diagnostic and reference services in 37 States, 
Alaska, Hawaii, and Puerto Rico with special funds allocated by Con- 
gress. Typing reagents for Asian and older influenza strains, with 
instructions for their use, were prepared and distributed to 160 labora- 
tories. Investigations were conducted on the efficacy of influenza 
vaccines and the practicability of different immunization procedures. 
Detailed, current accounts on the progress of the epidemic were 
published weekly. 


140 Department of Health, Education, and Welfare, 1958 


Venereal Diseases 

The trend in cases of infectious syphilis in the United States con- 
tinued upward with 20 States and the District of Columbia reporting 
increases. This year there were 6,651 cases of lesion syphilis, 5.9 per- 
cent more than in 1957. <A total of 125,978 cases of syphilis in all 
stages was reported by State health departments, a decline of 7 per- 
cent over last year. Deaths attributed to syphilis numbered 3,870. 

The number of reported cases of gonorrhea was 219,219, a slight in- 
crease over 1957. 

There were 49,484 cases of venereal disease reported among persons 
under 20 years of age. Thirty-four States reported increases in the 
proportion of venereal disease among this age group. Fifty-three 
percent of all infectious cases occurred among persons 15 to 24 years 
of age. 

Federal funds supported 93 venereal disease projects in 41 States. 
Activities included selective blood testing, contact interviewing and 
investigation, and cooperation with private physicians to improve 
morbidity reporting and extend epidemiologic services. 

Cluster testing, the new casefinding method that extends contact 
investigation to include blood testing of associates of patients and 
contacts, continues to be an excellent epidemiological tool and has 
been extended to 10 States. 

The relative sensitivity and specificity of treponemal and nontrep- 
onemal tests in the serodiagnosis of syphilis were evaluated in 15 
laboratories employing 388 different procedures. This evaluation was 
conducted by the Serologic Evaluation and Research Assembly. 

The search for an immunizing agent for syphilis continued both 
in Public Health Service and in other research laboratories. The 
Reiter protein antigen complement fixation test showed promise as a 
specific and economical treponemal test for syphilis. 


Poliomyelitis and the Polio-Like Diseases 


Incidence of pohomyelitis was about one-third that of 1956, with 
even more marked reduction in paralytic cases. A large proportion of 
the nonporalytic cases, some producing residual muscle weakness, was 
caused by Coxsackie Type B and ECHO viruses, but paralytic cases 
were usually true polio. A new pathogen responsible for epidemic 
meningitis and death in infants is being sought among unclassified 
bacteria isolated from affected newborn infants during two hospital 
outbreaks. 

Surveillance demonstrated the continued safety and effectiveness of 
the polio vaccine. Efforts are being made to simplify and improve 
diagnostic procedures for polio and the polio-like diseases. 


Public Health Service 141 


Staphylococcal Infections 


Coordinated planning was begun for long-range control of staphy- 
lococcal and other hospital-acquired infections, which, in some in- 
stances, are caused by antibiotic resistant strains of bacteria. These 
are creating nursery-obstetrical and general medical problems, and 
producing surgical wound infections. Resurgence of these prob- 
lems after many years of relative freedom following the advent of the 
science of bacteriology and the development of aseptic techniques is 
a matter of serious concern. 


Viral Encephalitis 


Field investigations showed that mass infection of birds with East- 
ern encephalitis in fresh water swamps enables various mosquito 
species to spread the virus far afield; that Western encephalitis virus 
can survive through the winter in experimentally infected birds and 
mosquitoes; and that the extreme efficiency of two mosquito species in 
transmitting St. Louis encephalitis would justify control measures in 
cities in risk areas. 


Rabies 


Wildlife rabies studies were continued in the Southeast, in New 
York, and in the newly established Southwestern Wildlife Rabies 
Station at the New Mexico State College. As broadly applied con- 
trol programs continue to reduce the urban rabies problem in dogs, 
contro] measures are being sought against the large reservoir of infec- 
tion in skunks, foxes, and other wildlife. Bat rabies has been re- 
ported from 19 States since 1953. 


Diarrheal Diseases 


Growing resistance of Salmonella typhimurium in fowl to tetra- 


_ eycline antibiotics has been detected, and the baseline of resistance in 


old cultures was established. Since tetracyclines are now common 
additives to animal diets, development of resistant bacteria must be 
watched closely. 

A 3-year investigation in eastern Kentucky showed that diarrheal 
disease morbidity, Shzgella infections in preschool children, and 
Ascaris infections in the general population were inversely related to 
the availability of sanitary facilities. 


Anthrax 


An outbreak of anthrax in a New England textile mill included 
five cases of inhalation anthrax, four of which were fatal. This 
outbreak—the first in which inhalation anthrax occurred in epidemic 
form—was studied intensively because of its serious implications in 
occupational health and in national defense. Cases were traced to 


142 Department of Health, Education, and Welfare, 1958 


imported goat hair. No cutaneous or inhalation anthrax developed 
in vaccinated individuals. 


Plague 

In a simulated field test, the transfer of radioactive fleas between 
California meadow voles and domestic (Norway) rats indicated how 
sylvatic plague could be spread to urban areas in the enzootic western 
States. 


LABORATORY SERVICES AND NEW TECHNIQUES 


This year the Center identified over 42,000 troublesome isolates sent 
in by State and Territorial laboratories, Federal agencies, and for- 
elon countries. Because the wide range of diagnostic reagents, which 
are essential in the laboratory diagnosis of viral, fungal, bacterial, 
and parasitic diseases, is not available commercially, CDC created a 
special section to produce and evaluate hundreds of these materials. 

Rapid growth of virulent strains—but not avirulent variants— 
of many organisms (tubercle bacilli, other cultivable mycobacterial 
pathogens, brucella, Bacterium tularense, staphylococci, streptococci, 
typhoid bacilli, and Histoplasma capsulatum) was attained in human 
tissue culture cells, and the action of antibiotics on them was observed. 

Significant cytopathic changes were obtained in hamster kidney 
tissue cultures inoculated with fixed rabies virus after repeated pas- 
sage, and with arthropod-borne encephalitis viruses. This was the 
first time rabies virus has been propagated in the absence of nerv- 
ous tissue—the component of the present vaccine responsible for 
the paralytic syndrome sometimes encountered in humans. Use of 
the hamster kidney tissue system may simplify diagnostic immuno- 
logic studies in these important viral diseases and lead to an improved 
rabies vaccine and a modified live virus vaccine against encephalitis 
for human use. 

With increased availability of fluorescein dyes and improved label- 
ing procedures, considerable progress has been made in applying the 
fluorescent antibody techniques to the rapid detection and identifica- 
tion of various pathogens. Especially significant is the straining of 
rickettsiae and viruses either from tissue culture or from direct smears 
of infected organs. 


VECTOR CONTROL 


Continuation and extension of the progress already made in the con- 
trol of vector-borne diseases are threatened by the growing re- 
sistance to insecticides of many important disease vectors. A testing 
kit developed by CDC has been accepted by WHO as a standard 
method for worldwide use in determining the susceptibility of mos- 
quitoes to insecticides. 


Public Health Service 143 


A pilot demonstration project has been activated in Pensacola, 
Florida, to obtain objective data on cost, methodology and practi- 
cality of eradicating Aedes aegypti, the urban vector of yellow fever, 
in the United States. 

A practical apparatus was developed for sampling large volumes 
of water for cercariae of Schestosoma mansoni to facilitate investiga- 
tion of the epidemiology of schistosomiasis in Puerto Rico. 


TRAINING 


More than 7,200 persons from State and local health departments, 
Federal agencies, academic institutions, industry, other organiza- 
tions, and from abroad, received organized training from CDC in 
various aspects of communicable disease control. Particular em- 
phasis was placed on courses in the principles of epidemiology and 
their application for all the professional members of the health team. 


Division of Dental Public Health 


The Division of Dental Public Health develops new methods of 
dental disease control and encourages their adoption by State and 
local health departments. 

States were given professional and technical assistance in dealing 
with such problems as personnel utilization, program planning and 
budget management, defining dental public health problems, ad- 
ministering dental health clinics, providing dental services for public 
assistance recipients, and carrying out inservice training programs. 


FLUORIDATION 


Fluoridation of community water supplies increased throughout the 
country. Over 34 million people in 1,709 communities, including a 


- majority of the Nation’s 18 largest cities, were using fluoridated drink- 


ing water. About 90 percent of all public water supplies serve com- 
munities with less than 5,000 population. Analysis of national fluori- 
dation data showed that relatively few of these smaller communities 
have fluoridated their public water supplies. 

One problem associated with fluoridation has been a shortage of 
suitable fluoride compounds for use in community water supplies. 
Division research found that the very common substance, fluorspar, 
could be used. A demonstration now in progress in a small community 
shows that the use of fluorspar will reduce by two-thirds the current 
cost of fluoridation. 

A practical device developed by Division staff for fluoridation of 
individual home water supplies now makes possible the extension of 
fluoridation to rural and suburban populations not served by public 
water supplies. 


144. Department of Health, Education, and Welfare, 1958 


DENTAL STUDIES 


In New Mexico, a 2-year project was begun to explore the preva- 
lence and patterns of pyorrhea and other peridontal diseases. Staff 
assistance was supplied for a study on dental needs of people in nurs- 
ing homes in two Georgia counties; for a Jefferson County, Mo. multi- 
phasic disease study of the aged which will include dental disease 
among ten conditions examined; and for a survey in Colorado to 
analyze dental services supplied in a State mental hospital. 


Division of International Health 


Through this Division, the Public Health Service participates in 
the activities of the World Health Organization, the Pan American 
Sanitary Organization, the South Pacific Commission, and other 
health agencies. It offers program and policy guidance to the Depart- 
ment of State on international health matters and to the International 
Cooperation Administration on training, educational and technical 
aid to United States Operations Missions abroad. 

At the invitation of Congress, the WHO held its Tenth Anniversary 
Commemorative Session in Minneapolis, Minn., on May 26-27, 1958. 
This was immediately followed by sessions of the Eleventh World 
Health Assembly which elected the Surgeon General its President. 

The Division completed special health studies on Taiwan, Hong 
Kong, Macao, Jordan, and Iran. This brings to 12 the number of 
studies made under the Division’s international epidemiology program 
which began in 1956. 

Reciprocal exchange missions in public health administration from 
the United States and the U. S. S. R. visited both countries late in 
1957. This was supplemented by a January 1958 agreement signed 
by both countries covering a broad area of cultural and scientific 
exchange missions in the fields of medicine and public health. 

At the end of the fiscal year, 162 PHS officers (physicians, nurses, 
engineers, and other technicians) were assigned to field missions in 
which the United States participates abroad. Assistance by Ameri- 
can health technicians ranges from consultation on demonstration 
health projects to evaluation of established national health programs. 
In response to a request, the Surgeon General recommended to ICA 
that health activities be intensified in the control of tuberculosis, 
trachoma, schistosomiasis and in the improvement of sanitation and 
the construction of medical facilities. 

A total of 599 foreign health trainees from 76 countries was given 
supervision and guidance in securing medical and public health train- 
ing which will help them to develop health department programs when 
they return home. Public Health Service installations provided train- 
ing for 163 of the trainees and 266 were placed in academic or clinical 
centers for specialized graduate work. 


Public Health Service 


145 


Table 1.—Statement of appropriations, authorizations, obligations, and 
balances, fiscal year 1958 


[In thousands] 


Funds available for obligation 
Total 

Appropriations Appro- Net Repay- Prior funds |Amounts 
priations | transfers | ments | year un- | available jobligated 

and between for obligated 

authori- | appro- | services | balances 

zations | priations 
AMOI. a 28 ce a $565, 963 $2,320 | $26, 537 | $116,305 | $718,477 | $613, 720 
Mppropmations, PHS. 22 _..-.--..- 565, 846 2, 320 26, 537 | 116,142 | 710, 845 607, 734 
Control oftuberculosis:.......-.---------- 7, 000 51 ie oe ae 7, 065 7, 051 
Control of venereal diseases______________- 4,415 soho ee ae ane (ae el SE 4, 503 4, 460 
Assistance to States, general_____--_---___- 22, 592 114 Q4AS TIES. te o 22, 954 22, 870 
Control of communicable diseases___------ 7, 050 122 AL Grlicpate onde 7, 588 7, 576 
Grants and special studies, Territory of 

PANIC Kee ee Sn ean 2, 165 1D a Oe ae ee 2, 215 2,211 
Sanitary engineering activities (1958-59) ___ A Se fsies e ae g  e  9e 3 (tes 26 
Sanitary engineering activities (1958) _____- 12, 640 2 G28 epee ie ete 13, 774 13, 535 
Foreign quarantine service_._..----------- 3, 876 147 1G4 ices. eaten 4, 187 4,131 

’ Dependents medical care___-------------- 900 Die Ds i Sick urate 2 en aa 899 899 
Hospitals and medical care (1958)________- 44, 399 224 Av ANG eas rau 49, 032 48, 996 
Hospitals and medical care (1958-59) _____-_ 305} 0 ed fies eee nee 2 er, Doha np aie 150 150 
Hospitals and medical care (1957-58) ______ NEA See ae | ae Sok a Sa ae 1 1 
Salaries and expenses, hospital construc- 

OMESCINICCSEE Eee = ooo tose 1, 450 48 i a ee oe ee 1, 499 1, 492 
Indian health activities (1958-59)__________ 71 (ms even te eee pe een ee ee 400 158 
Indian health activities (1958) ..___--_____- 40, 100 675 711 2615 40, 871 40, 810 
Construction of Indian health facilities 

(QMINEGIN 5. Se et Sa rr Red esl eae ee 7 oe See oe Oem a 3, 1380 640 
Construction of Indian health facilities 

CPD SALE). 2 ok ot a a aS (eee Ree (cere rm 11, 526 11, 526 3, 889 
Grantsior nospitalconstruction: (1958-59) _|, 121,200 |....-2_.--|_22.-.-_..|_-2-22..-_- 121, 200 44, 847 
CGranisiornospitalveonstriuction (1957-58) := |. ---4-.=|s- 2esens2| 2-0-2 s- 86, 083 86, 083 85, 187 
Surveys and planning for hospital con- 

SCD OU so). ugh = Ete Se a | Pe ee (ee 9 | (ee il alye! 1,174 124 
General research and ee National 

imsthigiutesof Health 2. s.2 3 14, 026 58 1 ae Tie 14, 085 14, 082 
Salaries, expenses, and grants, National 

acer idstiiutes................ OO; 402) | eens e ee Tey | Es pnp pain 56, 403 55, 455 
Mental health activities________.________- 39, 217 114 Gi ota a a 39, 367 39, 277 
Salaries, expenses, and grants, National 

Beatie Mastiimees sea ee el — es ee 5, 936 147 | eee eee 36, 084 35, 974 
Dental eaitheactivities...-__.. 2-8 6, 430 50 OO eee o a. 6, 519 6, 505 
Buridines andtachities; Cincinnati, Ohio-| 2-2-2 22-2<|_-2--s2222|2222- 22222 31 31 20 
Arthritis and metabolic disease activities_- 20, 385 97 262i | a dates keene 20, 744 20, 742 
Allergy and infectious disease activities___ 17, 400 114 TS ii\Faan 5) eens 17, 532 17, 525 
Neurology and blindness activities_______- DISS Teles eee o Sil rear. ae 21, 395 21, 068 

_ Operations, Nationa! Library of Medicine- 1, 450 Ae So ee IN SER Se 1, 497 1, 496 
PS OnsuUCiONsOmINOraty Tacllities. — \o 222222) 82 eal esc ce fee ue beac 18 18 —7 
Grants for waste treatment works con- 

SURHEXCOFS eS 5 een pe ASSO00 | Sars Oa a ere Oe 12, 379 57, 379 47, 709 
Construction of Biologics Standards Lab- 

Ee yori BETTIE GEG, a Sate ES SA aE rs | US pe ( 3, 343 3, 343 2, 745 
POMS LMMcCMoOneOnsiEeical facilities. .-2-- | oo2 ek bape oo ee elo el ee 1, 556 1, 556 8 
Constmirchion ofMental Research Building:|_...2-.-.2)--=.......|---------+ 129 129 28 
Grants for construction of health research 

I en ee Ba os eae Sema ent Oe se ell eae ee 30, 000 30, 000 
PousnnichroG Onanimabguarters..2 0-252 2/2 oot. Solent a ll -|oe ke ek 188 188 34 
“LC GIEDN CLLR TP I RG NT aaa ee a | |e a (em | 129 129 67 
@onstniction ot research facilities... 2/!. 22-2 |ee | eee 201 201 97 
Retired pay of commissioned officers__-_-_-_- 1, 570 ip (a (OVA peo Se 1, 451 1, 451 
Salariesiand: expenses. 9... 2... 5, 100 160 As (Ste iee Bee 5, 301 5, 280 
National Institutes of Health manage- 

| SROVBCONY, LEENG La. 2 en en | fr Ce 1OwG ile a eee 19, 167 19, 125 


See footnotes at end of table. 


146 Department of Health, Education, and Welfare, 1958 — 


Table 1.—Statement of appropriations, authorizations, obligations, and 
balances, fiscal year 1958—Continued 


Funds available for obligation 


Total 
Appropriations Appro- Net Repay- Prior funds | Amounts 
priations | transfers | ments | year un- | available jobligated 
and between for obligated 
authori- | appro- | services | balances 
zations | priations 
Appropriations, special project 
funds made available by other 
BVENCIES So se SS eee en ee ee 7, 352 5, 849 
Salaries and expenses, Bureau of Prisons 
(transfer to“ELEW , (PHS )o2 22 Soe ae | Bee ee eee ee ee 1, 751 1, 748 
American Sections, International Com- 
mission, State: (transfer ‘to ELE Wi, PHS) i) 225 2 |b ie ee |e eee 73 72 
Operations, Federal Civil Defense Ad- 
ministration’ (transfer to. HE W,°P HS) |. 2222 2) | ae a eee eee) | ae 175 174 
Operating expenses, Atomic Energy Com- 
mission (transfer \to: ELE. Wi. PS) <2! Sooo ae eee eee ee —1 —1 
Research and development, Navy (trans- 
fer to; HUB W); (PHS)ie 4 ooo) Se Oe 2 ad i | Ee ee Se ee | ee 8 8 


Farm labor supply revolving fund, Bureau 

of Employment Security (transfer to 

FLEW, EES) ee a eee eke a SOR eee ee oe ee eee | ee = 373 347 
Administrative expenses, Section 411, 

Mutual Security Agency Act, Execu- 


tive: (transfer to. ELE. W) ees shee aa Ses Pe Bee ie Ae es | ees a 66 62 
Technical cooperation, general executive 
(transfer ito vs W)) (io year) 25 2 ieee ate Soe | eS 5s ee a eee 1, 853 1, 209 
Technical cooperation, general executive 
(transfer tov HW) (annual) 2 2282 252 .|6e Sass Ce ee oe a eee 2, 948 2, 153 
Special assistance, general, executive 
(transfer ito“ ELE W) 222 e is «es ee = < ea ee ee 79 77 
President’s fund for Asian economic de- 
velopment, executive (transfer to 
MELE W Yet Ss te ole esos oes Pe bee tos | ee bee ihe Sere | 2 | 22 
Gift funds donated for general and 
specific purposes........-.----2--- 1627 5 pe eee 5 | eee 162.7 279. 4 136. 9 
Patients’ benefit fund, Public Health : 
Derwice, hospitals. 2h. 4.0014. jueesee cee yt: a Wnaaiaeipennpepagine POLST 20. 0 44,2 29.9 
Public Health Service unconditional gift a 
RTRs 5 8 2 RES Re nia oe Re 2530 [2 ste ee | ae oes 105. 4 130. 4 84.3 
Public Health Service conditional gift 
pO AG lepeiey OR Cail: OE Be eee Be ata ae 67. bs tee a en cee 37.3 104. 8 2250 


1 Adjusted by Treasury warrant. 
‘Liquidation of contract authorizations obligated in 1957 fiscal year. 


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Office of Education 


Education in 1958 


Iw 1958 Amertcan EDUCATION entered one of its most challenging years. 
It was under fire at home for many reasons. The criticism was in- 
tensified by the Nation’s shortage of trained manpower and by the 
challenge of Soviet progress in education. 

Some of the criticisms were well founded ; some were not. However, 
American educators and school administrators have no desire merely 
to answer the criticisms and consider the matter settled. Instead they 
are examining the charges, reappraising their school systems, and 
earnestly seeking sources of strength, for they realize that informed 
criticism indicates health, vigor, and interest; that much of the cur- 
rent criticism can be channeled into creative action. 
| Some critics of education have identified a single cause and an 
| easy cure of the problems in education, but unfortunately there is no 
simple or easy solution to them. They vary from school district to 
school district and from State to State, and in size and degree of 
complexity. But one condition contributes to a solution—the recogni- 
tion that problems exist, that they are serious, that schools satisfac- 
tory to the 19th century are not suitable for the 20th, and that some- 
| thing should be done. Furthermore educators and laymen generally 
agree on the basic aims of education, that it is a means of “making 
of men, free, conscious, self-reliant, fully developed men” who “by 
education learn to do by choice what other men do by constraint of 
| fear.” They agree, in general, on the specific objectives of the schools. 
Through the recent White House Conference on Education citizens 
from all sections of the country reaffirmed their belief in the aims 
of education and agreed on the services they expect from schools. 


487270—59——11 153 


154 Department of Health, Education, and Welfare, 1958 


Apparently, then, our educational objectives have not changed ; they 
are based on the values fundamental in a democracy, and our values 
have not changed, but because the schools must answer the needs of 
society for educated men and women, they must change as society 
changes. 


The Office of Education 


ONE OF THE FUNCTIONS of the Office of Education is to investi- 
gate and to make known its findings on the status of education 
in the United States and to recommend measures for improve- 
ment. For that reason this report discusses the conditions, 
developments, and needs of education in 1958 as they were 
revealed by Office surveys, conferences which the Office spon- 
sored or in which staff members participated, reports from 
State departments of education, national associations, and 
other groups, and from other sources. It also briefly describes 
other Office functions and reports on its administration of pro- 
grams supported by Federal funds. 

In 1958 the Office had approximately 650 employees, and its 
budget for administration and operation was $4,700,000. It 
administered the following federally supported programs: 
Vocational education, $40,888,412 ; higher education, $5,051,000 ; 
school assistance to federally affected areas, $225,650,000; co- 
operative research, $2,300,000; and library services, $5,000,000. 

The Office is staffed with specialists in subject-matter fields, 
school and college administration, housing, special services, and 
the various phases of school operation. These specialists were 
educated in public and private colleges, universities, teachers 
colleges, and professional schools, and have had many years of 
experience as teachers and administrators in schools and col- 
leges throughout the country. Their primary interest is help- 
ing States and local communities improve their schools. 

As fiscal year 1958 came to a close the Office was reappraising 
its activities in the light of the responsibility education bears 
for the Nation’s welfare, of the Nation’s need for educated 
citizens, and of the citizens even greater need for education. 


There is reason for public confidence, for there is evidence that our 
basic school system is strong, that it is suited to the needs of the 
country and flexible enough to respond to changing demands, and 
that our best schools are surpassed by none. On the basis of sound 


a nN ae nt a ee eee eee ee) 


Office of Education 155 


evidence, the schools, working under severe limitations, did a good job 
in 1958. A few facts to support the statement follow: 


p> For a total expenditure of $20 billion, or 4.5 percent of the gross national 
product of $440.3 billion, they provided school-housing, equipment, and 
instruction for 48 million persons. 

& School and college enrollments increased for the 13th consecutive year. 
The 1957-58 enrollment totaled 48,135,000 persons, or about 1 of every 4 
in the Nation’s population, an all-time peak and an increase of 1,769,000 over 
1956-57 (See table 1). Of the total U. S. population of persons between 
6 and 17 years old in October 1957, 96.5 percent were enrolled in school. 

p> Public and nonpublic elementary schools—kindergarten through grade 
8—enrolled 30,670,000 children, an increase of 959,000; secondary schools— 
grades 9 through 12—enrolled 8,424,000, an increase of 604,000; colleges 
and universities, 3,450,000, an increase of 206,000; and other types of schools, 
591,000, the same number as last year. Enrollment increase in the secondary 
grades was 7.7 percent and in the elementary grades 3.2 percent. 

p 94.4 percent of all children in the 5- to 13-year-old group were in school, 
and 89.5 percent of those in the 14- to 17-year-old group were in school as 
compared to 79.3 percent 10 years ago. 5,408,000 students were estimated 
to be in private elementary and secondary schools, an increase of 5.4 percent 
over last year. 

p> In urban areas 97 percent of the 6- to 17-year-old group were enrolled 
in October 1957 as compared with 96 percent in rural nonfarm areas and 
95 percent in rural farm areas. 

p> In the 30 years since 1927-28 the total enrollment in public secondary 
schools has risen by 75.8 percent. In the same period, enrollments in general 
science, biology, chemistry, physics, and the basic mathematics courses have 
risen 74 percent. 

P Degree-granting colleges conferred a total of 411,000 degrees in 1956-57, 
8.3 percent more than in 1955-56. Of the total conferred, 82.8 percent were 
bachelor’s degrees, 15.1 were master’s, and 2.1 were doctor’s. 

p> The total number of teachers in U. S. public and non-public elementary 
and secondary schools at the beginning of the 1957-58 school year was 
approximately 1,412,000, an increase of 69,900 over 1956-57. 


There are also reasons for action; available evidence shows that our 
poorer schools justify much of the current criticism and that all schools 
must continuously improve. A few facts indicate the need: 


p> To equalize educational opportunity. The length of the school term in 
one State is 165.2 days, in another, 186.9 days; in one State the average 
current expenditure per pupil is $158, in another $482; in one State the 
average salary of a teacher is $2,525 and in another, $5,750; in one State 
88.7 percent of the elementary teachers do not have a degree, in another 
only 1.7 percent. 

> To provide classrooms for 1.9 million children housed in crowded rooms 
or makeshift quarters. It is estimated that children on double shifts—the 
thousands who attend school only 4 hours a day—lose nearly 2 months of 
schooling during the year. 


156 Department of Health, Education, and Welfare, 1958 


p To reorganize the school districts too small for efficient and economical 
operation and to offer an adequate curriculum. Nearly 35,000 of the 104,500 
public elementary schools are still one-teacher schools. 
> To improve education in rural districts. An Office study of 101 most 
rural counties showed striking variation; in one county the average annual 
salary of the instructional staff was $1,676 and in another, $4,089; in one 
county the annual cost per pupil in average daily attendance was $110 and 
in another, $825. 

To erase the shortage of qualified teachers which was 135,000 or 14,300 
more than in 1956-57. The average beginning teacher’s salary was $3,600 
in 1958, about $1,000 less than a beginner of similar training earns in industry. 


> To strengthen the high school curriculum, particularly in small high 
schools. In the fall of 1956, 36 percent of the public high schools did not 
offer chemistry ; 43 percent did not offer physics; 19 percent did not offer 
plane geometry. (These were small high schools and enrolled only about 
5 percent of all high school seniors in the country.) 


These facts indicate that our schools are good, that there is reason 
for confidence, but that there is no reason and no room for com- 
placency. There are important reasons for action, and there were 
strong indications that action was being taken or planned. Maga- 
zines, newspapers, and radio and television stations devoted increased 
space and time to education; the U. S. Commissioner was invited to 
report on the status of education on a nationwide TV broadcasting 
system; State legislatures, alumni associations, professional organiza- 
tions, groups of individuals, and others searched for means of im- 
proving their schools. Recognizing the need for immediate improve- 
ment, the Administration submitted to the Congress a number of 
specific proposals for Federal aid to education. 


F inancing Educational Services 


A major problem confronting the systems of public schools over 
the Nation is that of securing funds in sufficient amounts to enable 
boards of education to finance the kind of program the public wants. 
This total problem is usually considered in terms of specific possibili- 
ties of improving the financing of education in the States. Some of 
the possible improvements are identified in the following paragraphs. 

Property tax tmprovement.—Unreasonably low and inequitable 
valuations of property make the general property tax less effective 
than it might be as a source of funds for schools. State departments 
of taxation are adopting plans to assist assessors in using good assess- 
ment practices and in assessing property at an equal rate throughout 
the State. 

State distribution formulas.—State funds are more effective in rais- 
ing the unacceptably low expenditure levels of the less wealthy school 
districts when distributed as equalizing aids. This means that a sub- 


ee of Education 157 


stantial portion of the State funds for education should be allocated 
to districts as equalizing funds. 

Educational finance can be greatly improved through the reconsid- 
eration of State distribution. formulas and through the adoption of 
procedures that will help to raise the expenditure levels in the less 
wealthy school districts. 

Increased State support.—Suburban school districts in which thou- 
sands of new homes have been built in recent years are having increas- 
ing difficulties in financing school programs. Usually, these residen- 
tial communities rely entirely upon taxes on homes for local school 
support whereas other communities having establishments of business 
and industry in addition to homes have a broader tax base for local 
school revenue. ‘These suburban residential communities are unable 
to secure tax revenue from business and industry in which their people 
are employed except as these are taxed by the State and the State funds 
redistributed to local school districts in proportion to measures of 
school need. Problems of financing the numerous suburban residen- 
tial communities indicate that a greater proportion of the revenues 
for education must be provided through State support funds to reduce 
the inequalities in the programs of education. 

Adoption of local nonproperty taves.—As one solution to the diffi- 
culty encountered in approving larger budgets in local school districts, 
States are extending authority to levy local nonproperty taxes for 
school purposes. In response, hundreds of boards of education are 
considering and levying additional local nonproperty taxes such as 
sales taxes, payroll taxes, per capita taxes, and other local taxes on 
amusements, automobiles, cigarettes, hotel rooms, and deed transfers, 
as a means of securing additional revenues for schools. 

State assistance for school construction—In 1950, only 19 States 


were providing assistance to local school districts for the financing of 


school construction, and these States were appropriating relatively 
small amounts compared to the capital outlay funds provided from 
local district sources. By 1958, the number providing this kind of 
assistance had increased to 35 States and 38 outlying parts of the United 
States. They are allotting to local school districts a total of 59 differ- 
ent funds for assistance in financing school facilities, and these funds 
are supplying about 9 percent of the total for school facilities. 
Federal funds for education —The relatively small percentage of 
school support funds from Federal taxation revenues continues as 
a major subject discussed in financing education. Questions on this 
point deserve careful consideration. Does the Federal Government 
have an interest and obligation to raise the school support levels in 
States financially unable to support schools at a level acceptable to 
the people of the Nation? Has the total tax structure—local, State, 


158 Department of Health, Education, and Welfare, 1958 


and Federal—shifted to such an extent that the educational program _ 
in most of the States will not be supported at levels acceptable to the 
people unless the schools derive revenues in reasonable proportions 
from the tax sources available ? 

Since the States have primary responsibility for public elementary 
and secondary schools, they provide funds and authorize local school 
districts to use local tax funds for public schools. For 1957-58, it is 
estimated that the Federal Government provided 4 percent, the States 
41 percent, and local districts 55 percent of the total revenue for these 
public schools. 

In an effort to help States and local school districts with their school 
finance problems, the Office disseminates information through its pub- 
lications. One publication, entitled School Finance and School Busi- 
ness Management, provides an analysis of the school finance respon- 
sibilities and services in State departments of education. It should 
be useful in determining State and local policies on school finance and 
in reconsidering service rendered by the State educational agencies in 
school finance and school business management. 

Another publication, /ederal Funds for Education, presents an 
analysis of 137 Federal programs in education provided by the various 
Federal departments, agencies, and offices. For these services in edu- 
cation, the Federal offices reported expenditures amounting to almost 
$2 billion for the 1956-57 school year. About 25 percent of these 
funds are administered by the Department of Health, Education, and 
Welfare and approximately 8 of this 25 percent by the Office. 


State School Administration 


The vast growth of public education has made it necessary for States 
to reorganize and revitalize their machinery for administering public 
educational programs. The outstanding development in this area 
in recent years has been the rapid growth of State departments of 
education, both in size and in professional stature. These depart- 
ments are staffed by highly trained specialists and technicians and 
are fast gaining recognition as State centers of educational leadership. 

The relationship between the Office and State departments has 
always been one of mutual assistance, and as problems and needs in 
education have increased, the cooperative relationship between the 
Office and State departments has become stronger. Much Office re- 
search and study are directed toward solving the problems State 
departments consider serious. In recent years the Office has made 
available basic information on the structure and organization of State — 
departments, State boards of education, and on the various responsi- 
bilities of State departments of education. In fiscal 1958 the Office 


continued to develop and distribute information on State school 


: 


. 


Office of Education 159 


administration and to provide advisory services to State departments 
of education and other State agencies. A few Office services are 
summarized below. 

A larger share of the American youth are being educated in non- 
public elementary and secondary schools. Nonpublic schools make 
reports to their private educational associations but very few to public 
education offices. 

Recognizing the need for more information on the nonpublic school, 
the Office conducted, in cooperation with the Study Commission of 
the Council of Chief State School Officers, a major study of State 
legislative practices relating to these institutions and published the 
findings under the title, Zhe State and Nonpublic Schools. This study, 
the first of its kind ever made by the Office, describes the legal frame- 
work under which nonpublic schools are enabled to enjoy desirable 
freedom in their operation and are encouraged to provide educational 
programs in the public interest. 

In 1958 substantial gains were made in establishing and maintaining 
a sound basis for comparable educational information among States 
and among local school districts. By the year’s end, a number of 
States had incorporated into their accounting systems the standard 


classifications of the cooperatively developed handbook, Financial 


Accounting for Local and State School Systems, published by the 
Office in 1957. Several more had accepted the handbook’s recommen- 
dations and were putting them into practice. 

The Cooperative Project on Property Accounting for Local and 
State School Systems, begun in 1957, was advanced toward successful 
completion. Aimed at developing a property accounting handbook 
that will provide a firm basis for presenting information about school 
land, buildings, and equipment, the project moved through a series of 


national and regional conferences which utilized a great reservoir of 


experience from people in all regions of the country. 

Another facet of the problem of establishing comparable educa- 
tional data is the internal accounting for school activity money within 
individual schools—for example, money for athletics and school clubs. 
Millions of dollars are involved each year in school activity funds, 
but the lack of comparable data makes it impossible to obtain a clear 
picture of what is happening. The Office is therefore developing, in 
cooperation with a number of national educational associations, a 
handbook to standardize classifications and terminology used in ac- 
counting for school activity money and to provide guidelines to the 
handling of such money. 


School Building 


The people of the United States are spending billions of dollars on 
school construction, and Office records indicate that they are getting 


160 Department of Health, Education, and Welfare, 1958 


good value for their school building dollar. During the last 20 years 
costs of building materials and labor have increased 200 percent or 
more, but the cost of a classroom with related facilities has increased 
150 percent. 

At the beginning of the school year 1956-57, there were 1,100,000 
public elementary and secondary instruction rooms available in the 
continental United States. During the year, 68,800 new instruction 
rooms with related facilities were completed; and 16,300 were aban- 
doned because they had become obsolete or were not needed because of 
school district reorganization. In 1957-58 pupils were housed in 
1,152,500 instruction rooms, which was 52,500 more than the number 
available in 1956-57. State departments of education reported that 
an additional 142,300 instruction rooms were needed, 64,700 to ac- 
commodate 1.9 million pupils enrolled in excess of normal capacity 
and 77,600 to replace rooms in unsatisfactory condition. A total of 
70,500 classrooms in public schools were scheduled for completion 
during the school year. 

The 1.9 million children in excess of normal capacity were on half- 
day schedules, in overcrowded classrooms, makeshift facilities, or in 
rented quarters which were not designed for school work. Although 
the rate of school construction increased in 1958, the country still has 
a long way to go to remove the backlog, accommodate the increasing 
school enrollment, and take care of normal annual replacements. 
Since many groups—the general public, the Congress, the construction 
industry, economic analysts, and educators generally—need precise 
information, the Office has taken concrete steps to develop several new 
series of statistics for analyzing the progress of school construction 
from the fiscal standpoint. 

Data on bond sales for public elementary-secondary construction 
are being tabulated from standard statistical sources and analyzed 
each month to show the amount sold and the interest rates charged 
for each State. Data on school bond elections providing insight into 
an earlier stage of progress in financing school construction are being 
received from the Investment Bankers Association each month. 
Projections of the cost of public school construction in the years ahead 
have been made and are revised veriodically as new data become 
available. 

In fiscal 1958 Office specialists assisted States and local districts in 
setting up criteria and procedures for school-plant maintenance and 
operation and periodic programs of renovation, rehabilitation, 
remodeling, and modernization. Since planning, construction, equip- 
ping, and management of the modern school plant require knowl- 
edge of many phases of building technology, including principles of 
design, construction, materials, management, and care, Office spe- 


Office of Education 161 


cialists cooperated with technological organizations in a number of 
studies. 

Staff specialists also consulted with market analysts on school 
equipment, with State departments of education on the development 
of State guides to plant administration and on standards of per- 
formance of local districts, and with the Council of Chief State 
School Officers on developing a program of State school-plant serv- 
ices. ‘They assisted State departments and local school systems in 
developing patterns of procedure in local school construction and 
essential long-range programs of school-plant planning and advised 
State and local officials on adaptation of housing to district reorgan- 
ization and curricular changes. 

In their research and studies specialists gave specific attention to 
the functional planning of school plants and to the effects of cur- 
riculum, instructional methods, and community programs on func- 
tional planning of school facilities, and to administrative facilities in 
school buildings and the selection of school sites. They made studies 
of elementary school-plant planning in cooperation with the National 
Council on Schoolhouse Construction. 


School District Organization 


The quality of a public school program depends in large measure 
on the size of the local school district, which is the area served by a 
single system of local school administration, usually a single board of 
education. The widespread reexamination of the public schools has 
stimulated efforts to improve local district organization. The funda- 
mental question back of reorganization is the ability of districts to 
provide modern educational programs. Can a small school district, 
usually defined as one enrolling fewer than 300 students, efficiently and 
economically provide a good school program? A small school district 
has high per pupil costs and does not have a broad enough tax base to 
provide the school revenue it needs to employ a professionally trained 
administrator, to offer a varied curriculum, to build and equip science 
laboratories and a good library; to provide special services; or to 
employ and hold good teachers. 

Establishment of soundly organized local districts for administer- 
ing schools has long been a major problem in education. In the past 
100 years some redistricting has been done in every State, but it has 
increased rapidly in recent years. Since 1945 the number of school 
districts has been cut drastically, from 103,000 in 1945-46 to about 
54,000 in 1956-57, according to a Bureau of Census count. 

Responsibility for improving district organization rests with the 
States, for within constitutional limits a State legislature has com- 
plete power over district organization. However, most legislatures 


162 Department of Health, Education, and Welfare, 1958 


have not reorganized districts by legislative decree but have enacted 
laws prescribing procedures by which local people could take action. 
Since many laws have proved ineffective in reorganization, a move- 
ment has been underway for a number of years to make permissive- 
type reorganization programs more effective. 

To aid State and local school officials, laymen, and local planning 
groups, in 1958 the Office analyzed policies and procedures contribut- 
ing to or hindering success of programs carried on by States and pre- 
pared and published a manual of local planning techniques and proce- 
dures and a summary of State policies and procedures. 


School Boards 


Within the last few years the responsibilities of local boards of 
education have become heavy. As a result, the year 1958 brought an 
upsurge of interest in the work of local boards of education and in 
efforts to assist them in functioning more effectively. State school 
board associations have been established in every State and in some 
States they have 100 percent membership. State boards are becoming 
increasingly active; they are offering inservice training programs; 
publishing manuals, handbooks, periodicals; organizing workshops; 
maintaining close relationship with State legislatures; and providing 
for visits between boards. Their operating budgets have been in- 
creased. Throughout the year the Office participated in the move- 
ment; staff members prepared and published an analysis of school 
board association periodicals and publications, and began work on an 
analysis of written statements of policies developed by boards. 

With a teacher shortage of major proportions, the need for sound 
personnel administrative practices and procedures continued to be 
important. Office specialists consulted with school officials on this 
aspect of school administration and began work on identifying specific 
personnel problems. After preliminary investigations they initiated 
a study of personnel handbooks and similar materials developed by 
local school systems and the organizational patterns for personnel 
administration. 

Office specialists analyzed a large number of surveys of school sys- 
tems to determine what standards for positions should be recommended 
for further testing and evaluation and began a study of State statu- 
tory provisions and factors in State school financing relating to posi- 
tions and services. 


Elementary Education 


The reawakening of interest in education and the determination of 
the people to shape their schools to meet the changing times and needs 
led elementary schools in 1958 to reassess their strengths and weak- 


Office of Education . 163 


nesses and to take a fresh look at some of their time-honored practices. 
The following paragraphs review briefly some of the developments 
and comment on current practices and needs in elementary education. 


ADMINISTRATIVE PRACTICE 


In the mounting variety of patterns and rapid growth of the size 
and numbers of elementary schools in recent years, certain established 
procedures and respected beliefs may have lost their original values. 
To this question, elementary education at large addressed itself during 
the past year. 

Among items of growing concern and increasing investigation were 
the following: Entrance age to school; class size and teacher-pupil 
ratio; grouping policies as they relate to administrative management 
and to instructional programs; pupil promotional policies; reporting 
pupils’ progress to parents; establishing bases for individual and group 
educational standards; effective educational guidance to pupils; pro- 
visions for meeting even wider ranges of individual pupil differences ; 
increasing demands on the classroom teachers; effects of the shortage 
of qualified teachers and of inadequate school accommodations; provi- 
sions for improving the efficiency of the experienced teachers; and the 
proper role of the school administrator as an educational leader. 


CURRICULUM 


School staff members responsible for leadership in determining ele- 
mentary school curriculum in the various school systems keep con- 
stantly in mind (1) the objectives of education in the United States, 
(2) emerging knowledge as it throws light on human growth and 
learning, and (8) the changing needs of our society. 

Last year, demands were made on elementary schools, as they were 
on others, for “more science,” “more mathematics,” and some in- 
novations were recommended without convincing proof of their 
value. The schools, with an eye on the continuing and basic needs 
of all children, attempted to meet these special demands. In many 
localities, curriculums were revised, special activities were organ- 
ized, and experimentation was widespread. 

Science in the elementary school, recognized as important by many 
educators over the past 25 years, was emphasized by schools, com- 
munities, and national organizations during 1958. Many schools in 
which science teaching had been more or less left to chance appointed 
curriculum committees to develop a science program. In elementary 
and high schools curriculum planners joined in urging that such 
programs be coordinated from kindergarten through the 12th grade. 


‘National organizations such as the National Science Teachers As- 


sociation, the National Association for Research in Science Teach- 
ing, and the American Association for the Advancement of Science 


164 Department of Health, Education, and Welfare, 1958 


gave more time during their national meetings, more space in their 
publications, and more staff time to stimulating programs in ele- 
mentary schools than in the past. College science and education 
faculties in increasing numbers discussed the relation of science in 
the elementary school to the future supply of scientists and engineers. 

Recognizing the need for better understanding of other countries 
of the world, educators in elementary schools increased their efforts 
to encourage better teaching and production of better materials for 
use in the schools. 

Elementary schools in locations favorable to the development of 
fluency in a foreign language have traditionally taken advantage of 
their resources. Spanish, for example, has been taught in many 
southwestern schools and in Florida; French in Louisiana and along 
the Canadian border in the northeast; German, Italian, and other 
languages according to the nationality predominance in the popula- 
tion and the availability of competent teachers. Recently, increased 
efforts have been made to locate and use resources 1n communities 
and colleges to teach children a second language. 


EDUCATION OF THE GIFTED OR TALENTED 


In the elementary schools improvement of education of the gifted or 
talented has taken three main directions: Grouping of gifted or 
talented, completely or partly; acceleration; enrichment in regular 
classrooms. Grouping of the more able children into special schools 
or special classes for only a part of the school day, ranging from an 
hour to a half day, has been tried in few localities. 

The plan of accelerating gifted children is also used in some com- 
munities, usually on a basis of individual selection, with careful guid- 
ance to insure that the child selected is not losing out in an important 
area of development. The method generally in use is that of enrich- 
ment in regular classrooms, with materials, methods, and experiences 
adapted to the abilities, interests, and needs of the learner. Serious 
handicaps to the success of this plan are, in many localities, the large 
numbers of students assigned to teachers, shortages of materials to 
meet variations in ability, and the reduced school day. 


EDUCATION IN GRADES 4-5-6 


In response to repeated requests for information about the education 
of children in grades 4-6, the Office in 1958 completed a study of edu- 
cation in these grades. The report of the study interprets research in 
the characteristics and needs of 9- to 12-year-old children; summarizes 
opinions expressed in 40 regional conferences involving, in all, ap- 
proximately 1,300 supervisors, principals, and teachers who deal with 
children of these ages in 415 rural and urban school systems in 35 
States and the District of Columbia; and analyzes observations in these 


Office of Education 165 


grades in 68 of the systems. It also describes content of the curriculum 
and methods used in guiding children and in providing them with 
challenging experiences. Although the report shows that a variety of 
experiences are being used, it also shows considerable uniformity in 
content and in methods and that many schools are experimenting with 
new methods and in the use of newer materials and aids to teaching. 

The report points out situations that educators across the country 
have repeatedly brought to attention—situations in contemporary life 
that seem to place too great responsibility upon children of these ages. 
Some of the situations result from parents being absent from the home; 
some from pressures of immature boy-girl dating; others from too 
great pressure on them to take part in too many in-school or out-of- 
school activities; or in some communities from scarcity of desirable 
activities. The study reveals how some schools seek home-school- 
community cooperation in dealing with the needs and problems of 
children. 


KINDERGARTENS 


The growth of kindergartens as a beginning unit of the elementary 
school shows marked progress. Ina decade public and private kinder- 
garten enrollments had increased by 121 percent; now, 46 percent of 
the 5-year-olds are in kindergarten in contrast to 28 percent in 1947. 
Children who live in cities of 25,000 and under have opportunities 
which only children in large cities had a little more than a decade ago. 


EXCEPTIONAL CHILDREN 

Even though States and local school systems still have much to do 
before programs for exceptional children will reach all of the 4 mil- 
lion who need them, the year 1958 saw major progress toward (1) 
extending school programs to serve more exceptional children, (2) 
acquiring more knowledge about exceptional children and the kind of 
instruction they need, (3) securing more and better qualified persons 
to teach and to give leadership in State and local school systems and 
in colleges and universities preparing teachers of exceptional chil- 
dren. Evidence of progress was seen in mounting school enrollments 
in special education, studies of the rural problem, multistate activities, 
and renewed efforts to coordinate the work of national organizations 
individually concerned with one of the various types of exceptional 
children. State education agencies, many of which had increased re- 
sources in funds and personnel, played a major leadership role in 
these developments. 

The extent and direction of this growth cannot be determined until 
the results of the current statistical survey of special education for 
exceptional children become available. The sharpest gains were 
undoubtedly made in the urban areas. 


166 Department of Health, Education, and Welfare, 1958 


Preliminary reports indicate that, of all the handicapped, the 
mentally retarded made the largest gain in school enrollments. It is 
not likely that such rapid advances would have been made without the 
organized support of parent and other lay groups at the local, State, 
and national levels, particularly as these groups have been encouraged 
by the National Association for Retarded Children. 

The lack of scientific knowledge about the various aspects of educa- 
tion of exceptional children has been generally recognized. Some 
information has been accumulated through the efforts of individual 
schools, clinics, and research centers in universities and large school 
systems, but the progress of valuable studies has often been hampered 
by lack of funds to carry forward the research needed. The avail- 
ability of funds for research has marked a turning point. 

Some progress was made in 1958 in securing adequate numbers of 
qualified special educators. The annual directory of special educa- 
tion staffs in State departments of education showed by far the 
greatest annual increase in such personnel since 1950, with the largest 
increase in supervisors of education for mentally retarded. Even in 
the face of a shortage of teachers much attention was being given to 
improvement of professional preparation of teachers for handicapped 
and gifted children. On this matter the Office published two more 
reports from its nationwide collaborative study. 


Secondary Education 


The discussion, study, and demand for more and better education 
in 1958 brought with them a growing realization of the importance 
of secondary schools to the Nation: that the strength of American life 
depends heavily on the strength of the Nation’s secondary schools 
and that there is a growing relationship between education and na- 
tional security, domestic and foreign policy. 

Although there were no sweeping reforms in curriculums and 
methods, many secondary schools did improve their programs 
through additions and the refinement of courses to meet more nearly 
the abilities, needs, and interests of pupils. Perhaps one of the most 
significant developments was the emphasis on programs and courses 
designed to challenge the capacities of talented pupils. This con- 
cern was reflected in the Office activities, State educational agencies, 
and professional organizations. 

In addition, numerous projects were concerned with reappraisal 
of course content and methods in science (particularly physics), math- 
ematics, and modern foreign languages. Secondary school teachers, 
college and university professors, citizen groups, and Office spe- 
clalists participated in many of these projects. Office specialists fur- 
nished background information, national statistics, and professional 


Office of Education 167 


advice. As the year ended, proposals of these groups were being 
applied and evaluated in selected secondary schools. 

Because of the new significance attached to foreign language study, 
the Office made an analysis of foreign language laboratories. Data 
for 1957-58 revealed that although 240 colleges had language labora- 
tories only 60 high schools had electronic equipment for drill in hear- 
ing and speaking the foreign languages offered. Schools which have 
used electronic equipment for developing aural-oral skills reported 
enthusiastically on it. A publication of the Office, Modern Foreign 
Languages in the High School, emphasized the importance of (1) in- 
creased offerings in modern languages in the high school, (2) longer 
sequences of study, and (3) greater emphasis on effective use of the 
foreign language. 


Problems, Needs, and Trends in Science 
and Mathematics 


In the past year attention was focused on the improvement of 
science and mathematics in the public schools and particularly, on 
the most critical problems in those fields. Brief background in- 
formation will perhaps point up the needs and clarify measures in- 
troduced to resolve some of the problems. 


CRITICAL PROBLEM AREAS AND NEEDS 


The accelerated pace at which we are moving toward a culture that 
is dominated by science and technology has placed new demands on 
the teaching of science and mathematics. To maintain our place of 
eminence in basic scientific research will require the training of an 
increasing number of scientists. At the same time the larger group 
of nonspecialized citizens will need more and better training in 
science and mathematics to be able to live effectively in the space age. 

Programs in science and mathematics education are closely related 
both to scientific manpower and to the available supply of teachers 
of these subjects. Recent statistics show that despite the great need 
for science and mathematics teachers fully one-third of those college 
graduates who are prepared to teach science and mathematics are lost 
to the teaching profession because the public schools are outbid for 
the services of the best qualified members of this group. 

We are failing to realize the fullest potential of a considerable por- 
tion of the academically talented youth. Two factors are basic to 
this problem: (1) The failure of many able young people to pursue 
their education beyond the high school and (2) the failure of the 
schools to identify academic talent at an early age and then make the 
best possible provision for its development. Solution of this problem 


168 Department of Health, Education, and Welfare, 1958 


is vitally necessary to our future scientific and technological well being 
and our national defense. 

One factor in the scientific shortage is the lack of effective guidance 
counseling. The school guidance counselor is a key person in a stu- 
dent’s choice of his school program and his career, yet fewer than 10 
percent of the guidance counselors in the public schools have back-_ 
grounds of preparation in science and mathematics. The early identi- 
fication through testing and the proper guidance of young people with 
interest and ability in science and mathematics is therefore a problem 
of first priority facing educators. 

Both State and local departments of education are greatly under- 
staffed with consultants in science and mathematics. Fewer than ten 
State departments of education employ specialists in these fields, al- 
though most States provide at least one supervisor and sometimes 
more for music, art, and other subjects. Long-range improvement is 
impossible unless personnel are provided who can assume the initiative 
and responsibility for continuing programs. 

Most curriculums in science and mathematics have not kept pace 
with the rapid advances in these fields. There is a vital need for revis- 
ing and updating both the materials and the methods of instruction in 
science and mathematics. 

Instruction in science and mathematics requires specialized facilities 
and equipment, and teachers of these subjects must have the best of 
teaching aids, including textbooks, laboratory manuals, and audio- 
visual materials. In many places where science and mathematics are 
taught facilities and equipment are in critical shortage. These condi- 
tions will continue to be a bottleneck to any long-range improvement 
of teaching until they are remedied on a nationwide scale. 


SURVEY OF SCIENCE AND MATHEMATICS MAJORS 


To provide early information on the probable supply of profes- 
sionally trained scientific manpower, the Office, in consultation with 
the National Science Foundation, initiated a nationwide survey of 
junior year men and women majoring in science and mathematics in 
colleges and universities. The major fields listed on the survey ques- 
tionnaire correspond to the major fields used in the Office annual 
survey of earned degrees. As the junior-year survey is repeated, 
annually or biennially, the data will provide the basis for future 
projections of number of bachelor’s degrees, information on changes 
and trends in science and mathematics majors, and on “dropout rates” 
in the various scientific fields. 

The first reports of the survey showed that in November 1957 ap- 
proximately 50,500 junior-year students were majoring in science or 
mathematics, or 12.9 percent of all junior-year students. On the basis 


Office of Education ; 169 


of the survey, it is estimated that between 40,000 and 45,000 persons 
will earn bachelor’s degrees in science and mathematics in the 1958-59 
school year as compared to 33,800 in 1956-57. 


TRENDS IN TEACHING 


There is very little available information on the national level deal- 
ing with the general status of science and mathematics teaching. A 
few studies on limited aspects of the problems have been made by 
certain States, but the most recent nationwide data are now nearly 10 
years old. The current interest in improving education in these sub- 
jects has directed attention to the need for information on the present 
status of science and mathematics teaching. To provide such in- 
formation, the Office, during the past year, planned a series of compre- 
hensive studies on the status of science and mathematics in public high 
schools, in public junior high schools, in public elementary schools, 
and in teacher education institutions. 

Before the year ended the first of these studies was in progress. Data 
were obtained from school principals and from teachers of science 
and mathematics in a representative sample population of the high 
schools. ‘The questionnaires used in the study covered most of the 
major problems in each field. 

In 1954 the Office conducted a study which provided useful in- 
formation on offerings and enrollments in science and mathematics. 
The study was repeated in 1956, and a small but encouraging improve- 
ment was found in enrollments, both in science and mathematics. 

The rapid advances in science and mathematics over the last few 
years have created a need for updating the training of high school 
teachers of these subjects. A number of associations and agencies are 
sponsoring or conducting programs to meet this need. The National 
Science Foundation has for the past few years made large grants of 
money to colleges and universities for conducting summer and aca- 
demic year institutes for high school and college teachers of science 
and mathematics. This agency is now planning an expanded pro- 
gram which may offer institutes for teachers in the junior high schools 


and for elementary school supervisors. The American Association 


for the Advancement of Science, in cooperation with the American 
Association of Colleges of Teacher Education, is conducting a pro- 
gram for the improvement of teacher education in science and mathe- 
matics. The Office maintains close cooperation with such projects. 

During the past year the Office of Education, in cooperation with 
representative scientific, mathematical, and educational organiza- - 
tions, held a national conference on the curriculum in high school 
science and mathematics. The report of this conference sets forth 
guidelines for improving the teaching of science and mathematics. 


487270—59——12 


170 . Department of Health, Education, and Welfare, 1958 — 


The Office gave considerable attention last year to identifying, 
guiding, and providing for the academically talented student in sci- 
ence and mathematics. Specialists in these subjects participated in 
a conference held by the National Education Association on problems 
of the talented student, and the Office published a study on the prob- 
lem as it relates to science and mathematics. 

Over the country there appears to be a trend toward developing 
and providing better facilities, equipment, and teaching aids in 
science and mathematics. In 1958 both the National Education 
Association and the Office of Education conducted research studies 
related to facilities and equipment. In addition to the two national 
programs several experiments are being conducted by other groups 
in teaching science and mathematics by television. 

In response to the need for focusing research on improvement in 
teaching mathematics and science, the Office published a bulletin in 
each field which analyzes and interprets the current research. In addi- 
tion, Office specialists in these subjects worked with other organiza- 
tions in defining the unresolved problems and in discussing research 
studies needed to solve them. 


Retention of Students 


The Department of Labor predicts that by 1965 the United States 
will probably need 45,000 more doctors, 75,000 more college-trained 
nurses, nearly 500,000 more elementary and high school teachers and 
120,000 more college teachers; and that skilled trades will need 250,000 
more trained workers each year just to maintain the present skilled 
force. Our schools and colleges must prepare persons to fill these 
needs, yet each year millions of young boys and girls drop out of high 
school, and others who complete high school do not go on to college. 

A number of recent studies show the seriousness of the education 
problem. One study made by the Educational Testing Service, Prince- 
ton, N. J., for the National Science Foundation, found that between — 
60,000 and 100,000 of the highly able high school graduates with apti- 
tude and interest in college do not go because of financial reasons but 
that a group of the same size and ability do not go because they lack 
interest and motivation. That means that one-third of the top 30 
percent of high school graduates, between 120,000 and 200,000, do not 
continue their education—a serious waste of intellectual resources of 
the Nation and a serious loss to the students who are shutting the door 
to occupational opportunity and the rewards of intellectual achieve- 
‘ment. In addition to the loss of superior students who graduate from 
high school but do not go on to college, considerable numbers of 
students of high ability drop out of high school before graduation. 

A nationwide study conducted by the Office, covering the period 
1950-54, indicated that during this 4-year period about 300,000 high 


Office of Education . 171 


school graduates who were in the top 30 percent of their classes did 
not go on to college. An additional 240,000, also in the top 30 percent, 
attended only night school or other irregular college classes. Further- 
more about 1 in 4 students who enter college drop out by the end of 
the first year. Altogether about 6 out of 10 who enter college are 
graduated. The Office study found that more than one-fifth of those 
who dropped out were in the top 20 percent of their high school grad- 
uating classes. 

Since the high schools must prepare students for college and since 
the greatest loss of students occurs at the 10th or 11th grade level, they 
must make the major effort to hold students, particularly the academi- 
cally talented. On the average from 15 to 20 percent of the high 
school students may be classified as academically talented. Studies, 
research, and surveys have found that some measures can reduce such 
loss. They are (1) improved testing of student aptitudes and use of 
cumulative records so that potential ability can be identified at an 
early stage of education; (2) skilled counseling and guidance to en- 
courage students to stay in high school, to prepare for college, to se- 
lect academic courses suited to their talents; (8) united community 
effort to get students to return to school; and (4) scholarships. 


GUIDANCE AND COUNSELING 


Although the teacher still has the primary responsibility for helping 
pupils attain their maximum development she cannot be expected to 
provide all the services required in modern education. And even if 
teachers had the time to provide all necessary services, many services 
require technical training which some teachers have not had, for ex- 
ample, administering and interpreting standardized tests. To aid 
the teachers and to provide for students, more and more schools are 
employing guidance counselors. 

Guidance counselors are specialists who identify individual differ- 
ences, give tests to determine students’ abilities, aptitudes, and talents 
and to measure their progress; advise them on choice of courses and 
vocations; help them solve their mental, physical, or emotional prob- 
lems; and estimate the educational needs of the community and 
methods of meeting them. Guidance counselors work closely with 
parents, teachers, school administrators, and local recreation and wel- 
fare officials. 

Guidance specialists in a school system, working closely with the 
teacher can provide information essential to making adaptations, such 
as special classes for the gifted or retarded, special equipment and in- 
structional materials, and special group procedures in the classroom. 
In other words the guidance counselor helps the teacher identify 
special needs and abilities, interpret them, and provide the kind of 
education needed to meet them. In the high school he helps the stu- 


172 Depariment of Health, Education, and Welfare, 1958 


dent, in consultation with his parents, plan his educational program, 
high school, vocational, and college; informs him of occupational 
opportunities; and helps him make a satisfactory transition from 
school to work. School people in general agree that schools should 
have 1 counselor to every 300 students, but in the country as a whole 
we have the equivalent of about 12,000 full time counselors for 814 
million students or 1 to every 710. 

Experience has shown that testing is valuable in guiding students 
into educational programs and careers suited to them and in measur- 
ing student abilities. A study by the Educational Testing Service 
found that even among the top 10 percent of high school graduates 1 
out of every 5 picked on the basis of grades alone as having abilities 
in engineering did not live up to expectations in college, but that of 
the students selected on the basis of scholastic aptitude tests in com- 
bination with analyses of high school grades, only 1 out of 12 did not 
cdo as well as expected. Other studies support this finding. | 

Only 6 States require that public schools maintain cumulative 
records on their students. Yet millions of children change schools 
each year. During 1956, the last year for which a record is available, 
of the total population of 38,210,000 children between the ages of 5 and 
17 years, more than 7,000,000 moved from one place to another. 

In all States and Territories an official of the department of educa- 
tion is responsible for guidance services, for helping local schools 
improve their programs; 20 years ago only New York State had as- 
signed a person to such work. The number of States that have estab- 
lished certification standards for guidance workers has increased by 
25 percent in the past year, from 382 in 1956 to 40 in 1957. Most 
States require a State teaching license and a master’s degree, or 
equivalent, in guidance training for certification. 

The trend in the use of guidance counseling has been upward for 
several years, and there are indications that it will continue upward, 
for the increase in juvenile delinquency, in the number of working 
mothers, and in the complexity of life will progressively call for the 
employment of more people who understand children. 

As a result of the increased interest the Office received many re- 
quests for educational and occupational information—on methods of 
improving counseling techniques, techniques of attacking the school- 
retention problem, on student personnel services in institutions of 


higher education, and on inservice and preservice education of — 


teachers. In addition to responding to requests for service and con- 
sultation, the Office conducted a number of studies during the year, 
including studies of the retention of students in high schools in large 
cities, individual analysis in educational and vocational guidance, 
preparation of guidance and student personnel workers, effective 


Office of Education PEs 


guidance practices in local schools, certification requirements for 
guidance workers, and the organizational pattern of student person- 
nel programs. Specialists in guidance prepared and distributed 
pamphlets, circulars, and leaflets on occupational and educational 
information. 


Audiovisual Aids to Education 


Education is now benefiting from increased use of audiovisual aids, 
including films, radio and television, recordings, slides, pictures, 
charts, maps, and others. Research and experience have shown that 
such aids, particularly television and films, used by capable teachers 
as supplement to classroom instruction, are of value in making teach- 
ing more effective. 

Educational television has many uses. It can be used effectively by 
administrators, local boards, and others to present their ideas to local 
communities and to gain community support for school programs. 
It can be used to improve classroom teaching, for even a few courses 
taught by master teachers and put on film can stimulate teachers 
by suggesting new methods and ideas. It can be used to give in- 
struction to the homebound and to adults. And last, and perhaps 
more important, it can be used in the classroom. 

Educational uses of both radio and television showed substantial 
gains in fiscal year 1958. Eight educational FM radio stations com- 
pleted within the year brought the total on the air to 201, and the 
number of educational television stations on the air increased from 
29 to 32, with 4 others nearing completion at the end of 1958. More- 
over, most of these stations were operating maximum broadcast 
schedules. 

Especially significant was the increasing emphasis on direct- 
teaching use of television. Over 600 credit courses—elementary and 
high school courses for in-school viewing and high school, college, 
and adult-education courses for home viewing—were broadcast on 
television in 1958, an increase of nearly 50 percent over 1957. More 
and more city school systems used air time made available to them 
by local commercial TV stations for broadcasting regular school 
subjects. 

Research and experimentation in teaching by television are being 
directed, increasingly, towards methods of TV-teaching, instructional 
content, lesson format, and instructional organization. In all, 160 ex- 
periments were being made. Perhaps the most comprehensive project 
at the public school level is the Washington County, Maryland, Pro}- 
ect at Hagerstown; it involves direct teaching of the four basic 


174 Department of Health, Education, and Welfare, 1958 4 


subjects, plus music and art, at all grade levels, intermediate through — 
high school, on a countywide basis, by closed-circuit television. : 

Even though there is widespread recognition that radio and tele- 
vision have added new dimensions to teaching and even though ex- 
perience has shown that their value depends on the skill, imagination, 
and flexibility of the teacher, many teachers are not using such aids 
and students preparing to teach are not being taught to use them. 
Further research is needed on the application of the new techniques. 

The Office cooperates with organizations and groups concerned 
with educational television, issues directories of university courses 
and school participation, publishes bibliographies and listings, and 
provides other services to applicants for educational channels, advises 
on organization and finance, and reviews the results of uses of educa- 
tional television. It also maintains close contact with most of the 
groups conducting research and experiments, and staff members par- 
ticipate in workshops training teachers to use educational television. 
The Office called a National Conference on Educational Television, 
May 26, 27, and 28, 1958. Participants from the 51 national organi- 
zations represented pointed up new developments and trends and 
attempted to identify broad principles that might serve as guidelines 
to future developments in television. 

As part of its program to strengthen State and local educational 
resources of audiovisual aids, the Office prepared a directory of 16mm 
film libraries, identifying 3,660 such loan and rental sources; pre- 
pared directories of key audiovisual staff members in the Federal and 
State Governments and in large city public libraries and school sys- 
tems. Staff members continued work on studies of audiovisual 
education in State departments of education and in large city school 
systems; continued to provide services related to the audiovisual 
materials of the U. S. Government, including cataloging new films for 
Library of Congress cards, administering the Government’s contract 
covering the sale of films, and sponsoring a seminar on the problems 
of governmental production and use of films. 


Vocational Education 


In fiscal 1958 a total of more than $40 million in Federal funds was 
distributed to the States and Territories to aid vocational] education of 
less than college grade in agriculture, home economics, trade and in- 
dustry, the distributive occupations, the fishing trades and industry, 
and practical nurse education. 

In 1958 enrollment in vocational classes exceeded 3.5 million, the 
largest number of students ever enrolled in vocational education. Of 
the total about half were in secondary schools, grades 9 to 12; the — 


Office of Education TS 


others, adults who had left the full-time secondary school, were in 
part-time and evening classes. 

Current social, economic, and industrial conditions focussed atten- 
tion on vocational education in 1958. The changing characteristics of 
agriculture, the increasing industrialization of industry, and the in- 
creasing numbers of women in the labor force all led to new demands 
for programs and for expansion of existing programs in vocational 
education. 

Programs of vocational education designed to prepare persons 
for useful employment in specific occupational fields require that the 
instructors have the abilities and skills of workers in the occupations. 
Securing such workers to serve as teachers becomes an acute problem 
because many of them have greater earning opportunity in their oc- 
cupational field than in schools as teachers of vocational subjects. 

There is a constant need to change the vocational curriculum of 
the schools to keep programs abreast of the times. The rapidity with 
which changes are being made is perhaps more pronounced than in 
any other decade. Since such changes make new demands on teachers 
and on colleges and universities, inservice training must be provided 
for employed teachers to help them make the adjustments needed. 

Throughout the year the Office cooperated with vocational leaders 
in their efforts to provide efficient and effective programs. A few 
Office activities are summarized below. 

After months of work with the States the revision of policies for 
the administration of vocational education was completed and the 
revised statements were published. Administration of Vocational 
Education in Practical Nurse Training was issued to assist States in 
developing practical nurse training programs under provisions of 
Public Law 911, 84th Congress. The National Advisory Committee 
on Practical Nurse Education, which held its first meeting in January, 
submitted a report to the U. S. Commissioner of Education making 
suggestions for the administration of the practical nurse education 
program. 

Other studies included: A nationwide survey of farm mechanics 
teaching in vocational agriculture to determine the current status of 
such programs and the need for improvement; a status study of pro- 
grams in vocational agriculture for young farmers, in cooperation 
with the American Vocational Association, to identify characteristics 
of successful programs; a review of unpublished theses in home eco- 


‘nomics to identify research techniques and findings of value to home 


economics education; a long-range cooperative research study of 
characteristics of prospective teachers as related to success in teach- 
ing home economics; a research report on the placements of coop- 
erative part-time students in distributive education, in cooperation 


176 Department of Health, Education, and Welfare, 1958 ; 


with the Central Region Association of State Supervisors and — 
Teacher Trainers of Distributive Education; a study of effective 
practices in both adult and cooperative distributive education pro- 
grams in metropolitan areas; and a series of studies of cooperative 
students employed in hazardous occupations, in cooperation with the 
Bureau of Labor Standards, U. S. Department of Labor. 


Adult Education 


In response to the need, various groups throughout the country are 
sponsoring adult education programs, among them, public school sys- 
tems, industry, labor unions, the Armed Forces, farm organizations, 
and civic associations. Most of the groups hold to at least one or 
more of the following purposes: To help the individual adult 
remedy the defects and fill gaps in his earlier schooling; to show him 
how to function effectively in a rapidly changing world; to help him 
understand and adjust to changes that take place in him as he grows 
older; and to develop in him the desire for continued self-improve- 
ment and self-fulfillment. In their efforts to provide interesting and 
informative programs, these groups are being encouraged and aided 
by public libraries, institutions of higher education, churches, radio 
and television systems, and Government agencies. 

One of the most significant developments in recent years has been 
the growth of adult education programs in the public school systems. 
By statute and regulation many States specifically authorize the 
establishment of such programs, and in States where no specific 
statutory authority exists, public school districts are providing for 
the educational needs of adults. In every State some districts are 
conducting public school programs for adults. They are of five main 
types: (1) Americanization of aliens; (2) elementary grade classes; 
(3) high school grade classes; (4) general education classes; and 
(5) education and training in arts, crafts, and recreational skills. 
One or more of the five types are now provided for in the statutes and 
regulations of 47 States. 

Public school classes for adults are generally financed by a combina- 
tion of ways—by State aid, authorized if not appropriated; by local 
school funds but no State aid; by other public funds or private funds 
but no school funds, State or local; and by State and Federal funds 
made available for vocational education. A majority of the States 
require that teachers of adult classes be certified by the State, and most 
of them require that teachers who give courses for credit have a reg- 
ular teacher certificate. 

There is widespread evidence that in 1958 vocational education, 
college extension, and many other groups improved their programs, 


Office of Education 177 


increased enrollments, and, in general, made better provisions for meet- 
ing the needs of adults for education. 

An estimated 9 million persons attended adult education classes, 
according to a national survey, the first of its kind. It was conducted 
by the Bureau of the Census at the request of the Office of Education 
and financed by a $10,000 grant from the Fund for Adult Education. 
The survey covered only organized adult classes and series of adult 
education meetings. 

It is estimated that altogether between 30 and 35 million adults 
participated in all kinds of adult courses, including correspondence, 
individual instruction, private lessons, one-time group meetings, 
courses offered on radio and television, self-directed study, on-the-job 
training, and training conducted by the Armed Forces. 

The Office of Education served adult education in a number of 
ways: By publishing articles; participating in national, State, and 
local meetings, workshops, and conferences; consulting with State 
and organization leaders and with officials of other Government 
agencies. 

Staff members completed three important studies: (1) The report 
of the national survey made by the Bureau of the Census in their Octo- 
ber 1957 population survey; (2) a study of adult education services, 
goals, plans, and programs of State departments of education; and 
(3) a bibliography of education for the aging, the first to be pub- 
lished in this country. And they prepared a publication, Adult Hd- 
ucation in American Education Week, copies of which were distrib- 
uted by the National Education Association in 10,000 kits to public 
school and community leaders. 

The Office assisted the Federal Council on Aging and the Special 
Staff on Aging of the Department of Health, Education, and Welfare 
in survey of services and programs for the aging; a number of univer- 
sities and colleges and the Joint Federal State Council on the Aging 
in a series of conferences; and the National Association of Public 
School Adult Educators in sponsoring a National Institute for State 
directors of general adult education to stimulate enrichment of public 
school adult education curriculums. A staff member continued to 
serve as consultant to the National Commission for Adult Literacy, 
a non-government agency established by the Adult Education Asso- 
ciation of the U.S. A. 


International Education 


Today, our children need to learn more about the world than many 
of them are now taught; they need broadened training in languages, 
natural science, the social sciences, and the humanities; and they 
particularly need to learn more about the non-western world. 


178 Department of Health, Education, and Welfare, 1958 


One of the traditional responsibilities of the Office of Education is 
to help Americans understand international developments in educa- 
tion. A more recent Office responsibility is to mobilize and service 
American educational resources for the improvement of international 
understanding and for technical assistance to the emerging nations. 

International educational exchanges have become a primary means 
of maintaining a climate of public opinion overseas favorable to the 
United States and towards American policy. Each year, thousands of 
Americans are sent overseas, and even larger numbers of persons 
from other countries are brought here to study, to do research, to 
lecture, and to observe in the expectation that they will learn to 
understand us and will remain our friends when they return. 

There is a growing American population overseas. Thousands of 
American teachers are annually recruited to staff schools for Ameri- 
can children around the world. Such demands are being met through 
a series of programs, both Federal and private, although they repre- 
sent a growing drain on strained educational resources. 


OFFICE ACTIVITIES 


When the Soviet Union launched the first man-made satellite, 
Americans suddenly became aware of the immense technical progress 
achieved in the USSR. Furthermore they realized that progress was 
founded on Soviet education. 

Since Soviet education is a rapidly evolving enterprise, continuing 
research and personal observation by American educators of Soviet 
schools are required. In recognition of that need a representative 
of the Office went to Moscow to arrange, in cooperation with the De- 
partment of State, for an interchange of books and other educational 
materials and of teams of 10 educators between the U. S. A. and the 
USSR. Some of the materials received from Soviet authorities have 
contributed to our understanding of education as an instrument of 
communist policy. This growing collection is a center for research on 
Soviet education, since the Office makes available to the public in- 
formation on Soviet education. The American team, headed by the 
U. S. Commissioner of Education, completed its visit to the Soviet 
Union and will issue a report of its findings in fiscal year 1959. A 
Soviet team is expected to arrive here during the 1959 fiscal year. 

Research in comparative education was continued to provide au- 
thoritative information needed by other Federal and State agencies, 
educators, leaders in international programs concerned with education, 
and the general public. 

Special reports on education in 10 foreign countries (Burma, 
Ghana, Indonesia, Iran, Iraq, Pakistan, Sudan, Thailand, Turkey, 
and Viet-Nam) were prepared for use in a U. S. Government project 
concerned with educational activities abroad to which the U. S. Gov- 


Office of Education Sones: vcteasiha Slee 179 


ernment or private agencies contribute funds. Work was continued 
on studies started in 1957 including bulletins on education in Brazil, 
Haiti, Israel, and Japan; comparative education bibliographies; the 
teaching of professional education subjects in northern Europe; and 
the functions and organization of ministries of education in nearly 
70 countries. New studies were started on teacher education in cer- 
tain European countries and on education in the Soviet Zone of 
Germany. 

The Office exchanges its studies with educational organizations and 
institutions abroad, ministries of education, and other foreign goy- 
ernment agencies. Requests for additional copies and for permission 
to use our material reflect widespread interest. 

The Office of Education interprets foreign educational credentials 
as a service to agencies, to U. S. citizens who have studied abroad, and 
to foreign citizens. The Office provides this service by analyzing 
data in some 40 languages and by maintaining and developing ac- 
cess to information on education around the world. 

The responsibilities of the Office have increased in size and geo- 
graphic coverage. By the close of fiscal year 1958, thousands of vet- 
erans and unnumbered other United States citizens had studied 
abroad. More than 40,000 foreign students were enrolled in U. S. 
educational institutions. Requests for assistance increased from 
2,283 in 1946-47 after postwar exchange programs had begun to oper- 
ate to 4,070 in 1957-58. 

One of the most important developments during the year was the 
application of the United States Government for membership in the 
International Bureau of Education. Since the Bureau is an inter- 
national center of educational research and provides for a wide 
exchange of information, the Government has sent delegates to many 
of the annual International Conferences on Public Education at 
Geneva, which are cosponsored by the International Bureau of Educa- 
tion and by the United Nations Educational, Scientific, and Cultural 
Organization, but the U. S. delegations have not enjoyed the full 
privileges and benefits that membership insures. 

Office specialists in many fields prepared information for publica- 
tion by the United Nations and contributed to UNESCO reports. 

The Educational Materials Laboratory expanded its services and 
undertook new ones. The Office cooperated with the International 
Cooperation Administration in developing educational materials for 
use overseas. A 6-month workshop was organized, in cooperation 
with George Washington University and the ICA, in which 20 teach- 
ers, writers, and illustrators from 13 countries of Asia, the Near East, 
Africa, and Latin America participated. They were selected and 
financed by ICA. The program included (1) orientation to educa- 


180 Department of Health, Education, and Welfare, 1958 


tion in the United States, (2) lectures and field trips, (3) planning 
and writing individual projects, and (4) two group projects: 7’he 
Workshop Sampler and The Workshop Weekly. 

The laboratory acquired some 1,500 items of educational material, 
consulted with visitors, and responded to requests for assistance from 
American teachers in locating teaching aids for developing interna- 
tional understanding and knowledge of world affairs and from edu- 
cators abroad seeking information on U. S. educational materials. 

The Office provided the Department of State with statistical tabula- 
tions on government-sponsored grantees entering and leaving this 
country during the year, a service it has given annually since 1952, 
including numbers and types of grantees by country of destination or 
origin, State of origin or destination, fields of specialization, age 
groupings, and veterans’ status. 

In addition to providing this information, the Office prepared rec- 
ords giving the name, address, category, specialty, occupation, and 
institution of placement of every foreign grantee entering this coun- 
try during 1958. 

In 1958, the Office of Education continued its assistance to the Inter- 
national Cooperation Administration by arranging training programs 
for 644 participants from 47 countries, an increase of 102 participants 
over fiscal year 1957. The largest number of participants came from 
Thailand and Indonesia. The participants included elementary and 
secondary school teachers, university professors, educational super- 
visors and administrators at local, provincial, and ministerial levels, 
and represented a variety of fields. They came to the United States 
for periods of training ranging from 2 months to 2 years, but the 
majority of them completed programs of approximately 11 months. 

There was an increase in the number of special projects to meet the 
needs of special groups. These included 11 Japanese professors in 
university-industry relations, 10 Brazilians in secondary education, 
9 Guatemalans in secondary education and administration, 7 Spanish 
professors in technical education, 6 Korean administrators and super- 
visors in trade and industrial, education, 5 Vietnamese professors in 
the organization and administration of higher education, and 3 Somali 
officials in elementary and secondary educational administration. 

During Christmas vacation, 150 participants attended special cul- 
tural programs designed to promote an understanding of American 
life. The largest program was at the Center for Continuing Edu- 
cation of the University of Georgia for 66 educators from 8 countries. 

The Office cooperated with the International Education Exchange 
Service, Department of State, in arranging educational programs for 
352 visiting educators from 54 countries during the year. Included 
were 27 teachers and administrators from Central America who took 


Office of Education 181 


part in a special 30-day teacher development workshop at the Un1- 
versity of Puerto Rico. The regular program consisted of two groups 
in elementary education, five in secondary education, five in English 
as a second language, two in American civilization, one in vocational 
education, and one seminar in elementary and secondary education. 

The considerable interest of educators from abroad in coming to 
the United States to observe educational practices through this pro- 
gram is indicated by the number of applicants for the limited 
number of grants available in some countries. For example, in 
Norway, 115 teachers applied for 6 grants; in Japan, 604 teachers 
and administrators applied for 25 grants; in Singapore, 129 teachers 
applied for 4 grants; in Italy, more than 400 educators applied 
for 27 grants; and in Egypt, 70 teachers applied for 9 grants. 

The 30-day teacher development workshops conducted in Spanish 
at the University of Puerto Rico have attracted great interest among 
Latin American educators. 

During the program year, arrangements were made for more than 
550 American teachers to participate in teacher exchanges. Among 
these were the first teacher interchanges between the United States 
and Cuba. For the first time, American teachers of Spanish were 
selected to participate in a summer seminar in Colombia, and Ameri- 
can history teachers were selected for a seminar in Italy. 

Over 40 countries, including Colonial Areas of the United King- 
dom, now engage in teacher exchange activities with the United 
States, and there are six summer seminars for American teachers. 
A seminar for American schoo] administrators was announced during 
this year; 20 American school administrators will study educational 
systems in France and The Netherlands early in 1959. 

Evaluative studies and statements in superintendents’ reports in- 
dicate that exchange teachers have been remarkably successful in 
promoting a better international understanding. American educa- 
tional associations are showing increased interest in having foreign 
educators participate in their conferences and annual conventions. 

The Office provides services to visitors from many countries who 
are not participants in official programs. These visitors are referred 
to the Office by other Government agencies, by foreign governments, 
by educational and other agencies, or they visit the Office on their 
own initiative. 

The Office of Education continued to work with the Internationa] 
Cooperation Administration in the development of technical assist- 
ance programs in education in 45 countries. | 

The Office also utilized the competencies of its specialized staff in 
furnishing technical support on special educational problems of 
these educators in the countries where they work. This professional 


182 Department of Health, Education, and Welfare, 1958 


assistance included the provision of Department publications of gen- 
eral and special interest to overseas educational specialists; annotated 
summaries of recent educational materials; and assistance on a va- 
riety of educational problems. 


Higher Education 


Numerous studies of population growth and projections of school 
and college enrollments leave no doubt that higher education will be 
confronted with unparalleled opportunities and with enormous re- 
sponsibilities in the years immediately ahead. Enrollments in the 
colleges and universities will reach 6 million by 1970, about double 
the number enrolled in the fall of 1957. During this brief period, 
faculties will have to be increased and facilities expanded to provide 
programs of quality and diversity adequate to the new demands. 
Colleges will have to recruit annually, on the average, between 15,000 
and 22,500 new teachers to keep pace with growing enrollments and 
to fill vacancies created by resignations and retirements. ‘The grad- 
uate schools now award doctorates to about 9,000 persons annually, 


but only about half of them enter college teaching; the other half — 


go into government, business, or industry. 

A large percentage of new college teachers will have to be recruited 
from the ranks of those who do not hold the doctor’s degree. In fact, 
the percent of new full-time college teachers employed in 1956-57 
holding the doctor’s degree was 23.5 compared with 40.5 percent of 
full-time teachers in 1953-54 who held this degree. The employ- 
ment of less well qualified teachers at a time when enrollments are 
rising rapidly threatens the quality of higher education. 

This manpower situation is intensified by the even greater need for 
qualified teachers in the elementary and secondary schools. In 
1957-58 there was a shortage of 135,000 teachers in public and non- 
public schools. More than 91,500 teachers, or about 6.5 percent of 
the total teaching staff in the elementary and secondary schools, were 
emergency teachers, which means that they did not meet the State’s 
requirements for the lowest teaching certificate. Turnover among 
teachers was high—about 7.5 percent of the qualified teachers. This 
does not include teachers who moved from one teaching job to another. 
Colleges and universities must therefore expand their own teaching 
staffs and at the same time increase the flow of qualified teachers into 
the elementary and secondary schools from a common manpower res- 
ervoir of college graduates. 

To provide information on what some institutions are doing about 
the shortage, the Office has under way two special projects: One on 
procedures employed by colleges and universities to meet faculty 
shortages and the other on salaries and conditions affecting faculty 
services. In addition it has initiated a survey of beginning teachers. 


Office of Education Spee eee 183 


USE AND EXTENSION OF FACILITIES 

The growing pressures of college enrollments require the maximal 
use of existing facilities and the development of well-considered plans 
for expansion. Studies already made show that generally with more 
efficient space utilization a considerable increase in enrollments could 
be accommodated in present classrooms and laboratories. To provide 
precise information on a national basis about present facilities and 
future needs, the Office is making a comprehensive inventory of col- 
lege and university physical facilities. It has also undertaken a 
study of summer sessions on the use made of facilities during the 
summer months. ‘This study will also provide information on pro- 
grams, use of faculty, and other phases of summer institutional 
operations. 

One important means of providing for increased enrollments is the 
establishment of junior or community colleges. State and local 
boards of education and citizens’ groups need criteria by which to 
decide when, where, and under what conditions a junior college or 
community college can and should be established. The Office has 
undertaken a study to produce such criteria. 


DEVELOPMENT AND MODIFICATION OF EDUCATIONAL PROGRAMS 


Studies of educational programs offered have been completed or 
are under way as follows: Engineering enrollments and degrees 
granted; social science requirements in bachelor’s degree programs 
irrespective of major subjects; 5-year programs for the preparation 
of secondary school teachers; organized occupational curriculums and 
enrollments; and college and university programs in business and 
public administration. 

IMPROVEMENT OF ORGANIZATION AND ADMINISTRATION 


As college enrollments increase, the magnitude and complexity of 
institutional operations will also increase. Moreover, as State-sup- 
ported institutions expand their programs, the coordination of de- 
velopments within a State becomes increasingly important. Prob- 
lems of organization and administration to promote high quality pro- 
grams and at the same time achieve efficiency and economies within 
an institution also demand consideration. To aid State boards, State 
legislatures, and the boards and administrations of individual in- 
stitutions in dealing with such problems, the Office has under way a 
number of projects, some new, some continuing or recurring. Espe- 
cially noteworthy are the following: 

1. A study of the structure and functions of State boards responsible for the 
coordination and control of institutions of higher education. 

2. An annual analysis of legislative enactments and proposals for legislation 
by State legislatures. 


184 Depariment of Health, Education, and Welfare, 1958 


3. A round-up report on the efforts of voluntary agencies and associations to 
plan and coordinate interinstitutional activities. 

4. An analysis of the processes and procedures by which administrative 
policy in higher education is determined at both the State and the institutional 
level. 


ASSISTANCE IN PLANNING AND CONDUCTING SURVEYS 


The demands for higher education and the resources for meeting 
these demands vary widely from one State to another. Each State 
must therefore appraise its resources and facilities in higher education 
in relation to its future needs. The Office is called upon repeatedly to 
assist in designing such studies, to suggest competent staff to conduct 
the studies, and to read and evaluate reports of the studies. Occa- 
sionally, as time permits, the staff members assume responsibility for 
making a survey. 


LEGISLATIVE PROPOSALS 


In July 1957 the President’s Committee on Education Beyond the 
High School, appointed by President Eisenhower in the spring of 
1956, issued its Second Report to the President. The Committee’s 
final report makes 47 recommendations dealing with the need for col- 
lege and university teachers, the need for financial assistance to stu- 
dents, the expansion and diversity of educational opportunities, fi- 
nancing higher education, and the relation of the Federal Govern- 
ment to education beyond the high school. 

Immediately after the Committee issued its report Secretary Folsom 
appointed a task force on higher education consisting of members of 
his staff and of the staff of the Office of Education, with the Commis- 
sioner of Education as chairman, to review the findings and recom- 
mendations of the Committee, to consider its implications for the 
work of the Office and for legislation, and to develop a program of 
legislation. 

The task force carefully devised proposals for legislation on 
education which were presented to the President and approved by 
him. The proposals, introduced in both branches of the Congress in 
January 1958, were for financial assistance for students in higher 
education; aid for foreign language institutes and for foreign 
language centers to teach languages for which instruction is not readily 
available but which is needed in the United States; aid for fellow- 
ships and the expansion of graduate education; assistance for strength- 
ening science, mathematics, and modern foreign language instruction 


in public schools; aid for guidance, counseling, and testing of stu- — 
dents in secondary schools; and assistance to State departments of 


education for the improvement of statistical services. At the end of 
the fiscal year the proposals were being considered by the Congress 
and. widely supported by the public. 


Office of Education 185 


RESEARCH AND STUDIES IN HIGHER EDUCATION 

Among the Office reports and studies in higher education made 
during the year are the following: A directory of higher educational 
institutions; baccalaureate degrees conferred by American colleges in 
the 17th and 18th centuries; survey of State legislation relating to 
higher education, July 1, 1956 to June 30, 1957; organized occupational 
curriculums, enrollments, and graduates in 1956; and financial aid for 
graduate students and for undergraduates. 


Assistance to Schools in Federally Affected Areas 


Public Laws 874 and 815 were enacted by the 81st Congress in Sep- 
tember 1950 to provide Federal assistance to school districts on which 
activities of the United States had placed serious financial burdens. 
Public Law 874 provides assistance for current operating expenses 
and Public Law 815 provides assistance for school construction. In 
general these two laws recognize as a financial burden the education of 
children who reside on, or reside with a parent employed on, tax-ex- 
empt Federal property such as military bases, atomic energy installa- 
tions, reclamation projects, Indian reservations, and National forests. 
Where Federal contract activities with private plants cause a sud- 
den and substantial increase in school enrollment, Federal assistance 
is authorized if the school district can show budgetary need for the 
Federal funds. 

Approximately $126 million was paid to school districts under P. L. 
874 in fiscal year 1958, on account of 140,000 children who resided on 
Federal property and 1,110,000 children who either resided on Federal 
property or resided with a parent employed on Federal property. 
This is a slight increase over fiscal year 1957 in the number of children 
for whom payments were made and an increase of approximately $14 
million in payments. These were attending school in 3,330 school dis- 
tricts which had an estimated enrollment of 7.75 million children, or 
about one-fourth of all children attending public elementary and 
secondary schools in the United States. 

The table below presents the significant figures for the 8 years the 
program has been in effect. 


Net entitle- | Percent of 

Number of ments of Total current | total current 

Fiscal year eligible applicant dis- | expenditures | expenditures 

applicants tricts—all of applicant financed by 

sections districts 
funds 

ISU ON Sa a ge eg ore Oe a Oe Le2 $29, 000, 000 $520, 370, 000 5.6 
ls er es Mac ee 1, 763 47, 815, 000 825, 926, 541 5.8 
Joe Sx SLOPE eee eee 2912 57,700,000 | 1, 040, 424, 071 5,5 
CR eer ee 2, 524 71, 850,000 | 1, 284, 960, 000 5.6 
OS pamaeenue oes Pency cs eet oT Savi ea 2, 683 75, 275, 000 | 1, 450, 700, 000 5. 2 
Lt) aera ee Se ee 2, 860 85, 750,000 | 1, 754, 530, 000 4.9 
Ge een eS FP tee Lied pyar eh a es | 3, 331 112, 370,000 | 2, 156, 450, 000 5. 2 
a neal ll ae ails ies Sein aps *3,330 | *126, 000, 000 | *2, 500, 000, 000 *5.0 


*Estimated. 
487270—59——_13 


186 Department of Health, Education, and Welfare, 1958 


The volume of school construction approved under P. L. 815 con- 
tinued at about the same level in fiscal year 1958 as in each of the 
past several years. During the year $74,519,000 was reserved for 
349 projects under all sections of the law. One of the principal 
reasons for the continued high level of school construction assistance 
is the construction of housing units for military personnel under title 
VIII of the National Housing Act—the Capehart Housing Program. 

Payments made during the year were for increases in school en- 
rollment of federally connected children in the 2-year increase period, 
from July 1, 1956, to June 30, 1958, and from July 1, 1957, to June 
30, 1959. Fiscal year 1958 marked the first year of operation under 
an amendment to the law which moved the increase period forward 1 
year at a time rather than 2 years, the period used during the past-6 
years. 

A total of $826,050,000 has been appropriated by the Congress for 
P. L. 815 through June 380, 1959. This amount includes $56,950,000 
appropriated in fiscal year 1958 to meet existing obligations through 
the 1959 fiscal year. Of the total appropriated, $821,325,000 has been 
used for project construction and $4,725,000 for services provided by 
other Federal agencies. 

When projects included under existing authorizations are com- 
pleted, this program will have provided 1,500 new elementary and 
secondary schools, 2,200 additions to elementary and secondary schools, 
37,235 classrooms and related facilities to house an estimated 1,117,050 
children. This total includes 190 projects which will provide an 
estimated 1,140 classrooms for approximately 33,000 children, mostly 
Indian children, living on Indian reservation land. 


LEGISLATION 


Under existing legislation P. L. 874 ends June 380, 1958, and no 
applications can be submitted beyond June 30, 1959, under P. L. 815. 
After an extensive review and study of these two programs the Depart- 
ment of Health, Education, and Welfare submitted recommendations 
to the Congress early in January 1958 for amendment and extension 
of the two acts to bring Federal payments more nearly in lne with 
the financial burden on school districts caused by Federal activities 
under present conditions. After extensive hearings by the House 
Committee on Education and Labor a bill was reported and passed the 
House on April 27, 1958, which extended on a permanent basis as- 
sistance under both laws for school districts educating those children 
who lived on Federal property or with a parent employed on Federal 
property, and extended all other categories of Federal impact until 
June 80, 1961. The bill as passed by Congress and signed by the 
President included a number of amendments, some liberalizing the 
benefits under both laws and others restricting Federal payments. 


ee of: Education 187 


Cooperative Research 


The Cooperative Research Program (P. L. 531, 83d Cong.) has been 
designed to permit the Office to increase the quantity of and add 
depth to its research by supporting such work in colleges and univer- 
sities and State school systems throughout the country. The proce- 
dure offers many advantages; for example, (1) it affords a means for 
gathering together the ideas of hundreds of highly qualified, profes- 
sional persons and selecting from among them those which seem most 
promising; (2) it secures the services of persons with knowledge, 
training, and experience in the special techniques and skills needed to 
do research; (3) it provides opportunities for training research per- 
sonnel; (4) it permits the utilization of research facilities and labora- 
tories in the schools and colleges; and, (5) because it requires the co- 
operating institution or agency to contribute either services or facili- 
ties, it yields a greater volume of research than could otherwise be 
purchased for the Federal funds expended. 

The purpose of the Cooperative Research Program is to develop 
new knowledge about the educational process and to devise new 
applications of existing knowledge. To accomplish this purpose, the 
program must be directed toward gathering information about. the 
fundamental processes of education. For example, educators need 
far more information than is currently available about the extent and 
nature of individual differences—information which explains not 
only the intellectual functioning of the mentally retarded, the nor- 
mal, and the gifted but also the subtle personality distinctions existing 
within each of these groups. 

Under present procedure proposals for specific research projects 
from institutions of higher education and from State departments of 
education are reviewed within the Office and then submitted to the 
Office of Education Research Advisory Committee for evaluation. 
This Committee, consisting of nine specialists in research appointed 
by the U. S. Commissioner of Education, evaluates all proposals on 
the basis of the (1) significance of the problem for education, (2) 
soundness of the research design, (3) personnel and facilities avail- 
able for the research, and (4) economic efficiency or relationship of the 
proposed expenditure to the procedures and probable outcomes. 

When a proposal is recommended by the Committee and approved 
by the Commissioner a contract is negotiated directly with the institu- 
tion or agency. Although the Office provides most of the funds, the 
cooperating institution or agency also contributes to the total cost of 
each project, usually by providing professional services and facilities. 

During 1958 the Office received 172 proposals for projects under the 
program, and the advisory Committee recommended 50 of them for 
approval. The appropriation available for this second year of pro- 


188 Department of Health, Education, and Welfare, 1958 


gram operation was $2.3 million. More than half was needed to con- 
tinue the support of projects begun during the first year, and the re- 
mainder—approximately $960,000—was used for the initiation of new 
projects. By the year’s end, 64 new contracts had been signed. 
Among them were 11 dealing with the education of the mentally re- 
tarded, 10 with the identification and development of gifted students, 
and 8 with the selection and career development of teachers and ad- 
ministrators, and guidance and counseling. 

The Federal funds expended in the first 2 years of program opera- 
tion were disbursed in 31 States, the Territory of Alaska, and the Dis- 
trict of Columbia. <A total of 53 colleges and universities and 12 
State departments of education participated. The length of the 
projects initiated ranged from 3 months to 5 years, but the average 
length was about 2 years. The total cost of the projects ranged from 
$1,500 to $600,000, with an average of $64,000 for projects on the 
mentally retarded and $33,000 for other projects. The average total 
cost for all projects was $49,000. 

A total of 14 reports on projects completed during the year were 
received by the Office; 9 were on the education of the mentally re- 
tarded; 2 on gifted students; 2 on teachers; and 1 on child develop- 
ment. 

To disseminate results of the program the Office plans to hold 
seminars on the information gained; to conduct clinics for the im- 
provement of existing techniques and the development of new tech- 
niques; to publish reports and articles in professional journals and 
periodicals; to demonstrate new procedures and techniques at meet- 
ings of various organizations; to urge researchers to talk about their 
work to local groups; and to give general publicity to the projects 
being supported. 


Libraries 


Libraries in 1958 continued to improve and extend their services 
but not rapidly enough to meet the needs of an expanding popula- 
tion with ever-increasing demands for information. 

Recruiting trained librarians was a major problem for all libraries. 
There was greater interest in work simplification and cooperative 
practices among libraries to decrease duplication of effort. Larger 
units of library service were being more rapidly organized, and in- 
service training programs for professional and clerical employees 
were recelving increased attention. 

Throughout 1958, the Office continued working toward one of its 
‘basic objectives: to improve the resources, services, and facilities of 


Office of Education 189 


school, college, research, special, State, and public libraries and to 
provide information on education for librarianship. 


SCHOOL LIBRARIES 


Chapter 6 of the Biennial Survey of Education in the United States, 
1952-54, “Statistics of Public School Libraries, 1958-54,” indicates 
the need to strengthen programs for recruiting and training profes- 
sional school librarians who are especially needed in the elementary 
schools. ‘The study reveals that only 3,416 professional school librar- 
lans were available for service to 104,365 elementary schools in 1953-54, 
and that schools reporting library expenditures for 1953-54 spent 
$25,222,207 on library materials for an enrollment of 24,017,371 stu- 
dents, or $1.05 per pupil, which is far below the minimum recom- 
mended by American Library Association. 

An examination of official announcements issued by nearly 1,900 
higher education institutions in 1956-57 revealed that 563, or nearly 
one-third, were endeavoring to meet the prevailing demand for school 
librarians through programs in school library education. The pro- 
liferation of library courses has raised some questions about standards 
for professional preparation of school librarians and has created 
problems in accreditation of many programs. 


PUBLIC LIBRARIES 

Three statistical surveys of public libraries were conducted and re- 
ports issued during 1958. A survey of county and regional libraries 
for fiscal year 1956 included responses from 148 library systems as 
against 120 for the year before, reflecting a rapid increase in the 
development of centralized library units. The responses also revealed 
increased per capita income and use of larger systems. 

Statistics of Public Libraries in Cities with Populations of 100,000 
or More: Fiscal Year 1957, reported increases on all items covered, 
with a 4.2 percent increase in book circulation in 1957 over 1956 and 
a total increase since 1950 of 27.1 percent. Salaries accounted for 
72.9 percent of the total operating expenditures; books and periodi- 
cals, 12.2 percent; and audiovisual materials, 0.4 percent. 

Statistics of Public Library Systems in Cities with Populations of 
50,000 to 99,999: Fiscal 1957, showed that the total number of volumes 
owned by public library systems in this population group had in- 
creased 14.5 percent between 1952 and 1957 and 4.1 percent between 
1956 and 1957. Overall operating expenditures for libraries had in- 
creased, salaries by 11.4 percent over 1956. Book and periodical ex- 
penditures absorbed 15 percent of total operating expenditures and 
audiovisual materials an additional 0.7 percent. 


190 Department of Health, Education, and Welfare, 1958 


LIBRARY SERVICES FOR THE AGED 


One Office responsibility is the coordinating of library service with 
other forms of adult education. To learn what public libraries were 
doing to meet the needs of old people, the American Library Associa- 
tion, in cooperation with the Office, conducted a survey of all public 
libraries in places with populations of 2,500 and over. The 1,391 
replies showed that provision of books, publicizing of available 
materials, provision of shut-in service, and working with other com- 
munity agencies were the most frequently offered services. 


GRANTS FOR LIBRARY SERVICES 


The Library Services Act (Public Law 597, 84th Cong.) authorizes 
the expenditure of $7.5 million a year for 5 years, beginning July 1, 
1956, to improve and extend library service to rural areas with no 
service or with inadequate service. 

The contribution of the act to the development and improvement of 
public library services to rural areas increased in the second year of 
the program. Forty-five States and the Territories of Alaska, Hawaii, 
Guam, Puerto Rico, and the Virgin Islands participated in the 1958 
program and shared in the $5-million grant. State and local matching 
funds raised the total budgets of the 50 State and Territorial programs 
~ to $15,464,175. | 

State plans indicate that over 300 rural counties with populations 
totaling more than 714 million children and adults were receiving 
new or improved library services under the program in 1958. State, 
local, and Federal funds totaling $7 million have been combined to 
buy books and other informational materials. More than 90 book- 
mobiles and 30 other vehicles were bought to bring materials to rural 
families. State library agencies responsible for administering State 
plans have added more than 100 experienced librarians and more than 
80 clerks and bookmobile operators to improve their service. 

The programs under the act have also aroused much interest in 
the development of public library service. There have been many 
inquiries about county and regional library service and other co- 
operative library programs including the centralized processing of 
books, scholarship programs, and inservice training in modern library 
techniques. This interest has resulted in an increasingly active com- 
munications and field work program by the Office staff with the States 
and Territories. 


Office of Education 191 


Table 1.—Enrollment in the continental United States, 1956—57 and 1957-58 


[Office of Education estimates] 


Year 
School 
1956-57 1957-58 
Kindergarten through grade 8: 
Pipe senor system (resular full-time). = <5 225252 2 seo ese p 25, 283, 000 26, 037, 000 
Nonpublic schools @erular full-time) s {2202 bo 2 ee pete cc bese lelee 4, 267, 000 4, 466, 000 
Reaeralscchools 1orlndiansa = 222. ors l sass oe Behe Lesa oe Se. 26, 000 26, 000 
imemeraiscnools under Ps W874. ve Pe ee ee 19, 000 20, 000 
AR CS ie ED eee ea pee eS 116, 000 121, 000 
Movouxindercarten- through erade Sai u2 soe sates Sees bk dees oenes 29, 711, 000 30, 670, 000 
Grades 9-12: 
Publhe school system: (regniar full-time). -. = = 22-2 eae 6, 876, 000 7, 399, 000 
Private and parochial schools (regular full-time) -__.___..-___.-._-______- 866, 000 942, 000 
MieGelal Choo lsuory Mn OlanS= Sse See foe Wee Sh ee eek 11, 000 11, 000 
BME GieseMOO ISINGer Eu. 8/4225 2eose ee  e See ee 1, 000 1, 000 
PUI ce ese ec pt I a FS er 66, 000 71, 000 
Totalerades.9-12....2...2..--252--. Bt cares pees a Me ek Dean fee 7, 820, 000 8, 424, 000 
hovauelementary ana secondary _-.-2--- 0 2 ee. 37, 531, 000 39, 094, 000 
Higher education: a 
Universities, colleges, professional schools, including junior colleges and 
TESESGE SEG) Sisco ea ete Mea as et ale a I Dale aca lee a Pet ok ge 3, 244, 000 3, 450, 000 
Other schools: 
Private commercial schools (day and evening)______________--_-__-__---- 500, 000 500, 000 
Nurse training schools (not affiliated with colleges and universities) _____- 91, 000 91, 000 
CAMO GUCTE SCHOO GE eee nels Sin Sx ey Reh es ee Pe Me be See 591, 000 591, 000 
Nat Fe So ite ac 1 Ft Dayle) ae a 41,366,000 | 43, 135, 000 


Table 2.—Supply and demand for elementary and secondary public and non- 
public school teachers, 1957-58 


Item Elementary 
and secondary 


Supply 

RIE I te et eh a ol Gee Ge IU ie at 1, 342, 100 
Wesste tiereeleyatecocCmers'. 900-01 0 aL ee ee eee 89, 400 
hot aionaaitiom beAChers: 1900-0 (ose Ne nue eh eo to a 1, 252, 700 
essen smercent vurnover of qualified teachers 2222002) 22. oe ek eee eaten nee 94, 000 
Ouarnceantcacners returning for 1957-682... ee Se ee bee 1, 158, 700 
Himeneoney, teachers qualifying for 1957-58222... ee eee 22, 000 

New supply of qualified teachers (80.8 percent of elementary and 63.2 percent of high school 
Pr eerOMEACHeIT SO00-—0)) rae tein Be wee at ar oe ee ee 81, 400 
ROPRmCUIALIACCISUDDLY I Obi—00% bao sete shee Sa eee ee a 1, 262, 100 

Demand 

Mi AE RCI TORI OD— Os cloeee ete oO td oe ee Se ee ee 1, 342, 100 
Teachers needed to meet increase in enrollment in 1957—58__________---------------------- 55, 000 
SME IRA ORLOD (Oe a ee cee te ee ek a ee ak 1, 397, 100 
SO AeesOLOUaliNeECISIPDEViscot oe aoe ee es Se ee oe Se eee Soe 135, 000 


1 The number of elementary and secondary school teachers in the public school system, in the fall of 1956, 
was 1,197,000 (Office of Education Circular No. 490). To this must be added an estimated 145,000 teachers 
in nonpublic schools (private and parochial), in model and practice schools, in subcollegiate departments of 
colleges and universities, in residential schools for exceptional children, and in schools operated under 
Federal auspices. 

2 Turnover, as used here, includes only those who leave the profession of teaching through death, re- 
tirement, marriage, or to take a position in some other field. Changes of positions from one school 
system to another are not included. 


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Food and Drug 


Administration 


PREVIOUS REPORTS have outlined recommendations made by the Citi- 
zens Advisory Committee in 1955 to strengthen FDA’s staff, facilities, 
and techniques to better protect the health and well-being of con- 
sumers of foods, drugs, and cosmetics. The Secretary’s Consultants 
on Medical Research and Education, after a study of the medical re- 
search activities of the Department, endorsed these conclusions in its 
report of June 30, 1958. 

That report pointed to the responsibility of the Food and Drug 
Administration for protecting consumers against foods, drugs, and 
cosmetics that are a threat to health by reason of such factors as 
contamination, deterioration, toxicity, or quackery. “The Consultants 
are of the opinion,” the report states, “that a vigorous research effort 
is critically important to the effective performance of the statutory 
responsibilities of the FDA.” The Consultants recommended that 
“High priority be given to (1) securing additional funds required 
for research and training and strengthening the staff, and (2) se- 
curing funds required for a suitable, well equipped building for the 
Food and Drug Administration functions.” 

In the fiscal year 1955 when the Citizens Advisory Committee was 
making its study, the FDA staff averaged 806 man-years. The recom- 
mended 3- to 4-fold expansion began on July 1, 1956. In the fiscal 
year 1958 the staff averaged 1,095 and was 1,215 at the close of that 
period. Seventy new positions for the new District to be opened 
in Detroit were provided for in the 1959 appropriation, which also 
included funds to begin equipping an eighteenth District in the 
Dallas-Fort Worth area of Texas. 

FDA has been going through a period of planning, to absorb this 
increase in manpower and the more substantial ones to come if the 
recommended goals are met. During the past two years a workload 


195 


196 Department of Health, Education, and Welfare, 1958 


survey was conducted which will be of value as a guide in directing 
future activities. “Training the trainers” has been stressed during 
the year. Those selected to indoctrinate an augmented staff and to 
equip the inspectors and analysts with the specialized skills for regu- 
latory work have been attending conferences and schools conducted 
by specialists from the technical divisions. Significant improvement 
has resulted in abilities to use new equipment and methods, and also 
in supervisory proficiency. 

One of the major recommendations of the Citizens Advisory Com- 
mittee was the enlargement and improvement of FDA’s educational 
and information program “to develop a better understanding of the 
objectives and requirements of the food and drug laws.” A Division 
of Public Information was established in 1958, by consolidating in- 
formation activities and staff formerly scattered in three units. This 
Division is coordinating and stepping up the information program 
for consumers, industry, and affected professional groups to the great- 
est extent possible until the staff can be increased. 

Added public protection has been provided by increased coverage 
of establishments and shipments. Establishment inspections rose 
from 16,287 in fiscal 1956 to 26,063 in 1958 and domestic samples col- 
lected from 17,675 to 25,269. During this period FDA inspectors 


reported increasing voluntary correction of unsatisfactory conditions 


pointed out to management during inspections. 

Progress has also been made in basic scientific research, streamlined 
processing of new-drug applications, increased activities in formula- 
tion and enforcement of food standards and pesticide tolerances, and 
more participation in industry meetings. 

This record would not be complete without an acknowledgment to 
those who have assisted FDA in its educational programs. There are 
strong trade and professional associations influencing the conduct of 
their members in almost every area of FDA regulatory activity. 
More and more of these associations are wholeheartedly undertaking 
campaigns to encourage better compliance with the law. 

The Proprietary Association launched an educational program to 
encourage consumers to read labels and follow directions carefully in 
the use of drugs. The new Pharmaceutical Manufacturers Associa- 
tion—merger of the American Drug Manufacturers Association and 
the American Pharmaceutical Manufacturers Association—is con- 
tinuing its Government-Industry Committee. This committee has 
been active for many years in efforts to promote voluntary compliance, 
understanding, and cooperation between member firms and FDA. 
Similar objectives resulted in a meeting with FDA of 90 representa- 
tives of food manufacturing industries and associations of food pro- 
ducers, called at the request of the Food Law Institute. 


Food and Drug Administration 197 


The American Medical Association launched a vigorous educational 
campaign to warn the public against medical and nutritional 
quackery. Collaborating with the FDA and the National Better 
Business Bureau, AMA produced an educational motion picture, “The 
Medicine Man,” designed to expose the public harm done by false and 
misleading promotion of vitamin products. 

Naming all who have assisted in specific programs is precluded in 
this brief report. They include national associations and their af- 
filiates, agricultural leaders, nutrition associations, consumer organi- 
zations, and State and local food and drug officials. The trade and 
professional press has performed an invaluable service in dissemi- 
nating information to industry members and groups. Major pro- 
grams showing progress include: 

Cleaner wheat for food use, including better sanitation of grain 

elevators; 

Protection of dairy products from spoilage, filth, or contamination 

with antibiotics or pesticides ; 

Proper use of pesticides to avoid excess residues ; 

Cleaner grapes for juice; 

Prevention of bacteriologic contamination in frozen foods; 

Prevention of diversion of incubator rejects to food channels; 

Improvement of bakery sanitation ; 

Protection of coffee shipments from ore contamination ; 


Codes of labeling for drugs and cosmetics to prevent misleading 

claims. 

One of the most promising opportunities for better consumer pro- 
tection is the legislation to insure safety of food additives passed the 
last day of the 85th Congress—the outcome of hearings that began in 
1950. This amendment is discussed under “Changes in the Law and 
Regulations.” 


Food, Drug, and Cosmetic Act 


ON THE FOOD FRONT 


Unusual attention was required of regulatory officials as floods, tor- 
nadoes, and hurricanes damaged extensive areas but caused relatively 
minor loss of foods and drugs in comparison with those damaged by 
fires, explosions, and wrecks. Local food and health officials take the 
major responsibility in such cases for preventing the consumption of 
polluted supplies. FDA inspectors assist in surveillance of damaged 
stocks and salvage operations when necessary. 


198 Department of Health, Education, and Welfare, 1958 


Potential Health Hazards 


Deleterious ingredients—Imports of tuna were checked through- 
out the year by FDA for evidence of radiological contamination fol- 
lowing atomic tests in the Pacific. No radioactive lots were encoun- 
tered. Some canners have acquired equipment for maintaining 
constant checks of tuna imported for processing. 

Authentic data on the natural radioactivity of a broad variety of 
foods produced before the first atomic explosions in 1945, secured in 
a survey initiated in 1957, were analyzed statistically. Present-day 
foods are being sampled and analyzed for comparison, with particular 
emphasis on fresh fruits and vegetables and forage crops from every 
production area to detect any trend indicating radioactivity affecting 
the food supply. FDA is also surveying the disposal of radioactive 
wastes to detect any contamination of plants grown on exposed land. 

Insect pests become increasingly difficult to control—hence growers 
may be tempted to use excessive amounts of recommended insecticides, 
apply them too close to harvest, or use insecticides which are not per- 
mitted on food crops. Man-hours spent for investigation, analysis 
of samples, educational activities, and other efforts to insure safe use 
of pesticides increased 28 percent compared with the previous year. 
Thirty-six shipments of raw agricultural products were seized because 
residues exceeded official tolerances. More than 8,000 bushels of fresh 
spinach were seized in 12 actions after FDA found that a grower had 
used several applications of numerous insecticides to control insects 
in his spinach and had shipped the crop with excessive DDT residues. 


Another seizure involved frozen spinach which contained DDT residue i 


in excess of that permitted on fresh spinach. 

Investigating mysterious deaths of dairy cattle in upper New York, 
FDA inspectors learned that the herds had been fed silage made from 
cornstalks that had been heavily sprayed with DDT and malathion. 
Tests showed that both uncut stalks and the silage contained large 
residues of DDT, and milk from the herds fed the silage also con- 
tained DDT. Sixteen tons of silage remaining from the only lot 
shipped were seized and State officials were notified. 

Twenty seizures involved nearly 2 million pounds of wheat, corn, 
oats, and barley mixed with seed grain that had been treated with 
poisonous mercurial and organic compounds. Another shipment of 
more than 14 million pounds of wheat contained hydrogen cyanide in 
excess of the established tolerance on wheat. 

Two seizures were made of poultry containing diethylstilbestrol 
pellets in the necks. Directions for artificial “caponizing” of young 
birds call for implanting the pellets near the base of the head so that 
undissolved portions will be discarded at the time of slaughter. 


Hard gum candy and two types of rindless cheese with mineral oil — 


coatings used to facilitate processing and packaging were seized on 


Food and Drug Administration 199 


the charge that mineral oil is an added deleterious substance not re- 
quired in good manufacturing practice. Alfalfa meal containing 
mineral oil was also seized. 

Other seizures of foods contaminated by deleterious ingredients 
included chocolate-flavored sirup containing coumarin, and_ shell 
pecans dyed with an uncertified coal-tar color. 

Two lots of food in storage were seized because of improper use of 
pesticides to control rodents and insects—bagged flour contaminated 
by DDT and mung beans on which fluorine had been dusted. 

Food poisoning.—Inadequate sanitary precautions in handling 
prepared foods, or lack of proper refrigeration were apparent in most 
of the 49 outbreaks of food poisoning which FDA investigated, affect- 
ing approximately 4,000 people. Seven botulism outbreaks involving 
20 individuals and 5 fatalities, were traced to inadequately processed 
home-canned foods. 

FDA participated with local and State officials in an extensive in- 
vestigation of the cause of illness of 423 persons following 3 church 
dinners. The food had been prepared by a caterer and hauled 500 
miles under varying conditions of refrigeration. Following the in- 
vestigation the caterer stopped using second-hand frozen-egg cans 
for refrigerated foods. He also corrected other practices and plant 
conditions which were potential sources of contamination. 

Food recalls—Three recalls were made of food products contain- 
ing glass in such amounts and size as to render them potentially harm- 
ful. The largest involved stocks of chili powder distributed so 
widely that a public warning was issued jointly by FDA and the 
manufacturer. Other foods recalled included a cheese product con- 
taining sharp lactose crystals, camphorated oil labeled olive oil, a 
decomposing canned food, and coffee with a kerosene odor and taste, 
but not containing enough kerosene to endanger health. 


To Keep Food Clean 


Major food sanitation programs of the year included improvement 
in the cleanliness of wheat, sanitation of grain elevators and ware- 
houses, continuation of milk and bakery improvement, and prevention 
of bacterial contamination of frozen foods. Continued surveillance 
over other products is reflected in table I. 

Increased staff has permitted more investigation into possible ave- 
nues of contamination and adulteration at various stages of food 
production. This has served to focus industry attention on problems 
developing at early stages of production or storage, with particular 
attention to the elimination of unfit materials for processing. 

Inspection time at food warehouses was doubled to remove unfit 
merchandise from food channels and bring: about basic corrections of 


200 Department of Health, Education, and Welfare, 1958 — 


insanitary conditions. Seizures increased to 178 from 109 the pre- 
vious year, and 24 criminal actions were filed in comparison with 9 in 
1957. Conditions that required correction included inadequate pro- 
tection against insects, rodents, and birds; acceptance of returned 
insect-infested foods; storage directly on floors or against walls; and 
storage of fit new shipments in contaminated areas. 

Fifty-seven carloads of bulk wheat were seized. One of the seized 
lots contained insect-damaged kernels, the remainder had rodent 
pellets in excess of actionable levels. 


Table 1.—Actions on foods during the fiscal year 1958 


Criminal 
Projects Seizures prosecu- | Injunction 
tions in- petitions 
stituted 
ROCA. Saks SB 1 Pes Yi ee ee Re a cee eee ee 824 91 17 
Beverages and beverage materials...5 2 2u2 2-5 eee a eee 228 17 2 Vaan ee 
Bakery, ready to eat cereal, and macaroni products____.__--__--__-- 18 11 1 
Cereals and grain products: 
SPLIT AMUSO ew ie ee ec a ai ee Ne 137 8 9 
EA MTNA WSS LER eas _ See eee ae a a See | kee ae Bie Ree See 12 6 ie eee 
Chocolates, sugars, and! related products: _= = == ee 15 6.2 oe ee 
Dairy products: 
BubteranGgchurnime Creaie se. 5.2 ee ee ee 37 GU eee 
Cheese/and-ofheridairy products 226s ae ee ae 11 4, hh ae es 
HerSian daeso PLOGUCtS= one 2. oe eine, a Gs = Suse e eee Oe eee oe 23 Cites ete ree. 
Flavors, ispices; andscondiments #2 ac. Fa. tae ew ERE ee ee 34 2 a 
PUGS AMOS PUG PV OGUTC See ake eee ee ie ce ee 44 fa a ae 
Miéat productsiand poultnyieesce= = = eke e se eee eee 21 2 1 
INUGS Aid MG PrOdUClS ss = wee. Te me ee ee oe (4 \lo a3) oe 
Oils fats, and oleomargarine #7 eek: et es ee ee a Eee 17 3 StU So ae 
DOBLOOG Be< een. beet ae a La cere ee ee ee pre 59 2 1 
Vegetables and vegetable products: 222.222 2 eee 88 4 a 
Miscellaneous foods. (mixed lots)... sa ee ok Pe ee ee 2 Diet 2a 
Wearehoused' foods izt. 32 Ce this) 581 staat Sh Se Pe hee es 178 24 1 
Koodsfor specialidietary Uses Ve. = 2 ie Ayes 2 ee ee 34 40 eee 
Miolative:serving-of oleomargarine == 22 oie eee en eee a ee eee i) 3 ee 
MOO AC jUNCtS. Sateen 2 ae ee a eee ee eee ts 30 | ee 


1 Includes vitamin products intended as food supplements. 


Increased attention was given to wheat storage, both in country 
and terminal elevators. Continued improvement in sanitation has 
resulted from a combination of educational and regulatory work. 
FDA personnel have given sanitation talks at many large and small 
industry meetings. | 

Inspections of elevators serve both educational and regulatory pur- 
poses. If the owner wants to improve sanitation as suggested, and a 
majority do, he has a custom-made guide to follow in the written 
comments the inspector leaves. Owners of some run-down buildings 
have found adequate repairs hopeless and converted them to storing 
nonfood products. 

Seven petitions were filed to enjoin elevators that failed to show — 
sanitary improvements on repeated inspections. At the end of the — 
year 5 were under court orders to refrain from shipping contaminated 
grains in their possession and to clean up their premises before 


Food and Drug Administration 201 


further shipments. The other two promptly corrected the conditions 
on which the petitions were based. 

Surveillance has been maintained over a few firms that apparently 
have cornered the market in incubator reject eggs. These operators 
collect the infertile eggs rejected by hundreds of small hatcheries and 
truck them to large breaking plants, sometimes hundreds of miles 
away. ‘Those not actually rotten, but undergoing decomposition, are 
broken out and frozen for sale to bakeries at bargain prices. Such 
firms operate by bootleg methods that challenge detection. Inspectors 
have had some success, however, through round-the-clock vigilance 
near concentration points until trucks were loaded and then following 
them across State lines where seizures were made. Law enforce- 
ment officers of several States have joined FDA in attempts to break 
up this million-dollar-a-year racket. 

Filth or decomposition was charged in 78 percent of the food seiz- 
ures; 5,466 tons were seized in 639 actions. Of these, 329 involved 
merchandise that became unfit after interstate shipment. An addi- 
tional 2,108 tons of unfit food were voluntarily destroyed or converted 
to nonfood use by their owners as a result of FDA inspections. 

Seventy-two criminal prosecution cases charging shipment of filthy 
or decomposed foods or insanitary operations were instituted. Sixty- 
six prosecutions based on filth and decomposition were terminated in 
the courts, with pleas of guilty or conviction in 65 and a verdict of not 
guilty in 1, a case brought by grand jury indictment. Penalties 
ranged from probation to a fine of $3,500. The 5 jail sentences 
imposed were suspended. 

In addition to the elevator injunctions mentioned earlier, the courts 
were requested to enjoin 9 firms from shipping food that had been 
processed or held under insanitary conditions. These cases involved 
flour, rice, crabmeat, vinegar, poultry, frozen peas, and wholesale 
items for the bakery trade. All were under permanent injunction 
or temporary restraining order at the end of the year. 


Pocketbook Protection 


A Federal judge refused to enjoin an oyster packer from shipping 
raw shucked oysters which the Government charged were adulterated 
with water. He pointed out that the proof adduced in the trial was 
in conflict with the findings of fact of the oyster standard, and was 
otherwise inadequate because of the uncertain state of scientific knowl- 
edge about oysters. The Government withdrew two other cases based 
on similar evidence but maintained one case based on more direct 
facts which can rarely be obtained. 

To acquire scientific facts on which enforcement evidence can be 
adequately founded for general application, plans have been made 

4872705914 


202 _ Department of Health, Education, and Welfare, 1958 


for joint research by the oyster industry, the Fish and Wildlife Serv- 
ice and FDA. If results of this research so indicate, revision of the 
standard will be considered. 

To obtain compliance with the bread standards and to prevent 
exaggerated claims for breads, a restraining order was obtained to 
prevent the distribution of articles labeled “Buttermilk Bread” and 
“Enriched Buttermilk Bread,” names not permitted for standardized 
bread. Increasing adoption of fanciful names for bread differing 
only superficially from standardized breads is misleading to the pub- 
lic. FDA advised bakers across the nation about the action and many 
voluntarily changed their labels to eliminate misleading names. 

A 9-month jail sentence was imposed for “butterlegging.” Inspec- 
tors found on the defendant’s premises a butter printing machine still 
containing margarine, butter wrappers, and margarine labeled 
“butter.” Fines were assessed against firms or individuals for 
shipping sorghum sirup adulterated with other sugar sirup, cocoa 
adulterated with cottonseed flour, short-weight potato chips, sub- 
standard enriched flour, cottonseed oil labeled “olive oil,” low-fat 
butter, and four low-protein animal feeds. Another fine was assessed 
for serving colored margarine without due notification. 

Among the articles seized because valuable ingredients had been 
extracted or replaced by spurious ingredients were spent paprika 
masquerading under misleading names, paprika containing powdered 
beets, peanut butter containing soy and cottonseed oils, sorghum 
with corn sirup and cane sugar, olive oil blends with cheaper oils 
in place of olive oil, and frozen shrimp with ice. 

Of 10 seizures for short weight, 4 involved coffee and 2 olive oil. 
Products seized for failure to meet official standards included low-fat 
butter and cheese, shrimp, oysters, enriched flour, and a number of 
canned fruits and vegetables. 


PRODUCTS OF SPECIAL DIETARY SIGNIFICANCE 


FDA has diverse responsibilities in the area of special dietary 
products. Ranking first is enforcement of regulations to guard the 
composition and informative labeling of products used in special 
diets for the ill, the pregnant, the obese, the aged, the infant, etc., 
and to supplement selected staple foods with additional nutrients. 
Products are tested for declared vitamin potency. 

The other broad area is combating false and misleading claims 
about the nutritive or therapeutic value of vitamins, minerals, or 
“health foods,” by either written or oral promotion schemes. House- 
to-house canvassers are particularly prone to promise that such prod- 
acts will prevent or cure disease, since claims are made under condi- 
tions often difficult to monitor. Three such salesmen were fined for 
unwarranted claims last year. 


Food and Drug Administration 203 
a eae a ch a i lid 

Of the 60 vitamin or special dietary items seized, 18 were promoted 
by false and misleading medical claims, some for serious conditions 
such as heart trouble, epilepsy, diabetes, muscular dystrophy, tu- 
berculosis, cirrhosis of the liver, Asian flu, and exposure to radio- 
activity. The longest list of claims of the year was used to promote 
a soy-germ and wheat-germ oil mixture. The labeling recommended 
it for 125 conditions, ranging from gangrenous ulcers and diabetes 
to quarrelsomeness, waddling gait, and middle-age spread. 

Forty-three were seized because they contained less vitamin po- 
tency than labeled or failed to meet U.S. P. standards for injectables. 
Several large warehouses instituted systems calling for smaller inven- 
tories and the rotation of stocks after over-age products were seized or 
voluntarily destroyed. Four articles seized failed to bear the re- 
quired information as to the sodium content or mineral supplementa- 
tion claimed. 


DRUGS AND DEVICES 


Recalls —Twenty defective or misbranded drugs were recalled by 
manufacturers during the year. Six antibiotics, 5 other drugs for 
human use, and 1 veterinary drug were below labeled potency, and 
an injectable vitamin B,, contained double the amount declared on 
the label. Two were recalled to change the dosage directions, one 
because of a label mixup and the other because general use of a new 
drug disclosed side effects not apparent in earlier clinical reports. 

Two recalled drugs contained fever-producing impurities. In an 
intravenous injection the emulsion had broken down. A hormone 
preparation had directions for intravenous instead of intramuscular 
injection. One product failed to bear the prescription legend which 
was a condition of its approval as a new drug. | 


Illegal Sales 


Of 112 drug prosecution cases filed, 99 were based on violative sales 
of prescription drugs for self-medication and for nonmedical use. 
As in previous years, FDA investigations were made following reports 
of injuries caused by misuse of the drugs. 

Investigations continued into illegal sales of amphetamine tablets 
at truck stops and how these drugs are being diverted from legitimate 
channels. Twelve truck-stop cases were included in the 102 illegal 
drug sale prosecutions terminated during the year. In addition, two 
cases were terminated and two others filed against medical practi- 
tioners charged with sales of large quantities of amphetamine tablets 
to FDA inspectors. In one case, an inspector made 4 purchases from 
a physician within a month, totaling 55,000 tablets. Convicted by a 
jury, the physician is appealing his 3-year prison sentence. In an- 
other case the court directed the jury to find the physician defendant 


204 Department of Health, Education, and Welfare, 1958 j 
ae 


not guilty, although the defendant said in court that he thought the 
inspectors (who had made 3 purchases from him on the same day) 
were truck drivers. Four truck-stop peddlers and 11 druggists or 
their employees received jail sentences for illegal sales. Others re- 
ceived suspended jail sentences or were fined and placed on probation. 


Adulterated and Misbranded Drugs and Devices 


In July 1957 the head of the Hoxsey Cancer Clinic of Dallas, Tex., 
sought a court order to have the Secretary of Health, Raueatiem md 
Wiektave and the Commissioner of Food and Drugs Gon chouswuis of 
“Public Beware” posters sent to post offices throughout the country 
warning consumers against his worthless treatment. In a second 


action he sought to enjoin these officials from administering the pub- — 


licity sections of the law, claiming them to be unconstitutional. Both 
cases were dismissed in October, with a decision strongly supporting 
the Department’s right to use publicity to warn the public against 
harmful practices even without the specific authorization given in the 
Food, Drug, and Cosmetic Act. In December he was enjoined by the 
State and leased the “clinic” to another man. 

A third petition to enjoin the Secretary and the Commissioner was 
brought by the Hoxsey Cancer Clinic of Portage, Pa., to stop FDA 
investigators from interviewing patients who had visited that estab- 
lishment. This was withdrawn in October, after the “clinic” stipulated 
to a permanent injunction, agreed to stop its pending appeal of the 
seizure sustained by a jury at Pittsburgh in November 1956, and to 
pay nearly $14,000 of costs in the seizure trial. 

A 1-hour television program exposing cancer quackery was pre- 
sented on a nationwide broadcast in March, entitled “The Meanest 
Crime in the World.” It was sponsored by an industrial firm which 
is noted for public service TV programs. Numerous groups are 
ereatly assisting FDA in its educational program against cancer 
quackery. United efforts are required to combat the misinformation 
being spread by publications, speeches, and other propaganda promot- 
ing various cancer “cures.” Some promotional schemes hide behind 
religious names and call for crusades of prayer—and cash donations— 
to help fight the “medical trust” they claim is dominating FDA. 
Others pose as philanthropic or scientific “foundations.” 

Of the 153 drug seizures, 65 were based on false and misleading | 
claims and a number of others on failure of the label to give directions 
for the uses promoted by salesmen or collateral literature. Prompt 
action was taken in the fall and winter against a number of simple gar- 
gles and dietary preparations promoted for the prevention of Asian 
flu. Arthritis, circulatory disorders, and other chronic disorders of 
the aging are usually included among the claims of a large proportion 


Food and Drug Administration 205 


of the drugs seized. Diabetes, tumors, and various respiratory con- 
ditions are also frequently named in labeling. 

Seven of the drugs seized were purported to be royal jelly prepara- 
tions containing the material fed to queen bees. This, according to 
labeling claims, would provide added vim and vigor and rejuvenate 
the body. Some were further misbranded by direct claims for the 
cure of specific diseases, and for providing longer life and overcoming 
grave illness in persons of advanced age. 

During the year Congress looked into the labeling and advertising of 
weight-reducing drugs and tranquilizers and members of FDA tes- 
tified as to enforcement problems related to labeling claims. 

Two drug injunctions were filed, one against shipments of herb tea 
and an ointment misbranded with false claims and inadequate direc- 
tions for use. The second was based primarily on inadequate manu- 


_ facturing controls that resulted in potent drugs deficient or excessive 


in active ingredients, and otherwise unreliable. The firm had been 
fined in 1957 but continued to ship undependable drugs. The injunc- 
tion, granted just after the close of the fiscal year, sets forth in detail 
the facilities, including qualified personnel, that the firm must acquire 
and the procedures it must follow before it resumes interstate trade. 

During recent years there has been a trend to drugs compounded 
so that after they are taken active ingredients are released over rela- 
tively long periods with continued effectiveness. Since these dosage 
forms ordinarily contain potent drugs, including stimulants and de- 
pressants, it is important that they disintegrate at the claimed rates to © 
avoid overdosage and provide the desired effects. A number were 
seized in 1958 for inaccurate timing. FDA made available to quality 
control chemists in the industry a method its drug chemists have 
developed to test these timed-release drugs. Many visited FDA 
laboratories to observe the method in operation. 

Two device injuctions were filed, both against previous offenders. 
One had been convicted in 1947 of misbranding a colored light pro- 
jector for the treatment of all diseases. His “institute” promoted 
the machines through an elaborate system of “planets” whose members 
held meetings designed to sell the machines. When he was convicted, 
fined $20,000, and placed on probation for 5 years, the institute was 
ordered dissolved and the literature (several tons) destroyed. When 
the 5 years ended he founded a new institute with a slightly changed 
name, built more machines, and resumed active leadership of local 
branches, renamed “studios.” New literature bore substantially the 
same former unwarranted claims. FDA requested an injunction and 
from December on the operator was under temporary restraining 
order; a permanent injunction was granted in July 1958. 


206 Department of Health, Education, and Welfare, 1958 


The second man had been enjoined in 1952 from shipping a worthless 
cancer diagnosis kit. In December he and two associated firms were 
enjoined from trafficking in a sound-wave device misbranded with 
claims for the treatment of inflammatory or circulatory conditions. 

A 1954 temporary restraining order prohibiting shipment of a blood 
specimen for diagnosis and a number of different “electronic” devices 
for the treatment of almost any disease was made permanent in May. 

Extensive promotion of vibrating devices for home use developed 
during the year and 11 lots of pillows, boxes, chairs, and mattresses 
were seized for false and misleading claims ranging from weight re- 
duction and the relief of nervous tension and muscle strain to treat- 
ment of serious disease conditions. Vibrating devices may be soothing 
or relaxing but they are not disease cures or weight reducers. 


New Drugs 


During the fiscal year 485 new-drug applications, including 91 
for veterinary use, were received; 348 applications including 68 for 
veterinary use were made effective, permitting the products to be 
marketed. In addition, 1,494 supplemental applications, including 
444 for veterinary drugs, became fully or conditionally effective. No 
effective applications were suspended nor were any orders issued 
refusing to permit an application to become effective. 

Among the drugs covered by the applications processed were: Four 
seat ities for human therapy and two for use in veterinary medi- 
‘cine; an enzyme for the prevention and treatment of reactions to 
penicillin; seven drugs recommended for psychotherapy; a diuretic 
useful in the treatment of congestive heart failure and hypertension ; 
a broncho-dilator for the treatment of asthma; two local anesthetics 
for dental use and one general anesthetic; the first intravenous fat 
emulsion designed for the nutrition of seriously ill patients; steroid 
compounds for the treatment of rheumatoid arthritis and other col- 
lagen diseases, and for gynecologic conditions; two products for 
relaxing skeletal muscle in spastic states and three for relaxing 
smooth muscle of internal organs and useful in the treatment of such 
conditions as peptic ulcer; two drugs for the suppression of cough; 
two for the relief of pain and one for itching; one product for the 
treatment of bacillary dysentary, and one for amebic dysentary; and 
an antihistamine, an anthelmintic, two cathartics, an antiseptic. and 
three drugs for fungus infections. 


COSMETICS AND COLORS 


Two cosmetics were seized, one under the drug provisions of the 
act, because it was falsely labeled as a tranquilizer. A public warn- 
ing and recall were required for a nail treatment that seriously 


Food and Drug Administration 207 


damaged the fingernails after the plastic film was worn according to 
directions on the label. 

Two seizures were made of food colors containing uncertified coal- 
tar dyes. A firm was fined and enjoined with its partners from 
further shipments of coal-tar colors made from uncertified mixtures 
and uncertified bronze powder sold for cake decorations. 


CERTIFICATION SERVICES 


Coal-tar colors——All coal-tar colors used in foods, drugs, and 
cosmetics (except hair dyes) must be from batches certified as harm- 
less by FDA. In 1958, 4,994 batches representing 5,976,392 pounds, 
were certified and 21 batches, representing 23,976 pounds, rejected. 

Insulin—All\ batches of insulin must be tested and certified before 
distribution. Examination of 371 samples resulted in the certification 
of 283 batches of 7 insulin drugs and 81 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. Exami- 
nations were made of 16,264 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 
certification. Twenty-one batches were rejected for failing to meet 
the following standards: Potency (15), sterility (3), purity (2), and 
moisture (1). In addition, manufacturers withdrew their requests 
for certification of 12 batches because they were substandard. 


Enforcement of Other Acts 


A total of 103,266,609 pounds of tea was examined under the Tea 
Importation Act. Rejections for failure to measure up to the stand- 
ards set by the United States Board of Tea Experts totaled 92,184 


pounds, or 0.089 percent. Three rejections were appealed to the 


United States Board of Tea Appeals which upheld the decision of 
the FDA examiner in two cases and sustained the appeal in one. 

Four shipments of a bowl cleaner were seized for failure to bear 
the word “poison” as required by the Caustic Poison Act. A fifth 
seizure involved a photo chemical containing more than 10 percent 
sodium hydroxide which was not labeled “poison” and did not give 
adequate directions for treatment in case of accidental personal injury. 

No permits were issued for importations of milk from Canada, 
nor were any actions instituted under the Filled Milk Act. 


208 Department of Health, Education, and Welfare, 1958 q 


New Court Interpretations 


Only two petitions for certiorari were filed with the Supreme ~ 
Court during the fiscal year. The Court denied a petition filed by — 
a physician to review his conviction for selling amphetamine drugs — 
without a prescription. This establishes the criminal liability of a 
licensed physician for selling dangerous drugs outside the recognized 
scope of medical practice. | 

The Supreme Court accepted the Government’s petition to review 
the decision of the United States Court of Appeals for the Fifth 
Circuit in which it set aside the Secretary’s Order delisting FD&C 
Red No. 32 as a permitted food color and held that FDA has au- 
thority to establish tolerances for colors. This case is pending. 

The Court of Appeals for the Seventh Circuit reversed the district 
court’s decision awarding pre-seizure costs in a libel action and held 
that such costs are not assessable against the Government particularly 
where there is a reasonable basis for the seizure. 

Two decisions by the Court of Appeals for the Eighth Circuit in- 
volved a seizure of mineral water that has been pending since 1953. 
In the first decision the court reversed the jury verdict and held that 
the water was misbranded because it failed to comply with the dietary 
food regulations. The district court entered a decree contrary to 
that decision and at the Government’s request the circuit court set 
aside the decree of the lower court. 

The Court of Appeals for the District of Columbia ruled that the 
Government could not refuse to permit relabeling of a condemned 
drug preparation with the name “Buticaps,” where the falsity of the 
name had not been adjudicated, since the claimant was entitled to a 
judicial hearing on the meaning of the word. 

A district court judge in the District of Columbia denied a peti- 
tion for an injunction to prevent the distribution of a poster warning 
against a worthless cancer cure, as discussed under drugs. 

A district judge ruled that the amendment covering the sale of 
oleomargarine applies only to retail packages. 

A district court denied a petition for an injunction to restrain the 
Government from making multiple seizures of a new drug. 

A district court ruled that a corporation cannot claim privilege 
against self-incrimination for refusing to answer interrogatories since 
the corporation can appoint an officer or agent to answer the inter- 
rogatories. ‘The claimant said he will appeal this decision. 


Changes in the Law and Regulations 


One of the most significant advances in public health protection 
under the Food, Drug, and Cosmetic Act in the last two decades was 


Food and Drug Administration 209 


the passage of the food additives amendment (Public Law 85-929) 
the last day of the 85th Congress. 

Hearings before a Select Committee of the House, beginning in 
1950, produced evidence that the 1938 act was inadequate to cope 
with changes in food production since the end of World War II. 

The amendment provides that the manufacturer or promoter of a 
new additive submit the results of tests to establish its safety to FDA. 
The Secretary will issue regulations for those found safe under 
proper conditions of use, specifying the amount that may be used 
in certain foods, and other conditions necessary to protect public 
health. If the additive is not established as safe in the opinion of 
FDA, its use will not be permitted. No additive may be used that 
would promote consumer deception or serve to adulterate or misbrand 
the product. The Secretary shall not fix the amount of the additive 
which may be used at a higher level than required to produce techni- 
cal effects intended, or permit its use if it will not accomplish this 
purpose. 

Public administrative hearings will be held when requested by any 
person adversely affected by an order of the Secretary. Any order 
issued after such a hearing will be subject to review by a Circuit 
Court of Appeals. 

Petitions may be submitted any time after enactment of the law 
on September 6. The requirements go into effect on March 5, 1959. 
Industry will have 18 months to obtain clearance by the regulation 
procedures for substances already in use before January 1, 1958, and 
not generally recognized by experts as safe. 

This new law provides two major benefits for consumers. First, it 
safeguards against the use of inadequately tested additives. While 
most sponsors of new food additives made the necessary tests first and 
checked with FDA before adopting new substances, some did not—and 
the law did not require it. The product could be marketed without 
safety tests or before long-term tests were completed ; the Government 
could not remove foods containing such additives from the market 
until it could prove in court that the additive was unsafe. 

The second benefit to consumers is that the new law makes way for 
advances in food technology. The additives used are to improve the 
food and bring it to the housewife in better condition and a more con- 
venient form. The amendment removes unnecessary restrictions on 
many useful chemicals that are perfectly safe if properly used. 


REGULATIONS 


Drugs.—The following drugs were exempted from prescription-dis- 
pensing requirements and permitted to be sold with labeling for lay 
use: Preparations containing pramoxine hydrochloride, a local anes- 


210 Department of Health, Education, and Welfare, 1958 


thetic for external application to the skin; preparations containing ~ 
carbetapentane citrate, an anti-tussive; preparations of pamabrom 
with an analgesic for use in the temporary relief of minor pains and — 
discomforts of the premenstrual and menstrual periods; and prepara- 
tions of diphemanil methylsulfate for external application to relieve — 
minor skin irritations. 
The list of habit-forming derivatives of substances named in sec- — 
tion 502 (d) of the act was revised to designate the drugs by official or — 
common names in addition to proprietary names. 
Four hundred and fifteen amendments and 31 new monographs ~ 
were added to the antibiotics regulations. 4 
Semi-lente insulin and ultra-lente insulin were added to the list 
of certified insulin drugs, bringing the total to 7. 
Food Standards.—A proposed order setting forth detailed findings — 
of fact and identity standards for ice cream, french ice cream, fruit — 
sherbets, and water ices was published in March 1958. This proposed — 
order was based on 22,000 pages of testimony given in two hearings — 
held before passage of the Hale Amendment. The order provides — 
safeguards against methods that might be used to cheapen ice cream — 
and ingredients not adequately tested for safety. 
All other food standard proposals during the year were governed ~ 
by the Hale Amendment procedure, which requires hearings only — 
on controversial issues of proposed food standards. A standard for — 
prickly pear jelly was promulgated based on a manufacturer’s pro- — 
posal on which no adverse comments were filed. The prune juice — 
standard was amended to permit the addition of from 2 to 3 per- — 
cent of honey to prune juice with appropriate label declaration. — 
This order was based on the record of a hearing held the previous ~ 
year on the objection filed to the standard of identity for prune juice ~ 
because it did not provide for the optional use of honey. q 
A standard was established for enriched rice requiring thiamine, — 


niacin, riboflavin, and iron, the same enriching ingredients required 


in the standards for other enriched cereal products. A stay was re- 
quired as to riboflavin because objections were filed, and a hearing — 
will be held to determine this issue. All of the other parts of the — 
standard became effective in March. 

Two hearings on food standard orders were held on which final — 
orders have not issued. One involved proposals to establish identity — 
standards for mozzarella and part-skim mozzarella cheeses. The 
other resulted from objections raised to two of the labeling provisions © 
in the canned tuna standard; other provisions are in effect. 

Pesticides —During the year 403 permanent tolerances or exemp-_ 
tions were established involving 26 pesticide chemicals for raw agri-— 
cultural commodities, and 86 temporary tolerances were established 


Food and Drug Administration 211 
ie ee 


involving 9 pesticide chemicals. Since the enactment of the Pesticide 
Chemicals Amendment, a total of 1,940 tolerances or exemptions have 
been established for 98 pesticide chemicals. 

Because of the special place of milk in the diet of infants, children, 
the sick, and the aged, FDA requested the National Academy of 
Sciences to select an advisory committee to consider a request for a 
tolerance for methoxychlor in milk. The committee found that the 
data on safety were inadequate to justify the establishment of a tol- 
erance which would permit residues of methoxychlor in milk, and 
a zero tolerance was announced. 

In 1955 a tolerance of 1 part per million was established for 
Aramite, a miticide, following recommendations of an advisory com- 


_ mittee which reviewed the petition for such tolerances. On the basis 


| 
_ are being formulated to improve the products and their specifications. 


of new evidence which showed that long-term feeding of Aramite 
caused cancer in two species of test animals, a proposal was published 
to revoke the 1 ppm tolerance and establish only zero tolerances for 


_Aramite. The company which originally petitioned for this tol- 


erance has requested that the proposal be referred to another advisory 
committee to be selected by the National Academy of Sciences. 


Scientific Investigations 


The seven Divisions comprising the Bureau of Biological and 


Physical Sciences are engaged in a broad range of scientific studies 
_ to develop or improve methods of analysis, to evaluate safety of pesti- 
cide residues and food additives, to develop effective specifications 
_ for certifiable antibiotic preparations, insulin, and coal-tar colors, to 
_ provide a sound scientific basis for administrative policies, and to 
improve certification enforcement and procedures. 


“Performance methods” were developed for the control of anti- 


biotic diagnostic disks, containing various concentrations of 16 antibi- 
_otics. Since these disks are used by physicians to determine which 
antibiotic or combination of antibiotics will be effective for use in 
_ treatment, it is important that they be dependable and accurate. A 


survey indicated need for improvement in their manufacture and 
control. A meeting of industry representatives was held and steps 


Studies on antibiotics included work on a number of products to 


determine the validity of manufacturers’ claims; over 14,000 blood 
_ specimens were assayed for antibiotic activity. In collaboration with 
the Department of Agriculture a fluorescent dye marker was incor- 


porated in 10 lots of antibiotic mastitis preparations. The effect of 
the dye on antibiotic stability was studied as well as its utility in 


showing the presence of residual amounts of antibiotics in the milk 


of treated cows. 


212 Department of Health, Education, and Welfare, 1958 7 


Infrared spectrophotometric methods of analysis were devised for — 
several important drugs including cortisone, hydrocortisone, reser- — 
pine, atropine sulfate, nitroglycerine, and other organic nitrates. — 
Paper chromatographic methods were developed for detecting im- — 
purities in cortisone, hydrocortisone, and other drugs. 


A comprehensive survey of frozen precooked foods was started to — | 


study the application of bacteriologic methods in controlling sanita- 
tion in their manufacture, in coordination with investigations con- 
ducted by industry and State control officials. 

Research was continued in the study of methods for detection and 
identification of Salmonella and for Staphylococcus and its toxin, 
organisms frequently associated with food-poisoning episodes. 

Progress was made in studies of insect-fragment identification, to 


enable identification by microscopic analytical methods of contami- .7 


nants in foods related to insanitation in production. 
The development of methods of analysis for detecting and measur- 


ing pesticide chemical residues on raw agricultural products continues 


to be important. Most pesticide chemicals now in use fall largely into 
two general groups: Chlorinated hydrocarbons, the organic phosphate 
compounds, or mixtures. Because of their high toxicity, the toler- 


ances for some of these compounds are quite low and very sensitive 


methods of analysis are required to insure compliance. In addition 
to methods based upon classic principles of analytical chemistry, 
others developed are based on biochemical phenomena, such as the use 
of enzymes, and biologic assays with the common housefly as the 
experimental animal. 

To study the efficiency of the analytical procedures for residues 
from food crops, a study was carried out with a pesticide chemical 
tagged with radioactive Carbon 14. The procedures were found 
adequate in detecting and measuring the residues. 

The safety of a proposed tolerance for pesticide chemicals on for- 
age crops involves not only the safety of the chemical to the animals 
but also the possibility of residues in the food products of the con- ~ 
suming animals—such as meat, milk, and eggs. In cooperation with — 
the Department of Agriculture dairy animals were fed forage contain- — 
ing small amounts of heptachlor, one of the chlorinated hydrocarbon 
pesticides, to determine whether this chemical or its breakdown ~ 
products appear in the milk. The data are still under study. | 

Work was successfully completed in the development of a physico- ~ 
chemical method for assay of vitamin D, which will replace the ex- — 
pensive and time-consuming biologic method for many purposes. 

The protective actions of 13 tranquilizers against alkaloidal con- — 
vulsions in mice were investigated to develop methods and procedures 
for evaluating and classifying claims for efficacy as a tranquilizer. 


Food and Drug Administration 213 


Preliminary studies were completed on procedures for testing pos- 
sible carcinogenic activity of food additives. 
A 2-year feeding study with rats on the effect of atomic-blast-ir- 
radiated foods was completed during the year. Thirty-six animals 
received the exposed food and a like number were used as the con- 
trols. Detailed microscopic examination of the rat tissues showed no 
effect, either deleterious or beneficial, from irradiation of the food. 
In the latter part of 1957 reports were received that a mysterious 
disease was causing large losses of birds in the broiler industry. In- 
vestigations have revealed that the disease was caused by a toxic ma- 
terial in a fat byproduct used in several brands of commercial feed. 
High-energy feeds utilizing added fats have become popular and are 
widely used in the poultry industry to induce more rapid growth. 
Residues from production of fatty acids had been used by several 
feed producers as part of the fatty material incorporated in poultry 
feed, and investigation revealed that this was the source of the toxic 
substance. Intensive studies have been undertaken to identify this 
substance and develop methods of assay. This work is not yet com- 
plete but success has been achieved in preparing a concentrate of the 
toxic substance. The disease has been produced in poultry experimen- 
tally with as little as 8 milligrams of this concentrate in 100 grams 
of ration. 

Some progress was made during the year in equipment replacement 
_ and modernization. 
The Bureau of Medicine conducted clinical studies of the absorption 
of tetracycline when combined with various other drugs. Sodium 
_metaphosphate, citric acid, and glucosamine were found to enhance 
| absorption and produce higher blood concentrations, while calcium 
carbonate and other binders and excipients interfere with absorption. 
The properties of kanamycin, a new antibiotic, and repository penicil- 
lin were also tested clinically. The results indicated proper dosage 
| schedules. 
| Other clinical studies were made to evaluate the claims of drugs and 
| devices. Veterinarians collaborated in the studies on antibiotics in 
/milk and the toxic poultry feed reported earlier in this chapter. 
| The pilot study on the reporting of adverse reactions to drugs is 
continuing, with 11 hospitals participating. 


| Enforcement Statistics 


The 26,063 establishment inspections conducted by FDA were 
divided into 21,683 for foods, 3,701 for drugs and devices, 444 for 
cosmetics and colors, and 235 for miscellaneous products including 
caustic poisons. Of 25,269 domestic samples collected, 15,745 repre- 


214 Department of Health, Education, and Welfare, 1958 © 


sented foods, 9,011 drugs and devices, 353 cosmetics and colors, and — 
160 miscellaneous. | 
In the 200 criminal actions terminated (or terminated for some de-— 
fendants) in the Federal courts during 1958, fines assessed totaled ~ 
$188,282. Jail sentences ranging from 1 month to 3 years were im- ~ 
posed in 35 cases involving 38 defendants. Eighteen individuals were — 
required to serve imposed sentences, averaging 9 months; they were — 
suspended for 20, on condition that violative practices be discon-— 
tinued. Records of actions terminated in the courts were published 
in 490 notices of judgment. 


Table 2.—Number of samples on which criminal prosecutions and seizures were — 
based and number of court actions instituted during the fiscal year 1958 


Total Criminal prosecu- Seizures 
tions instituted accomplished Injunce- 
Item a eee 
quested 
Violative} Actions | Violative| Actions | Violative| Actions 
samples ! samples samples 
Total Saeet pets es eee 2, 603 1, 252 891 203 1, 712 1, 027 Do: 
HOOGS. et Ser es Re ee eee ee te 1, 591 932 296 91 1, 295 824 17 
Drugs and devices-_--.---------- 999 310 595 112 404 194 4 
Cosmetics and colors_---------- 6 Bi] Se Eo Gee ee oe ee 6 4 1 
Caustic poisons = 2223272 si 2-2 7 HAS Sesele oer ee if 6") 2 


1 The number of samples on which the actions are based always exceeds the number of actions; in seizures — 
a variety of articles may be contained in a single shipment, while in criminal actions each sample usually 
represents a single shipment which forms one count of the action. 


Table 3.—Import samples collected, examinations made, and lots detained i 
during the fiscal year 1958 


Item Samples Examina- Lots 
collected | tions made detained 
oS D0 2) BL Se ae 2 a aba RA Oe 8, re ape 8 an) veel ewok nih a SNE Meh oe As 9, 200 14, 614 4, 980 % 
Woosh) Arete ais At Oe ees ie ee eee Sh ee ee 6, 876 13, 704 2, 687 
Drugs‘and devicess 82045 eo ees oe ge 2, 192 799 2,117.9 


Cosmetics, colors, and miscellaneous----..---------------------- 132 111 176 


Office of 


Vocational Rehabilitation 


Services to the Disabled Expand Through Enlarged 
Research Program and Attack on Severe Disability 


Tue number of handicapped persons prepared for employment and 
_ placed in jobs through the public program of vocational rehabilitation 
in 1958 * set a new record for the third consecutive year. 


The total of 74,317 rehabilitated was 4.8 percent greater than in 


| 1957. Despite the economic uncertainty during the spring and sum- 
| mer of 1958, marked by shutdowns and layoffs, 34 of the 53 general 


State rehabilitation agencies showed increases over the previous year, 


| and 18 of the 37 agencies for the blind also reported gains. 


An additional 18,584 disabled persons were prepared for employ- 


‘/ment through the public program, but had not found jobs at the end 
_of the fiscal period. 


The steady progress of the State-Federal program is not measured 


entirely innumbers. It is evident in other ways, and is no more strik- 
|ing anywhere than in the research activities, which, along with 
other revitalizing provisions, were made possible through Public Law 


565 in 1954. 
Research into the problems of disability is the only window through 


which there comes a clear picture of what has happened in rehabilita- 


tion, as well as a view of the nature, directions and requirements of 


'the rehabilitation program in the coming years. 


Since the research and demonstration program was inaugurated 
in 1955, a total of 352 applications have been considered by the Na- 


‘tional Advisory Council on Vocational Rehabilitation. Of these, a 


1 Unless otherwise indicated, all subsequent references to aenP will be to the fiscal year, 


| that is, to the period between July 1, 1957 and June 30, 1958. 


215 


216 Department of Health, Education, and Welfare, 1958 


total of 177 in 38 States, the District of Columbia, and Puerto Rico © 
have been recommended to the Secretary, and grants awarded. | 
Out of 153 such requests received during 1958, approval was given — 
to 81, and grants were awarded in a total amount of $1,972,667. 
The grants included those in the regular research and demonstration — 
program, of which there were 51. Twenty-eight of these were from ~ 


universities, medical schools and research organizations, thus bring- — 


ing closer to realization a basic purpose of the invigorated program— — 


to enlist and foster the talents, energies and resources that are in all — 


parts of the country that can be focused on solution of rehabilitation 
problems that are common to all. 


The remainder of the projects approved during the year were in ~ 
a new category—a series of demonstration projects in many parts ~ 


of the country to apply knowledge gained from research to those ~ 
within selected categories of disability. : 

The Office of Vocational Rehabilitation announced at the beginning ~ 
of the fiscal year that it would give priority to demonstration projects — 


that would provide services to the mentally retarded, cerebral palsied, 


disabled persons with emotional problems, epileptics, the homebound — 
disabled, the blind and visually handicapped, disabled workers over ~ 


50 years of age, and the chronically ill. There were three major pur- _ 


poses: to accelerate services to these groups, to provide widespread { 


application of knowledge and experience acquired through research, 


and to test application of the research findings under varying circum- — | 
stances in different parts of the country. | 
During the first year of these special demonstration projects there 


were established a total of 30 in 22 States. Each was designed to ; 
duplicate the research projects in which there had been developed 


successful techniques for the rehabilitation of severely handicapped i 


persons in the same category. All of the selected categories were 7 
represented, and the Office will continue the program along these lines — 


until there is more complete representation in categorical and geo- 
graphical distribution. | 

Another gratifying phase of the regenerated program of vocational < 
rehabilitation in 1958 was the expansion of community resources _ 


toward the creation of rehabilitation facilities. Many communities, 


recognizing that the comprehensive rehabilitation center is the most — 
practical and complete means of constructive aid for their handi- 
capped people, were showing increased interest in centers that pro-— 
vide in addition to medical and physical restoration services, such 
vocational services as prevocational evaluation, vocational counseling, — 
sheltered employment, and vocational training. . 

In the 3-year period ending with fiscal year 1958, a total of 82 re-— 
habilitation facility projects were approved for construction under 


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218 Department of Health, Education, and Welfare, 1958 — 


the Medical Facilities Survey and Construction Act—20 of them in 
1958. Their total cost was more than $60.4 million, of which local 
sponsors contributed about $47 million. In addition, Federal aid was 
extended to a number of rehabilitation centers under Public Law 
565. And, as a measure of the increasing utilization of rehabilitation 
adjustment centers, the number of handicapped persons referred to 
them by State agencies in 1958 increased over three times the number 
referred in 1955, and the amount spent in rehabilitation facilities by 
State vocational rehabilitation agencies for benefit of handicapped 
persons was two and a half times the 1955 total. 


REHABILITATIONS IN 1958 


In the new record of 74,317 handicapped persons restored to useful 
activity and established in employment by the State vocational re- 
habilitation agencies in 1958, the major types of disability continued to 
be orthopedic impairments—amputations or other crippling condi- 
tions. About 38 percent (or 28,551) 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 
(33 percent) was from physicians, health agencies, or hospitals. 
Another 14 percent were referred by public welfare agencies, and 7 
percent by State employment service offices. About 12 percent ap- 
plied for services on their own initiative. 

More than half of the rehabilitants of 1958 had dependents, and 
63 percent were men. The average age at the time of disablement 
was 27, but the average age at the time the rehabilitation process was 
started was 36. 

The occupations in which rehabilitants were placed in 1958 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, 17 percent; 
service workers, 19 percent; family workers and housewives, 18 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 1958. 

About 53,700 of the 74,317 handicapped persons prepared for 
and placed in employment during the fiscal year were unemployed 
when their rehabilitation began. The group that had been working 


Office of Vocational Rehabilitation 219 


at the time they were accepted for service were earning at the rate of 
$23.3 million a year and generally were employed in unsafe, unsuit- 
able, 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 $144.2 million. 

Nearly 15,000 of those who were rehabilitated received public as- 
sistance at some time during the process, at the estimated rate of $13 
million a year. ‘The estimated total cost of the rehabilitation of these 
persons was about $13 million. 

It is estimated further that those who were established or placed in 
employment through the public rehabilitation program will pay dur- 
ing 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. 


Demonstration Projects in Selected Categories 


of Severe Disability Apply Research Findings 


The research and demonstration program, through which Federal 
funds are made available for partial support of a wide variety of proj- 
ects which hold promise of contributing to the solution of vocational 
rehabilitation problems, was characterized in 1958 by sharp increases 
both in the number of applications received and those approved. It 
was also the first year of a program of demonstration projects in 
selected categories of severe disability, in which the knowledge emerg- 
ing from research is given practical application. 

Kighty-one new research or demonstration projects were approved 
during the year, bringing the number of projects activated since the 
beginning of the program in 1955 to a total of 177. The total of grants 
for the first year of support for the 81 projects was $1,972,667. An 
additional $1,626,982 was provided for continuation of 60 previously 
initiated projects, so that the total of Federal grants for research and 
demonstration during 1958 was $3,599,599. 

Applications for research and demonstration projects are accepted 
from universities, State vocational rehabilitation agencies, other public 
agencies and private nonprofit organizations, and are reviewed by the 
National Advisory Council on Vocational Rehabilitation. ‘The Coun- 
cil, appointed by the Secretary, is composed of 12 persons whose con- 
nections with rehabilitation, labor, business, medicine, and related 
fields give them authoritative standing. Miss Mary E. Switzer, 
Director of the Office of Vocational Rehabilitation, is Chairman. 

There was a considerable broadening in the variety and scope of the 
projects submitted and approved during the year, reflecting a height- 
ened interest among the creative research talent in universities, medical 


220 Department of Health, Education, and Welfare, 1958 a 


facilities and research organizations, and the selected demonstration 
program provided a new phase for the program. 


SELECTED DEMONSTRATIONS 


The new program of selected demonstration projects was announced 
at the beginning of the year. Its purposes were to accelerate services 
to the severely disabled and to provide for prompt application of new 
knowledge and experience acquired under the research program. 

There was immediate response. Thirty projects were approved, 
and are in operation in 22 States, permitting the testing of research 
findings under varying circumstances in different parts of the country, 
and a broad attack on several forms of severe disability. 

So that there will be as wide and equitable distribution of projects 
as possible, only one type of project is presently allowed in each State. 
Five States, however, have two or more projects in different categories. 
Of the total amount awarded for new projects in 1958, $712,750 was 
for the first year of the selected demonstration projects. 

The grants are concentrated primarily in seven categories. Eleven 
of the 30 projects are occupational training centers for the mentally 
retarded. Six others are optical aids clinics to enhance opportunities 
for employment for persons with low visual acuity. Four are work 
adjustment centers for disabled persons with emotional problems, 
three are work classification and evaluation centers for the cerebral 
palsied, and three more are providing vocational adjustment and 
other rehabilitation services for disabled persons confined to their 
homes. ‘Two more are occupational adjustment centers for persons 
severely disabled by epilepsy. One other project has as its goal the 
determination of the vocational rehabilitation potential of chronically 
ill persons in hospitals, and provides such services as are necessary to 
return these individuals to productive work. | 

All of these projects are based upon successful prototype research 
projects that have been assisted under the program. The selected 
demonstration program will continue to be expanded. The goal will 
be at least one such project in each State, with effective distribution 
among the various categories in all States and regions. 


RESEARCH AND DEMONSTRATION 


The 51 projects approved during the year under the regular research 
and demonstration program cover a wide range of disabilities. Six 
projects are concerned with the mentally ill, alcoholism, or persons 
with personality problems. Nine are concerned with speech and hear- 
ing, including aphasia, cleft palate, laryngectomized speech, and 
stuttering. 3 

Six more are in the broad area of employment and workmen’s 
compensation, including services to the disabled over 60 years of age, 


Office of Vocational Rehabilitation 221 


and to paraplegics and epileptics. Others deal with blindness, the 
problems of disability in rural areas, and four projects are concerned 
with the problems of amputees, the development of externally pow- 
ered orthopedic devices, and a survey of the field of assistive or 
adaptive appliances for the orthopedically handicapped. Still others 
deal with problems of administration among the States, and with de- 
velopment of methods of concerted community action in meeting 
rehabilitation needs. 

The rapid growth of the program is shown by the fact that in 1955, 
the first year it was operative, 18 projects were initiated in eight 
States and the District of Columbia. Today there are projects in 38 
States, the District of Columbia, and Puerto Rico. 


Training Program Grows With Emphasis on Medicine, 
Speech-Hearing Therapy, Prosthetics, and Counseling 


The program of training grants experienced a marked upswing in 
1958, for available funds increased by about 50 percent from 
$2,950,000 in 1957 to $4,400,000 in 1958. With this increase, it has 
been possible to accelerate the attack on the serious personnel short- 
ages that exist in all professional fields directly concerned with re- 
habilitation of the disabled. 

Teaching grants to colleges, universities, and other institutions 
numbered 177 in 1958, as compared with 112 in 1957, and totaled 
nearly two million dollars. These grants enabled educational in- 
stitutions to expand or strengthen their instructional resources in the 
fields of medicine, nursing, occupational therapy, physical therapy, 
prosthetics education, rehabilitation counseling, social work, speech 
and hearing, and other fields closely related to rehabilitation. 

Traineeship grants to educational institutions made scholarship as- 
sistance available to over 950 full-time students enrolled in basic or 
advanced training programs in the professional fields contributing to 
rehabilitation. 


REHABILITATION MEDICINE 


Because the physician is a key person in the rehabilitation of per- 
sons disabled by chronic illness, injury, or congenital condition, ma- 
jor emphasis has been placed upon strengthening the teaching of 
rehabilitation principles and practices to undergraduate medical stu- 
dents. Nineteen medical schools received teaching grants to expand 
that aspect of their curricula in 1958, so that all graduating phy- 
siclans would have a basic understanding of rehabilitation. Another 
related area of major interest has been the support of physicians dur- 
ing their residency training in physical medicine and rehabilitation. 
Since July 1, 1955, when the Office of Vocational Rehabilitation as- 


222 Department of Health, Education, and Welfare, 1958 q 


sumed responsibility for this program, 189 physicians have received — 
OVR traineeships. At the end of the fiscal year, 109 physicians were — 
still in residency training programs with financial assistance from 
OVR. 

Initiation of grants in the field of speech and hearing therapy was 
a significant accomplishment in 1958. Grants were made to seven 
universities to help them give better preparation to graduate students 
who will work with adults who are handicapped by speech or hearing 
disorders. 


COUNSELING 


Continued progress is being made in the graduate rehabilitation 
counselor training programs established in 30 colleges and univer- 
sities. About 500 students in those programs received OVR trainee- 
ships in 1958. In the absence of a professional association or ac- 
crediting body concerned with the nature and quality of professional 
education in this new field, OVR has encouraged periodic meetings 
of the directors of the rehabilitation counselor training programs. 
The second annual workshop was held in Cleveland, in April, with 
the 3-day program focused principally on problems of supervised 
field work. 

In addition to support of year-round academic training programs 
for professional personnel, OVR has helped to finance nearly 70 
short-term training courses in various aspects of rehabilitation. 
These courses are intended to raise the level of knowledge and skill 
for vocational rehabilitation personnel and those in related agencies, 
so that services may be of higher quality. Over 2,500 persons have 
been reached through these short-term courses. 

The prosthetics education courses have been attended by large num- 
bers of physicians, surgeons, physical and occupational therapists, re- 
habilitation counselors and prosthetists who were seeking training 
in serving the amputee more effectively. Other short courses have 
been concerned with esophageal speech for laryngectomized patients, 
rehabilitation of persons who have suffered cerebrovascular accidents, 
of the mentally retarded and the cerebral palsied, and of discharged 
mental hospital patients. 

The Office’s continuing concern for raising the level of performance 


of the staffs of State vocational rehabilitation agencies has been ex- __ 


pressed in a variety of ways: (1) through a series of in-service train- 
ing grants to State agencies to assist them to organize continuing and 
comprehensive staff development; (2) conducting orientation courses 
for newly employed counselors and advanced courses in counseling 
or other aspects of vocational rehabilitation for experienced coun- 
selors; (8) providing seminars on administration for State executive 
personnel; (4) developing plans for a nationwide program of super- 


Office of Vocational Rehabilitation 223 


visory training for State agency supervisors; and (5) conducting a 
course for State medical consultants on administrative and program 
development. 


Increased State-Local Support Brings a Greater 
Number and Usefulness of Rehabilitation Centers 


Each year more States and communities become interested in es- 
tablishing rehabilitation centers that offer, in addition to medical and 
physical restoration services, other essential services for vocational 
rehabilitation. 

Funds for centers come from various sources, including the 1954 
Medical Facilities Survey and Construction Act (Hill-Burton), the 
Office of Vocational Rehabilitation, State vocational rehabilitation 
agencies, State appropriations, and private or community resources. 

In 1958, 20 projects in 19 States received grants for the construction 
of rehabilitation facilities under the Medical Facilities Survey and 
Construction Act. Federal grants of $2,134,317 for these projects 
were matched by approximately $8,185,835 of sponsor’s funds, making 
a total of $10,320,152 obligated during the year. 

This brought to a total of 82 the projects that have been approved 
for assistance under this Federal legislation. The total cost was 
$60,430,458, of which the Federal share was $13,453,440. 

Of the 20 projects approved during 1958, two are located in medical 
schools or teaching hospitals, four are in general hospitals, three in 
specialized hospitals, four are community type centers, and seven 
are single disability centers. 

Federal aid to rehabilitation centers under provision of Public Law 
565 was granted to specialized facilities providing improved or 
special services to such disability groups as the mentally and emo- 
tionally ill, blind, epileptics, homebound disabled, cerebral palsied, 
and others. Federal funds of about $1,500,000 were available to these 
projects, matched by expenditures of almost half as much in State 
or local funds. 

Many new centers are in operation or under construction. A Good- 
will Industries establishment in Cincinnati has opened a new million- 
dollar vocationally oriented center that is serving a large surrounding 
area. A comprehensive center was dedicated in Mobile, Alabama, in 
the spring of 1958, to serve that State, and nearby areas of Mississipp1 
and Florida. Pennsylvania’s new 8-million dollar center is nearing 
completion. The center operated by the West Virginia agency was 
enlarged during the year to almost double its capacity, and Puerto 
Rico has completed plans for a 100-bed, vocationally oriented center 
as part of a large medical center in San Juan. 


224. | Department of Health, Education, and Welfare, 1958 j 


The growing importance of rehabilitation centers in physical res- q 


toration and vocational preparation of disabled persons is reflected — 


in the number of persons referred to rehabilitation centers by State 
vocational rehabilitation agencies, and the amount of money they 
paid to centers 

In a 4-year period, the expansion was on this order: 


Persons | Statefunds 
receiving | expended 
services 


1056 Soca c panera ee 2, 436 $857, 666 


1956 ec oe ote Re oe eS 5, 088 1, 453, 984 
1957S SESE eee eee 6, 874 2, 141, 784 
1058 2 Se tes ee 8, 326 2, 676, 356 


The provision of services in a rehabilitation center does not always 
result in rehabilitation into employment, though generally this is the 
aim, where service there is purchased by a vocational rehabilitation 
agency. An amputee may go toa center to learn how to walk, properly 
and efficiently, with an artificial limb or how to use an artificial arm. 
In such cases the stay in the center is short and the results immediate. 
An older person stricken by paralysis, accompanied by speech im- 
pairment, may receive intensive treatment that frequently brings 
resumption of normal living habits and productive work. A crippled 
child may find opportunity to prepare for a useful life through early 
provision of services. 

In a study completed in June 1958 by the Conference of Rehabilita- 
tion Centers—composed of executives of most of the principal centers 
over the country—a cross-section of 57 representative centers reported 
services to 59,118 disabled persons in a 12-month period. They had a 
combined operating budget for the period of almost $16 million, and 
employed 1,250 professional workers. A composite of their estimates 
covering the ensuing five years revealed their expectations of a total 
annual operating budget which would expand by 55 percent, to $43 
million, with the number of persons served growing 63 percent to 
88,500. 

To assist rehabilitation centers in dealing with their operating prob- 
lems and to help communities that are planning rehabilitation centers, 
the Office, in cooperation with the Conference of Rehabilitation 
Centers, has prepared a new publication “Rehabilitation Centers To- 
day” describing in detail the operating programs of -77 rehabilitation 


centers. 
SHELTERED WORKSHOPS AND PROGRAMS FOR THE HOMEBOUND 


With the rehabilitation of more and more disabled persons each 
year, there is a corresponding increase in the number who require 


Office of Vocational Rehabilitation 225 


sheltered workshop services—which include training under simulated 
industrial conditions—as a prelude to competitive employment, and 
in the number whose condition at the time requires sheltered employ- 
ment for a period. 

To expand and improve programs and facilities for sheltered or 
home employment, the Office, in conjunction with the National Reha- 
bilitation Association and the National Association of Workshops and 
Homebound Programs, held two Institutes in 1958. Attendance was 
on a selective basis from State agencies and from workshops. 

Of particular importance were the findings and recommendations 
of the National Institute on the Role of the Workshop in Rehabilita- 
tion, held in April. A comprehensive report of the Institute has 
received enthusiastic acceptance from several thousand persons con- 
cerned with the use and operation of workshops in rehabilitation, and 
1s leading the way to preparation of other criteria and guides for 
operation and utilization of such workshops. 

Programs for the homebound received increasing attention also dur- 
ing the year. This category of the disabled is one of those selected by 
the Office for inclusion in the selected demonstration program. 

Three such projects for the homebound disabled were initiated 
during 1958. The Boston (Mass.) Dispensary is demonstrating how 
provision of vocational rehabilitation services in a community home 
care program for the chronically ill can be effective. Projects in 
Arkansas and in New Mexico are demonstrating the value of industrial 
homework programs for the disabled who are confined to their homes. 

The beneficial effects of a program for the homebound is illustrated 
by the activities of the Alabama Society for Crippled Children and 
Adults. This organization is well into a demonstration project to 
show how the development of an organized marketing program for 
products made by the homebound disabled can increase employment 
opportunities for them. 

The products made by the homebound disabled who are in this 
project—toy and gift items made of wood, fabric and metals—are 
sold nationally, bringing satisfactory returns under the organized 
methods that have been formulated. 


Rehabilitation Services for the Aging Assuming 
Importance as OASI Referrals Continue To Rise 


The increasing number of older persons in the population is giving 
rising importance to the provision of vocational rehabilitation services 
for the aging. 

This aspect of the rehabilitation program is given pointed signifi- 
cance by two facts. First, the number of rehabilitated persons over 
45 years of age increased from 18 percent of the total im 1945 to 31 


226 Department of Health, Education, and Welfare, 1958 


percent in 1958. Second, the State agencies in 1958, assuming re- 
sponsibility for a much greater portion of the disability determinations 


that are made in the cases of those individuals who apply to the Social | 


Security Administration for disability benefits, found the median age 
of those so referred to be 58.1 years. 

State agencies make assessments of the rehabilitation potentialities 
of individuals in this group, so that, through provision of rehabilita- 
tion services, as many of them as possible may be returned to gainful 
employment. 

During 1958, the 47 States or Territories that have working agree- 
ments with the Bureau of Old-Age and Survivors Insurance made 
approximately 278,000 initial disability determinations, compared to 
155,000 in 1957; screened more than 360,000 for rehabilitation poten- 


tial, compared to 154,000 in 1957, and accepted over 42,000 for further 


consideration for rehabilitation compared to 19,000 in 1957. 

These actions are taken in accordance with provisions of the Social 
Security Act, whereby disabled persons of any age may make applica- 
tion to have their benefit rights protected during periods of disability ; 
and persons 50 years of age or over, and dependent children of de- 
ceased or retired workers entitled to OASI benefits may make applica- 
tion for each disability benefit. For disabled persons to qualify for 
disability benefits under the Social Security program, there must be a 
finding by the State agency that they are unable to engage in sub- 
stantial gainful employment. 


Mental Illness 


There was continued reflection during 1958 of the Nation’s in- 
creased awareness that mental illness is one of the major health prob- 
lems of the country. There was further strengthening of the united 
front that is combatting mental illness, in which the Office is playing 
an increasingly conspicuous role. 

The Office joined with the National Institute of Mental Health of 
the Public Health Service, and a University in each of two Depart- 
mental Regions during the year, in sponsoring conferences and work- 
shops for mental health personnel in State governments, in State 
mental hospitals, and vocational rehabilitation staffs from State 
agencies. 

Personnel from these sources in all of the Department’s Regions 
now have had participation in one of such workshops. These oppor- 
tunities to share experiences and to plan together for new services 
for the mentally ill are reflected in greatly accelerated activity in a 
variety of rehabilitation programs for this group. 

One State agency now is operating three “half-way houses” for 
patients discharged from its mental hospital, where they learn to live 


. = < ee alias Si 
a ion aint es in sf § sank See ‘a “<a = 5 
7 a ee = a - 


3 
7 
4 

4 

4 
Gg 
i 


a in — 


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i 
i 


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Office of Vocational Rehabilitation 227 


again as members of the community while learning a trade, and get 
assistance in finding employment. 

A notable improvement in rehabilitation of the mentally ill is the 
development of vocational training programs in a number of State 
mental hospitals. Equally important is the fact that in nearly all of 
the States, special counselors are assigned to work exclusively with 
State mental hospitals. 


Services to the Blind 


A segment of the disabled population of the country for whom not 
enough has ever been done received significant attention during the 
year. The first major attempt at rehabilitation of those who are both 
deaf and blind was begun with completion of a study of the possibili- 
ties and methods of rehabilitating persons within this group. The 
study was conducted by the Industrial Home for the Blind of Brook- 
lyn, New York, with the aid of a research grant from the Office of 
Vocational Rehabilitation. In addition to its own experts, the Home 
enlisted the aid of other persons prominent in work for the blind and 
for the deaf, to produce and consolidate a series of monographs on the 
social, psychological, vocational, economic, and communications 
aspects of rehabilitating those who must rely entirely on their sense 
of touch for communication among themselves and with sighted 
persons. 

The volume is intended for the use of professional rehabilitation 
workers over the country, who heretofore have been handicapped in 
their attempts at rehabilitation of the deaf-blind because of lack of 
means of communication. The book constitutes a new manual which 
particularly describes the recognized methods of communication with 
the blind, and adds the recently developed International Standard 
Manual Alphabet, which uses block letters imprinted in the hand as 
the medium. 

The number of blind persons rehabilitated in 1958 by special agen- 
cies for the blind in 37 States, and by the general agencies in the 
remainder, was 4,007. ‘This reflects the steady status over recent 
years, the total in 1957 being 4,005, and 3,765 in 1956. The occupa- 
tions the rehabilitated entered in 1958 ranged through many cat- 
egories. Outstanding among them were factory employment, espe- 
cially in electronics and aircraft manufacturing for men and women, 
and many kinds of office work for women. Training courses for 
instructors in piano tuning were continued. 


VENDING STAND PROGRAM 


In the program of vending stand operations by blind people, the 
total number of stands increased from 1,830 in 1957 to 1,901 in 1958. 


228 Department of Health, Education, and Welfare, 1958 


Of these, 621 were on Federal locations, and 1,280 on non-Federal 
property. 

Total gross sales of all stands were $31,683,474, 9 percent more than 
in 1957. Net proceeds to operators and blind assistants were $6,269,- 
882, an increase of about 11 percent over 1957, producing an average 
income of $2,838 to operators and $1,619 to the blind assistants. 

The Division of Services to the Blind continued its efforts to assist 
the States in development of programs for the rehabilitation of blind 
workers in agriculture and related programs. 

One State reported that in a 8-year effort in this direction, more 
than 60 persons were rehabilitated into gainful employment as opera- 
tors of their own farms, as tenant farmers, or as farm laborers. 

The second year of a project of the Georgia Division of Vocational 
Rehabilitation to expand employment opportunities for the blind in 
greenhouse and nursery work has resulted in a total of 20 blind per- 
sons completing their training, 19 of whom have been placed in com- 
petitive employment, and one in his own business. 

Another special project in Alabama is demonstrating the benefits 
of coordinating the services of the State Division of Vocational Re- 
habilitation with those of Federal and State agricultural agencies for 
the training of blind agricultural workers. The continuing project 
has enabled 10 blind men—eight of whom had been considered non- 
feasible for rehabilitation—to operate farms, and two others to 
become hired farm workers. 


Small Business 


An increasing number of disabled persons are being rehabilitated 
each year through small business enterprises. Such businesses are 
possible under provisions of Public Law 565 which authorize State 
rehabilitation agencies to provide to disabled persons, when prac- 
ticable, the tools, equipment, licenses, initial stock, and supplies neces- 
sary for a small business, or for homecraft production and marketing. 

The increase in this phase of the program in 1958 is shown in this 
table: 


Expenditures in small 
business enterprises 


General Agencies for 

agencies blind 
LO (ee ace ae ee tre SE IT es ESI ee RRC, $1,026, 539 $499, 343 
PQS Ee ee Fee ee a shots Ee RE De Foe a ee at enn ee 1,270, 603 795, 470 


Cooperation With Public Assistance 


The trend toward an increasing emphasis on rehabilitation services 
aimed toward rehabilitation of disabled persons whose major sup- 


¥ 


Office of Vocational Rehabilitation 229 


port came from public assistance funds continued during the year. 

In 1958, approximately 20 percent of the 74,317 persons rehabili- 
tated by the State agencies received public assistance at some time 
during the course of services. 

The Council of State Directors of Vocational Rehabilitation, work- 
ing in conjunction with the Office, took more intensive steps to de- 
velop, strengthen, increase, and make more effective those vocational 
rehabilitation services which help to restore to employment those 
disabled who receive public assistance. 

Many kinds of specific cooperative activities were carried on in 
State programs. Examples from various States are: team review 
of disabled public assistance clients for assessment of their rehabili- 
tation potential; improved referral processes; regular inter-agency 
cooperation and client motivation; and use of rehabilitation centers 
for evaluation of applicants for aid to the disabled. A considerable 
number of States revised or adopted new cooperative procedures or 
agreements with State public assistance agencies. 


State Plans 


With the approval of plans during fiscal year 1958 for the newly 
organized vocational rehabilitation program in Guam and the sepa- 
rate vocational rehabilitation program for the blind in Nevada, the 
total number of approved State plans for vocational rehabilitation 
has now reached 91. A State plan for vocational rehabilitation, ap- 
proved as meeting the requirements of the Vocational Rehabilitation 
Act and regulations, is a prerequisite for Federal grants. 

By the end of 1958, fifty-three of the State agencies had provisions 
in their plans for the establishment of rehabilitation facilities, and 
45 had provisions for the establishment of workshops. Also, by that 
time plans in 47 States included provisions authorizing State agency- 
managed business enterprise programs for the blind, or for all types 
of the severely handicapped. 


State Administration Development 


Continuing recognition was given during 1958 to the need for 
executive development training for State agency administrators. 
Because of the State agencies’ interest in effecting efficient and eco- 
nomic operation of their programs, the State Vocational Rehabili- 
tation Council—which consists of all State Directors—appointed a 
special committee to work with the Office toward that purpose. 
Through this committee, special executive and supervisory training 
programs, utilizing experts in management outside of the field of 
rehabilitation, were developed. 


230 Department of Health, Education, and Welfare, 1958 q 


Four seminars on administration were conducted during the year. 
A total of 113 State Directors and their assistants, from 49 States 
and Territories, participated in the seminars. 3 

A second major approach to the improvement of State programs 
has been through development and completion of the first in a series 
of Program Administration Reviews. During the year, such reviews 
were made by regional staff in all State vocational rehabilitation 
agencies. The purpose is threefold. First, an opportunity is af- 
forded to each State agency to assess its position in relation to voca- 
tional rehabilitation goals. Second, the review process provides 
assurance that Federal money is being properly spent by State agen- 
cies. Third, the Program Administration Reviews provide a con- 
tinuing device for exploring a variety of questions or problems 
relating to provision of services to the handicapped. 

During the first series of the new reviews conducted during this 
year, primary emphasis was placed on determining progress being 
made toward attainment of national goals, with particular concern 
on evaluating factors which may lead to the rate of expenditure 
exceeding the rate of increase in rehabilitations. It is anticipated that 
this same method will be used to explore such questions as eligibility, 
high rates of rejecting referrals, and other significant problems. 
Reports from all State agencies are being evaluated for a national 
report to be completed early in fiscal year 1959. 

On request of State agencies, several consultative survey methods 
have been employed. In West Virginia, Kentucky and North Caro- 
lina, intensive high level consultation has been provided regarding 
overall problems of planning and organization. In the District of 
Columbia and the Pennsylvania agency for the blind, comprehensive 
management surveys of administration and program operations 
were completed. In Michigan, assistance was provided to the State 
agency in developing a “Five Year Plan for Vocational Rehabilita- 
tion.” Marked improvement in administration has resulted in each 
instance. 

During the year the Division of State Administration Development 
also concerned itself with progressive development of regional office 
operations. One additional professional staff member was added to 
most offices. As staffs have expanded, the need for more effective and 
efficient planning has been recognized. Regional activity has been 
improved and developed both by regional staff and by Central Office 
staff assistance. To a greater extent than ever before, the regional 
office staff has become recognized as the focus for vocational rehabilita- 
tion activities in the field. 


Office of Vocational Rehabilitation 231 


STATE STAFF TRAINING 


The year marked the Eleventh Annual Guidance, Training and 
Placement Workshop sponsored by the Office for the formulation and 
improvement of case work and other technical performance among 
State supervisory and consultative personnel. From year to year 
workshop committees gather information and develop reports on 
various phases of rehabilitation practices and present them to the 
annual workshop meeting for discussion, recommendations and appli- 
cation in the States. 

In the 1958 Workshop, its committees, assisted by outstanding con- 
sultants in rehabilitation, presented reports on techniques and methods 
of determining in-service training needs of counselors and supervisors, 
rehabilitation services to OASI referrals, development of small busi- 
ness enterprises, and guidelines for the utilization of rehabilitation 
facilities by State vocational rehabilitation agencies. Ninety-five 
workers from 66 agencies representing 46 States and Territories 
participated. 

Close liaison has been established with the nine-member Committ: ® 
on Training of the States Vocational Rehabilitation Council, since that 
committee is charged with responsibility for consultation on all aspects 
of the training program, including both in-service and pre-service 
training. 


Total of Federal Grants 


The total of Federal grants in the vocational rehabilitation program 
in 1958 was $50,157,030. 

These included grants to States and Territories for services under 
basic support programs in the amount of $41,083,273, about $6.2 mil- 
hon more than in 1957. This sum was matched by $24,974,604 in 
State funds, some 17 percent more than in 1957. 

Federal grants to States for extension and improvement of programs 
amounted to $1,094,483, which was matched by $364,828 in State 
funds. 

Research and demonstration awards during the year amounted to 
a total of $3,599,599, of which $1,972,667 was for first year support of 
new grants, and $1,626,932 for continuation of existing projects. 

Training grants, long and short term, and research fellowships, 
amounted to $4,379,675, about 50 percent more than in 1957. 


EXPANSION GRANTS 


Fiscal year 1958 was the final year for the expansion grant program 
which, under authority of Section 4 (a) (2) of the Vocational Re- 


232 Department of Health, Education, and Welfare, 1958 


habilitation Act, provided for Federal grants to States or other non- 
profit agencies for planning, preparing, and initiating substantial 
expansion of vocational rehabilitation programs. The authority was 
originally for fiscal years 1955 and 1956. This authority was extended 
for fiscal year 1957. Another amendment gave authority for grantees 
with unexpended balances on June 30, 1957, to use the balances in 
fiscal year 1958. 

The expansion grant program proved a notable example of what 
can be accomplished in meeting community needs through the coopera- 
tive efforts of public and voluntary agencies. During the four years 
this program was in effect, Federal funds totalling over $2,700,000 
were spent for 259 community projects. State and private funds, 
spent on a matching basis, totaled over $1,350,000, and private agencies 
spent additional sums above this amount. 

Thirty-three of the projects, or 13 percent, were conducted by State 
vocational rehabilitation agencies. Other public agencies and volun- 
tary groups conducted 226, or 87 percent, in cooperation with State 
vocational rehabilitation agencies. 

Voluntary groups included State and local affiliates of the National 
Society for Crippled Children and Adults, the National Association 
for Retarded Children, United Cerebral Palsy, Goodwill Industries 
of America, Inc., the American Hearing Society, and others, which 
sponsored 77 percent of the projects. Such groups also worked 
closely with public agencies on many of the projects operated by the 
public agencies. 

Expansion projects were in effect in all States except Nevada, and 
the District of Columbia, Alaska, Hawaii, and Puerto Rico. 

The emphasis in this program was the initiation of new and broad- 
ened programs of services needed to rehabilitate the disabled, par- 
ticularly expansion of the resources needed. The majority of the proj- 
ects involved the establishment or expansion of rehabilitation facili- 
ties and sheltered workshops. Seventy-six percent of the funds were 
used for this purpose. 

Many projects were designed to meet the needs of a particular 
group of the disabled, such as the blind, the deaf, the hard of hearing, 
the mentally retarded, and the cerebral palsied. Many were devel- 
oped to serve a combination of two or more disability groups, and 
others to meet the needs of the disabled as a whole. Keeping in mind 
the considerable overlap in such a classification, the following list 
shows the proportion of projects in each disability group; blind, 44; 
deaf or hard of hearing, 35; mentally retarded, 36; mentally ill, 5; 
cerebral palsied, 10; tuberculosis, 5; heart, 3; two or more disabilities, 
121. 


Office of Vocational Rehabilitation . 233 


STUDY OF BRIDGE PROVISIONS FOR MATCHING REQUIREMENTS 


When the system for financing the vocational rehabilitation pro- 
gram was revised in 1954, transition or bridge provisions were in- 
cluded in the Act to avoid disruption in the State programs already 
in operation. The Act provides for a change in the matching require- 
ments for the base allotment beginning July 1, 1959, with adjustments 
to be effected during the four fiscal years 1960, 1961, 1962, and 1963, 
so that by 1963 the entire support allotment will be matched at rates 
related to the fiscal capacity of the States. 

By the end of fiscal year 1958, four years of operation under the new 
financing system provided an established base from which the impact 
of the bridge provisions on program operation could be evaluated. 
During 1958, the Office made comprehensive studies and analyses of 
the bridge provisions, working in close cooperation with the States 
Vocational Rehabilitation Council. A Committee of State directors 
was established this year to study the effect of the bridge provisions 
and their implications for program development and growth. 

As a result of this intensive study, the consensus of both the States 
Council and the Office has been that the present bridge provisions in 
the Act should be allowed to take their course, and that no recommen- 
dations be made to change or defer the bridge provisions or to extend 
the period of transition. The study showed that although the tran- 
sition to be achieved in the four year period could be expected to 
pose a real problem in some States, the national pattern of expansion 
in State financing of these programs would support the conclusion 
that the States generally will be able to cope with the impact of the 
matching requirements through and at the completion of the transi- 
tion period. 


INTERNATIONAL ACTIVITIES 


The Office continues to have a leading role in developing basic 
philosophy for a worldwide program of vocational rehabilitation. As 
a member of the Interdepartmental Committee on International So- 


cial Policy, the Office is responsible for developing materials on re- 


habilitation, health and welfare programs for use by the Department 
of State in its work with the United Nations Secretariat, the Kco- 
nomic and Social Council, and the Social Commission. One such 
project was preparation of materials for the United Nations’ biennial 
second international survey of programs of social development, under 
“Social Service Programmes and Vocational Rehabilitation.” 
During 1958 the Office provided program and policy guidance for 
more than 110 long-term trainees, observers and short-term visitors 
487270—59 16 


234 Department of Health, Education, and Welfare, 1958 . 1 


from 88 countries, and for more than 20 labor attaches and training 
officers prior to foreign service for the Department of State. These 
services were provided in cooperation with the International Co- 
operation Administration; the United Nations and its Specialized 
Agencies; other Federal agencies; and educational institutions and 
rehabilitation facilities over the country. There is evidence of the 
effectiveness of these efforts in the marked progress in rehabilitation 
in some countries, within short periods after return of their trainees. 
The Office has been responsive in other ways in strengthening 
worldwide vocational rehabilitation. The Director attended the 
Seventh World Congress on Rehabilitation in London, and an Assist- 
ant Director participated in the Third Inter-American Conference 
on Rehabilitation in Guatemala. Two consultants in rehabilitation 
were recruited by the Office for surveys of rehabilitation needs in 
other countries, one for the World Health Organization to survey 
needs in the Dominican Republic, and another for the International 
Cooperation Administration, for a similar survey in El Salvador. 


Office of Vocational Rehabilitation 235 


Table 1.—Number of referrals and cases, by agency, fiscal year 1958 


Referrals Cases 
During fisca: year During fiscal year 
Agency ! Remain- Closed from active load Remain- 

ing at Ot Wee ee ee ing at 
Ac- Not ac-| end of | active end of 
cepted | cepted | year’ | load (re- After Before | year 6 

Total | for serv- | for serv- ceiving | Reha- | rehabil- | rehabil- 

ices ices 2 services)| bilitated| itation | itation 


plan in- | plan in- 
itiated 4 | itiated 5 


| es | a fe | ec | | | LT 


United States, 


HOtBle >< acoeo 369, 873 | 113,855 | 135,268 | 120,750 | 258,439 | 74,317 8,606 | 16,675 | 158, 841 
maabama +22 8, 046 3, 387 791 3, 868 8, 321 2, 240 253 392 5, 436 
OS 29s c-= ~~ - 562 103 108 351 282 53 13 14 202 
Arizona 

General--._-__- 1, 776 593 725 458 1, 285 496 118 86 585 

bli 97 52 23 22 125 11 12 6 96 
Arkansas.....----- 8, 086 2, 674 3, 347 2, 065 4, 689 1, 900 144 100 2, 545 
California__._------ 28, 759 5, 151 17, 798 5,810 | 10,703 1, 527 616 1, 436 7, 124 
Colorado: 

General_-_-_----- 3, 079 1, 174 1, 038 867 2, 263 737 199 87 1, 240 

Bling 222. 2 253 40 13 200 158 31 2 6 119 
Connecticut: 

General__-_----- 2, 474 1, 547 514 413 3, 883 927 173 287 2, 496 

Bind oo =. - .|- 205 70 105 30 159 35 20 2 102 
Delaware: 

General_-_------ 1, 420 609 579 232 1, 278 490 15 85 688 

ie uhla\e baer 39 25 9 5 54 18 10 1 25 
District of Colum- 

Fy ete 4, 667 639 3, 475 553 1, 490 291 130 130 939 
Florida: 

General... = = =) 12, 515 3, 924 4, 656 3, 935 7, 490 2, 389 306 543 4, 252 

hinds - 3, 800 441 2, 076 1, 283 969 261 49 23 636 
Gegreinw oe. 21, 410 6, 784 6, 606 8,020 | 12,362 5, 518 273 529 6, 042 
Hawaii: 

General-_---_--- 980 253 427 300 609 206 38 25 340 

apis ek 42 27 11 4 86 13 1 6 66 
Idaho: 

General_____--- 1,771 315 855 601 711 195 41 27 448 

pepe. 50 16 21 13 10 1 1 26 
Miliwoiss sto 2. 8 16, 754 5, 398 8, 254 3,102 | 12,805 4, 031 335 750 7, 689 
Indiana: 

General_2... 2. 2, 909 1, 584 595 730 4,120 1, 149 90 261 2, 620 

BSAC ee 220 59 73 250 4 16 28 172 
lowa: 

General_____--- 6, 033 1, 539 2, 041 2, 453 3, 862 1, 132 174 310 2, 246 

Beads ok 345 153 128 149 4 it 13 105 
Kansas: 

General_-_-__---- 3, 790 1, 076 1, 1387 1, 577 2, 415 676 67 169 1, 503 

lingdetes 28 37 5 108 178 214 54 8 145 
Kentucky ...--..-- 6, 660 1, 669 2, 618 2, 373 3, 481 1, 010 103 279 2, 089 
Louisiana: 

General-_--__-_--- 4, 539 2, 509 836 1, 194 6, 628 1, 719 96 356 4, 457 

ISH es Ee cau eee 750 135 186 429 537 102 10 18 407 
Maine: 

General_-___-_--- 2, 256 436 1, 023 797 1, 220 284 27 135 774 

Bindi es. 22s 213 89 81 43 148 35 8 16 89 
Maryland__---_---- 5, 542 2, 182 1, 605 1, 755 5, 015 1, 188 183 576 3, 068 
Massachusetts: 

General_-_-_-__--- 4, 507 1, 675 843 1, 989 3, 851 1, 031 83 223 2, 514 

pling wees... 2 343 104 40 199 352 1 16 23 242 
Michigan: 

General__--_---- 10, 377 3, 906 2, 527 3, 944 9, 363 2, 964 413 146 5, 840 

Ge tree I. 368 192 99 7 411 9 36 37 239 
Minnesota 

General_.___--- 5, 558 1, 383 1, 660 2, 515 4, 543 951 172 124 3, 296 

mundo oS 1 300 412 64 23 19 306 
Mississippi: 

General_-__-_--- 2, 50D 968 609 978 2, 498 886 71 108 1, 433 

ata Gee 81 324 350 138 882 246 41 37 558 
Missouri: 

General___-_---- 5, 942 1, 851 2, 056 2, 035 3, 840 1, 272 92 176 2, 300 

i3iiiets | 871 187 296 3 536 136 14 19 367 
Montana 

General_-_-_---- 2, 104 507 872 725 1, 238 408 19 43 768 

Blind ss.2e2.+.- 527 38 427 62 19 0 2 46 
Nebraska: 

General_------- 1, 833 864 321 648 2, 225 530 56 60 1, 579 

ONS aYo ee 217 72 78 67 152 59 4 1 88 


See footnotes at end of table. 


erent 
Hy 


236 Department of Health, Education, and Welfare, 1958 


Table 1.—Number of referrals and cases, by agency, fiscal year 1958—Con. ; 


Referrals Cases 
; | ie 
During fiscal year During fiscal year 
Agency ! Remain- Closed from active load | Remain- 

ins.ate |. Totall = oe oo AS nee 
Ac- Not ac- | end of | active end of 
cepted | cepted | year | load (re- After Before | year 

Total | for serv- | for serv- ceiving | Reha- | rehabil- | rehatil- 

ices ices ? services)| bilitated| itation | itation 


plan in- | plan in- 
itiated ‘ | itiated 5 


| | J | | | | | 
ee ens ef a 


Nevada 

General_._.:-_- 821 111 577 133 229 75 19 33 132 

Bilis ee 48 32 0 16 32 1 0 2 29 
New Hampshire 

General.__.__-_- 792 318 76 898 475 153 35 21 466 

Dilind se 46 OT, 13 6 78 10 6 5 Sia 
New Jersey: 

General_...2.-- 6, 432 2, 202 2 oo 2,075 3, 950 1, 030 160 361 2, 399 

Binds. 944 185 220 539 482 124 13 ie ooe 
New Mexico 

General_.____-- 1, 394 285 640 469 568 PHD 15 11 270 

Blinds 52.3. -ee 227 39 61 127 97 33 4 2 E 
New York 

General______.- 20, 944 7, 058 6, 783 W108 14, 351 4 455 559 1, 050 8, 287 

Blinds os. 931 306 269 356 786 209 52 97 428 
North Carolina 

General. _._._-- 9, 568 5, 435 2, 653 1, 480 11, 630 3, 537 350 481 7, 262 

Blind 1, 399 521 595 283 1, 511 374 32 97 1, 008 
pert Dakota-_-.-- 1, 514 334 354 26 967 254 15 24 644 

hio: 

General.--..-- 6, 280 1, 959 1, 677 2, 644 4,191 1, 286 100 243 2, 562 

Blind 2s. 28 518 233 111 174 694 99 29 52 514 
Oklahoma_--_-_-_-_.-. 5, 622 2, 641 2, 054 927 7, 469 1, 480 185 799 5, 005 
Oregon: 

General_______- 6, 592 1, 022 2, 863 2, 707 2, 679 667 89 308 1, 615 

BD ideas 161 37 34 90 144 29 3 5 107 
Pennsylvania: 

Gencral_....... 24, 574 8, 755 8, 153 7,666 | 20, 081 6, 299 1, 001 1, 566 12S 

Blind se 3, 792 437 2, 421 934 1, 066 238 74 6 658 
Puerto Ricos, 2.22 7, 188 1, 798 ahah 38, 625 4, 036 932 86 269 2, 749 
Rkode Island: 

General_-222 222 2, 055 959 539 557 1, 726 539 45 8 1, 184 

Bind so = 56 54 0 2, 205 33 SPLOU 4 158 
South Cerolina 

Generalec_____- 6, 644 1, 240 Dy, AS 2, 491 4, 945 1, 522 152 286 2, 985 

Binge sees e ce = 322 130 147 45 288 93 8 26 161 
South Dakota: : 

Generalz:_--=-2 1, 042 323 108 613 936 198 8 118 612 

Blind-se. 3) see 275 39 116 120 88 19 4 0 65 
Tennessee: 

General_-____-- 9, 447 3, 129 3,118 3, 200 5, 758 2, 055 137 214 8, 352 
a iBlinde=. eee 1, 249 313 380 547 796 215 17 34 530 

exas: 

General_.._.--- 11, 106 8, 220 25d t 5, 329 9, 449 2, 050 121 508 6, 770 

Blindiwse 4 912 379 263 270 815 330 16 ye! 455 
Utah. ee = eae se 1, 519 527 219 773 Weave 358 32 24 913 
Vermont: 

General______- 1, 278 363 821 594 780 168 47 49 516 

Blind: seco ds 29 32 16 69 14 4 3 48 
Virginia: 

General_____-_- 16, 507 3, 967 8, 831 4,299 8, 159 2, (10 166 869 4, 369 

Bind. sees. 48 117 172 198 267 16 20 4 
Virgin Islands____- 85 39 22 24 42 Lie 0 0 $i 
Washington: 

Generali=. 22.2 4,911 1, 663 1, 822 1, 426 3, 790 823 148 355 2, 469 

Blind ase 267 o 129 55 187 37 10 16 124 
West Virginia__.___ 15, 041 3, 769 4, 398 6, 874 9, 199 2, 3382 88 792 5, 987 
Wisconsin: 

Generale 3 8, 376 1, 877 3, 923 2, 576 5, 947 1, 324 140 89 3, 494 

Plinde= ee 176 101 38 37 207 63 8 14 122 
Wyoming 2s) 2 3 948 213 446 289 474 183 29 6 256 


1J3n States with 2 agencies, the State division of vocationa! rehabilitation is designated as “gener al,’’? and 

Ue 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, etc. 

5 Closed prior to initiation of rehabilitation plan because of indifference of individual, probable increase 
in degree of disability, loss of contact, etc. 

6 In process of rehabilitation on June 30, 1958. 4 


Office of Vocational Rehabilitation 237 


Table 2.—Vocational rehabilitation grants, 1958, State divisions of vocational 


rehabilitation 
Support Extension 
State or Territory grants and improve- Total 
ment grants 

OOD ee aol ees a a eh ee $36, 427, 855 $892, 960 $37, 320, 815 
LOTUS te eee am 1, 348, 622 5, 932 1, 354, 554 
Sue ee ee kg 324, 777 9, 178 333, 955 
AUPIRGN OSES, <a ul A RR iG PAO OuON 15, 761 1, 120, 271 
Lg on 2 Cg RR Ie en 2, 379, 301 116, 647 2, 495, 948 
een ere ek ea 242, 282 10, 499 252, 781 
CPST BE GUI). =. cs ep Se se 315, 277 15, 505 330, 782 
DOO ESV ONO jen he ee a a2 OO |e eee eee 142, 756 
TEU OEPVGIE.. a Sok 2 5 a le 1, 145, 439 T7A220 1, 162, 659 
COO occ Se a ee eee 2, 127, 749 82, 234 2, 159, 983 
rc eenemmrere oS tre VSI GS OF eee rca 131, 639 
LW LGROIS 22 + ose bceS ees ee ee a 1, 606, 201 81, 905 1, 688, 106 
Se aaa SR le me 479, 533 28, 741 508, 274 
NOD on. adic SES SS eae a a ee ae 670, 998 21, 624 692, 622 
ee. Sy ea ge 351, 937 9, 565 361, 502 
TRC RTA EDLY ice ae 429, 331 26, 198 455, 529 
SLAC AIQS Sn ua lle ag oe a a eg LOS 206 eae es ae 2 1, 198, 706 
IVE QTEELD oS he a ig a 216, 558 7, 902 224, 460 
BY (ASEUP! SIERO! - 5 = ef ll AGS 5088 eee ee eee 463, 598 
ee eta ere a oe 615, 645 33, 429 649, 074 
DME HHESE Ao se le aR a pa me 1, 181, 908 65, 266 1, 247, 174 
IW MENU ESOPB 2 = pesca a gn 759, 456 22, 216 781, 672 
Oa oe ane eee ee SSirodie frre res hehe os 331, 941 
PAI TRSBDSTTT es ecceat s  ee aa  A 585, 778 18, 441 604, 219 
DIONE eS ae a en 154, 023 5, 540 159, 563 
INA STSIS 2) at HR Se a en ee ee 265, 680 8, 679 274, 359 
BREW ETE ae es Se a Sto pitete a) egg a teeta ea 33, 885 
IN(OWY [FIEVERTOSIOUUY S65 2) PSSA ass anes ae ee elegans eee el eeenaes MOS OS OM leer eecnettes 70, 630 
INTE 2] BTERNY «ee, i a ne a 791, 819 43, 477 835, 296 
ISI aray MISC KGB) a aS a ee a a i 158, 356 2, 925 156, 281 
IN WOR 3. oe Lh re ee 2, 471, 396 94, 057 2, 565, 453 
IGT RTSEIS AMOUNT ke ee ok 1, 155, 078 15, 577 1, 170, 655 
INPRNS 2DIBUR OVERS ont: a gi a Sag ag 22620496 |b aes See eee 226, 049 
COUT. on eect eal Se i 572, 105 20, 461 592, 566 
CUES OOVOTSS. - 55 5k 0 A ee 896, 985 19, 425 916, 410 
CURED ID: ses ie lp 423, 103 12, 982 436, 085 
| Preyeva gh Ata AW, 30 Ee Sea ae ee ee 2, 667, 187 9, 900 2, 677, 087 
Tinos USNS AG Le SI i mp ec el 213, 249 7, 190 220, 439 
Shoe ths (CENT INAS) 5S a a a a 613, 339 19, 875 633, 214 
SOU IDO eTeRe. 5 SoS ee ee ee ee ee eee 191, 092 4, 836 195, 928 
“NORMGSSUS. 2 ese Go ee eee eer We UDO ROAO Maes Soe Se 1, 159, 540 
Giese: 5 eee CS enacts ---- 1, 152, 761 15, 000 1, 167, 761 
TO oe pe a 191, 130 7,051 198, 181 
\UEEETE DOES sep a 1465760, [Eat a eee 145, 766 
Dstt abt en TEN A ol ce LS eee eek ne 1, 053, 883 31, 704 1, 085, 587 
VUES VEE OTE a Se GSOPUS Reece wana e 680, 157 
AW SRE VS TEG) TO 7256080 [Seen meee 1, 072, 668 
AWG ITO CUM A Se ee 820, 523 28, 017 848, 540 
WY ROTEDE Dee a eS e DOSES AO) | nee eee ee 108, 879 
IAT 1c eo Eee on omnees co ew ee Lek 102, 443 5, 000 107, 443 
GUTTER er PAOLO i eee cae 700 
TRGB OPENS, oli aes a a ee, ae 151, 044 3, 000 154, 044 
TPAGVERPD TET VOvE) i AT A Ce 2 ns gn a ee ee ASS GA) MRE oe eon S 483, 640 


Wai Selo Seren ee ee ee ee eb cc ss SALAS tees sees oe 13, 148 
DISC mOMOONMM DIAS =o) he DSS KOO lel ue weet eee Baws 238, 661 


238 Department of Health, Education, and Welfare, 1958 


Table 3.—Vocational rehabilitation grants, 1958, State commissions or agencies 


for the blind 
Extension 
State or Territory Support and Total 
grants improvement 
grants 
Total oe ie sec ee ee oe ea ae ee ene eee $4, 655, 417 $201, 524 $4, 856, 941 
INGIZON Ro ancora tees ee eee SO eet ese eee 44.0797 |. eee 44, 079 
Colorado eo aoe Soe ns nn ee ae oe eee Rene een ceen eae 69, 598 3, 499 73, 097 
Connecbicut: 2.2. bos ose ee oe ee eee ee 38, 677 3, 876 42, 553 
Delaware: ccs oe-at cuss ceo aceon s dae cree eee nea ees eee 37, 470 5, 000 42, 470 
Bloridas 22s. cues coe sso scene ene eee 408, 000" |2 22. eee 408, 000 
REST ee ee eee ae oo ee eae eee ca ae eee ee eee ee 10; 401-22 eee 10, 401 
Fndiatia wast 223250 So Jo eee anne ee ate Se ees eee 67, 033% | 222 eee 57, 033 
OWaserecs on ont coupe eae beac oecat ean eme Lone esac sane eeacee 44,177 1? 45, 930 
TAN SAS See ue a eee EE aS ei eee oe wee eee eau erat setae 108, 168 4, 200 112, 368 
TOUISIAN G28 oe oe cae oes a ee ee aes 143, 442° |e 148, 442 
IMPaIn ees ook eee AEN Sar Se re od See ah tone eee 67,360: eee 57, 360 
Wiassachusetiss. ac oe. ocean eeaae oc onen een ane a eee 128,174? |e ose ee 128, 174 
IMIG Tea eee re ee eee Se Os Ree eee ee ees 117, 796\2. ose 117, 796 
IVEIRNGSOTS 22 a2 on ee ee oe oe ee toes eee See 131,653 -|2232 266 ee eee 131, 653 
IMISSISS! DDI) Ceo oe oc oe ec ne ee ee meee eee eee 235, 050 [22 eee 235, 050 
IVEISSOUDISS <2 Cart oR SO ee eee ee ee ae ee eae ee 211, 6903) 2.222 eee 211, 690 
Montane <2 eos oe ee oe ee ee ea ere eee ee 44.1385. 532 eee 44, 138 
INebraskaiec| Stee mae ote co tone cor eee oe eens aaa eis 73, 513 3, 600 77, 118 
INGEN Sd eas ee eT eee eee ee ae 4, 000 5, 000 9, 000 
News Ham pshires.3 25-2 een. Sloot eee ee eee cee se 24, 760i). --- eee 24, 760 
INGwiJelSOVees: cocoon tee ctcc ene ee ee ee ee 140, 886 1, 875 142, 761 
Ne waMViex@o a5 = oo ee a ee eee oe eee eee 42-433 12 co aeeeee 42, 433 
ING WER OG Re nk Se a eo ee ies Cae eras) ne ee eee 377, 723 46, 575 424, 298 
NortlivCarotins. 22-4...) See te ee ee oe 5 ee ee ee se 472, 2060 ee 472, 296 
OE hee A ae a ar eS 216, 657 48, 258 264, 915 
OREGON re Soe Se PN le ee, ec ee 74, 442 1, 936 76, 378 
| e(oiaba toa hash bh Mom Govier Aer nee Seley Jie. Fee Shs i ao a Bee ey Se 403, 793 24, 000 427, 793 
Rhoderisiand 2 fe seein Pe aoe aetna eae 34; 99051 see eee 34, 999 
SoutmuC@oarolinag = 3. sces ©. =) ee eee ees ee ee eee ene 53, 386 "|. So ee ee 53, 386 
SOULMMDAKOta sbi ao es. SSeS ae Ree eee ee ee ee ee 49, 319 1, 200 50, 519 
EROMTESSEG 22522 cos ee a en Ee ete ee eee eee 235, SOS0 Seen ee ae 235, 895 
Sy ios ua eR, Spe Hee wwe peek luted tanye Sah gee polyps RSE Yate iede ag pelea ny Saas 269, 649 17, 592 287, 241 
MGrimou tes ore ee ee ae ee ee ee 30, 788 5, 000 35, 788 
Bits big) 500 2 a Seen ARIS eel ees = Ot I SL Bre BA ak praca en fas, 5 oot 10, 407 | cee 77, 497 
Wiashing tome 2 oot a0) a) ee. 8 ee ee eee 61, 691 23, 160 84, 851 
WoSconsinihee ce he 5s ae Caen Ceo ee tere cm eens 94, 681 3, 000 97, 681 
SEV y abit) 20 = eT ao a Ae eet ees MBI 30, 103 2, 000 32, 103 


ee ee a ee ee eS 


eer 


a 


Saint Klizabeths Hospital 


THE YEAR Just Past has been an active one and one of progress. The 
general health of the patients has continued good; despite the prob- 
lems of understaffing and overcrowding, the dedication of the medical 
staff, ward personnel, and other employees of the Hospital has main- 
tained a high standard of care for the patients. _ The so-called ataractic 
or “tranquillizing” drugs have continued to prove their usefulness. 
More “open” wards have been established, and patient self government 
has been further developed. Every effort has been made to em- 
phasize to the patients their responsibility not only for their improve- 
ment but for that of their fellow patients. More elderly patients are 
being admitted and more of the patients in the Hospital are reaching 
advanced years. With the increased number of elderly and infirm a 
constantly heavier load is being thrown upon the already overloaded 
ward personnel. 

In the report a year ago mention was made of a self-evaluation of 
the hospital operation, a study which had indicated that more than a 
50-percent increase in staff is needed in order to give adequate treat- 
ment to patients and to provide training and research. During the 
current year a Board of Consultants, distinguished in the field of hos- 
pital administration, was invited to make a survey of the hospital. 
The Board reported that in almost all details they agreed entirely 
with the hospital’s estimate of additional personnel needs. <A con- 
siderable increase in court activity has been noted during the year; 
nearly 100 writs of habeas corpus or orders to show cause were served 
on the hospital. As a result, members of the medical staff had to 
spend many days in court, thus detracting from their attention to the 
patients. It has continued to be necessary to maintain a waiting list 
for prisoner patients; however, work is progressing satisfactorily on 

239 


240 Department of Health, Education, and Welfare, 1958 


the new maximum security building, which should relieve this — 
situation. 

As usual, the hospital was visited by many persons, both from this 
country and abroad, who are interested in one phase or another of 
psychiatric hospital administration. Twenty foreign countries were 
represented. An active program in education has been carried on, 
and training has continued in the fields of psychiatry, psychology, so- 
cial work, medicine, surgery, pathology, occupational therapy, nurs- 
ing and clinical pastoral work. Students from the three local medical 
schools received a part of their clinical training in psychiatry at the 
hospital, and in-service training in a number of fields was carried on. 
The Hospital continues to be the only public mental hospital in the 
county which is approved for a rotating internship. 

One of the most significant developments during the year was the 
establishment of the National Institute of Mental Health—-Saint 
Elizabeths Hospital Research Project. The ground floor and the 
fifth floor of the William A. White Building were entirely remodeled, 
so that well-equipped laboratories and offices are available. Some 
of the Institute staff are already functioning in the laboratories and 
on the wards. It should be pointed out that this is truly a joint 
project. Although the personnel of the National Institute of Mental 
Health participate, they are regarded and regard themselves as an 
integral part of the Saint Elizabeths organization. One Director of 
Research serves in that capacity for both the Hospital and the In- 
stitute staff. The Hospital is highly enthusiastic about these possi- 
bilities; indeed, there seems good reason to expect that this may be 
one of fe ates significant activities in the whole field of psychiatric 
research in the country. 


Division of Medical Services 
CLINICAL BRANCHES 


The general care and treatment of the patients is borne by three — 
clinical branches, each of them subdivided into services. A Medical — 
and Surgical Branch is charged with the acute medical and surgical 
treatment of all patients and emergency attention to employees. 

As has been noted in previous reports, the shortage of staff con- 
stitutes the greatest operational problem. The increased alertness 
of the patients due to the “tranquillizing” drugs has laid much greater 
responsibilities upon the ward and medical personnel. Thus the 
shortages which have existed previously have become far more notice- 
able and pressing. Perhaps of equal importance as a problem is that 
of overcrowding. ‘The general overcrowding of the Hospital is about 
15 percent, but there are areas in which the crowding is considerably 
greater than this; indeed, in some areas patients are cared for in 


Saint Elizabeths Hospital 241 


decidedly substandard circumstances as well as being crowded. The 
importance of this feature can hardly be overestimated. The last net 
increase in hospital beds dates from 1944; buildings authorized since 
that time have constituted replacement only. 

The increasing number of elderly and infirm patients is not unique 
to Saint Elizabeths Hospital. It is, indeed, one of general prevalence 
in mental hospitals, and has laid very serious nursing obligations 
upon the hospitals. Not all of the elderly patients are poor risks 
and, indeed, a fair number of them could be released to the com- 
munity were greater services of social service and rehabilitation 
available. 

New admissions showed a decrease of only 10 over the previous 
year, namely, 1,605. Interestingly, however, the number of readmis- 
sions, that is, patients who have previously been in Saint Elizabeths 
Hospital or similar institutions before, has been rising steadily during 
the last few years and this year stands at 28 per cent. During the 
year 1,076 patients were discharged, a slight increase over the year 
before, this constituting 67 per cent of the admissions. In addition 
532 deaths occurred, so that the number of all discharges exceeded 
the admissions by anne 

The increasing recognition by the courts of the mental factors in 
crime has resulted in recent years in a greater load upon the West 
Side Service, in which is found the maximum security section. One 
hundred and forty-five prisoners were admitted to Howard Hall 
during the year, 16 of these being so-called “sexual psychopaths.” 
Twenty-one of the patients had been acquitted by reason of insanity, 
a, very considerable increase over previous years. Somewhat more 
alarming and time-consuming is the steadily increasing number of 
cases in which patients appeal to the court for release. The amount 
of time involved in preparing the returns and in taking the patient 
to court has consumed an inordinate amount of the time of the physi- 
cians. In fairness it must be said that this entire situation reflects 
a very desirable rapprochement between the courts and the hospi- 
tals and a growing interest by the courts in the mental state of the 
offender. It is our expectation that in the near future the waiting list 
for prisoners may be substantially reduced. | 

The increase in open wards is decidedly in tune with the present 
trend in hospital administration. Group therapy has been exten- 
sively used, and the effect of the patient government committees has 
served to increase the feeling of responsibility of the patients. Elec- 
tro-shock therapy has been used almost not at all, and no lobotomies 
have been performed. The services of the Rehabilitation Division 
of the District Government, cooperating with the Occupational and 
Social Service Branches of the Hospital, has been most helpful in 


242 Department of Health, Education, and Welfare, 1958 


restoring patients to the community. Further cooperation with the 
Department of Public Welfare and the Office of Vocational Rehabili- 
tation are expected as a result of negotiations now under way. — 


MEDICAL AND SURGICAL BRANCH 


It is by reason of this Branch that the Hospital is approved for 
rotating internship. The work of the Branch is extraordinarily 
varied and of high efficiency, in spite of the fact that the Medical 
and Surgical Building, now 30 years old, is approaching obsolescence. 
There were 2,305 admissions to this Branch during the year and 74,- 
000 hospital days. There were clinical visits, too, of over 50,000. 
The pharmacy has been refurbished and its efficiency has been much 
improved as a result. The same may be said of the dental division, 
which has been expanded and reorganized. One of the problems in 
the Medical and Surgical Branch is a reflection of the crowding of — 
the rest of the Hospital, namely, the necessity to keep patients in the — 
buildings of the Branch when their condition indicates return to the 
other services. There have been many lectures and committees, and 
an extremely active program of various studies such as a cytology 
study on the female patients and chest X-ray program. During the 
year radiology was added to surgery as one of the departments in 
which the Hospital cooperates with the George Washington Univer- 
sity School of Medicine. 


PSYCHOTHERAPY BRANCH 


This Branch provides services to certain selected patients in the 
field of individual psychotherapy as well as group psychotherapy, 
psychodrama, dance and art therapy. Exhibits of the art produc- 
tions of patients were sent to the International Congress of Psy- 
chiatry in Ziirich and to the meeting of the American Psychiatric 
Association in San Francisco. 


PSYCHOLOGY BRANCH 


A very active training program is carried on in this Branch; no 
less than 61 lectures and 90 hours of clinics were provided. In addi- 
tion to routine psychological testing (including Rorschach and voca- 
tional), five research projects were completed. Space here, as in 
other parts of the Hospital, continues to be a problem. 


RECREATION THERAPY BRANCH 


This Branch, formerly known as the Special Services Branch, has 
carried on a very active program, providing ward parties, various 
entertainments, both in the wards and Red Cross Building, and 
Hitchcock Hall. Through the courtesy of the Commanding Officer 
of the Bolling Air Force Base patients have been taken to the swim- 
ming pool there. Church choirs and a glee club have been conducted, 


_ Saint Elizabeths Hospital 243 


as well as various bands and orchestras, and a program of sports has 
been carried on. 


VOLUNTEER SERVICES BRANCH 


This relatively new Branch has accomplished much for the bene- 
fit of the Hospital. One hundred and thirty-eight volunteers con- 
tributed over 12,000 hours of their time during the year. One of 
the new ventures was the establishment of an apparel shop operated 
by volunteers which provided articles of clothing and ornamentation 
to over 600 patients. The American Red Cross and many other com- 
munity organizations have been most helpful in giving service to this 
Branch; their contribution has been deeply appreciated. 


OCCUPATIONAL THERAPY BRANCH 


An educational-rehabilitation program has been developed during 
the year with 15 courses being given by volunteers. Preindustrial 
therapy has been further developed and an increasing number of pa- 
tients are being prepared for placing out in various activities. In 
some of these the Department of Health, Education, and Welfare 
through its Personnel Division has been most helpful in providing 
opportunities for patients to prove their ability to carry on useful 
activities outside the Hospital. 


SOCIAL SERVICE BRANCH 


This Branch has been most helpful in the rehabilitation of patients 
and during the year served 1,037 patients. Opportunity for field 
work is given to the social work students of Catholic University and 
Howard University and during the year 16 students had this experi- 
ence under supervision. Eighteen patients were sent to the District 
of Columbia Village, of whom two were later returned. This Branch 
has had general supervision of the school program, under which two 
full-time instructors from the Board of Education have been provid- 
ing instruction for the teenage patients. ‘Two of these patients grad- 
uated from the high school course this year, and several received 

prizes in the Science Fair held by the schools of the District. 


NURSING BRANCH 


This Branch has done yeoman service in spite of a general shortage 
of graduate nurses. There are 14 schools of nursing which affiliate 
with the Hospital, and a number of Navy hospital corpsmen are 
trained by the Nursing Branch. 


MEDICAL RECORDS BRANCH 


This Branch has continued to develop but is considerably hampered 
by the need of additional space and personnel. These problems will 
be remedied as soon as possible. 


244. Department of Health, Education, and Welfare, 1958 _— 


LIBRARY SERVICES 


The Medical Library had 640 acquisitions during the year, bring- 
ing the total to 19,238 volumes. Two hundred and five journals are 
subscribed to. Six hundred and three inter-library loans were made. 
Unfortunately, some of the libraries with which the Hospital deals 
are curtailing their services somewhat so that the service received has - 
slowed down. Much space is needed and it is hoped that eventually 
this can be remedied if the plans for an additional wing to the Ad- 
ministration Building are carried out. The Patients’ Circulating 
Library now has over 57,000 volumes. It carries on an active pro- 
gram of circulating books to the various wards. It does bookbinding 
and carries on a number of classes, particularly in shorthand, typing, 
and foreign languages. 


CHAPLAIN SERVICES BRANCH 


This Branch under Catholic and Protestant chaplains carries out 
religious ministry to the patients both in the Chapel and on the 
wards. The chaplains visit new patients and such other patients as 
request their services. In addition training is carried on by the 
Catholics in affiliation with Catholic University and by the Protestant 
chaplain under the program approved by the Council for Clinical 
Training. Community organizations have been most helpful to the 
chaplains as well as to the Volunteer Branch and thanks are expressed 
to them. A fine new electric organ, paid for entirely with donated 
funds, has added much to the dignity of the services. 


Division of Administration 


Space does not permit mention of the various activities in the Ad- 
ministrative Division of the Hospital, financial, personnel, construc- 
tion, grounds, laundry, and so on. Substantial progress has been 
made in developing new methods of property control] and of billing. 
Much surplus property has been obtained. The grounds have been _ 
maintained in excellent condition, and several contracts, notably for 
the construction of the Maximum Security Building, have been 
supervised. 


Needs of the Hospital 


Two needs stand out, one preeminently, namely, increased personnel 
both medical and administrative. - Additional space is also needed to 
overcome the crowding which exists in a number of areas of the Hos- 
pital, both for patients and for administrative activities. 


Saint Elizabeths Hospital 245 


Table 1.—Movement of patient population, fiscal year 1958 


Male Female 
Total 
White | Colored | Total | White | Colored | Total 
Total number under care and treat- 
s-ment, tiseal year 1958.0. -_ 32-3. 9, 071 2, 604 1,904 | 4,508 | 2,677 1, 886 4, 563 
Remaining on rolls, June 30, 1957__._____--- 7,466 | 2,170 1,540 | 38,710 | 2,209 1, 547 3, 756 
POumitea GUrinouVear so. oad sedence 1, 605 434 364 798 468 339 807 
Total discharged and died._.._______- 1,608 | 479 344} 823 | 500 2851 785 
Discanodeene ens oe oe 2 1, 076 312 246 558 329 189 518 
Conditions on discharge: 
PC COV ELOU ee no as ee teen 74 18 30 48 18 8 26 
BOCIMIENCCOMVEN cee. 25. =~ es 389 64 82 146 136 107 243 
LEST ROTC es a a 421 146 79 225 135 61 196 
OMIT ROWeOss so 228s Le cael 150 64 Be] 97 40 13 53 
AW @IGE 3 = Se ee (0) 9 fear ite Fe eet MT ke EN ane She ee ae ee eee eee 
INomnentalidiserder: 22 -s2ce Lael ee 39 18 PAA 39 0 0 0 
UR STOR TS eee a ee 3 Di 1 3 0 0 0 
Dc (eee 8 8 SLL ee ee 532 167 98 265 171 96 267 
Remaining on rolls, June 30, 1958_____-____- 46302125 1 OOO mero KOSOr lal 1, 601 3, 778 
Corrections, change in sex and color______-_- 0 +3 —11 —8 +8 0 +8 
Adjusted on rolls, June 30, 1958__-____-_-__- 7,463 | 2,128 1,549 | 3,677 | 2,185 1, 601 3, 786 
Absent on visit and elopement________--_-- 469 il 71 148 153 168 321 
Patients in hospital, June 30, 1958__.-____-_- 6,994 | 2,051 15478 |) 3,529" | 2.032 1, 433 3, 465 


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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 educa- 
tional books and supplies for the blind school children throughout the 
country 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 blindness as follows: “Central visual acuity of 20/200 
or less in the better eye with correcting glasses, or a peripheral field so 
contracted that the widest diameter of such field subtends an angular 
distance no greater than 20 degrees.” 

The Printing House maintains large catalogs of Braille books, 
Talking Books, recorded tapes, Braille music publications, large-type 
_ texts, and tangible apparatus. A rich collection of educational ma- 
_ terial is thereby provided for the kindergarten through the high school 
_ grades. A total of 6,459 blind pupils was enrolled in the residential 
schools for the blind and 4,724 in public schools—a total of 11,183 
_ blind pupils being served by the Printing House—for the fiscal year 
_ ending June 30, 1958. 

_ During the 1958 fiscal year, Braille books, educational periodicals, 
and music made up approximately 4814 percent of the materials re- 
_ quired by the schools; Braille slates, Braillewriters, maps, and other 
_ mechanical devices about 1414 percent; Talking Books about 5 per- 
— cent; recorded educational tapes about 1 percent; and large-type books 
_ about 2714 percent. Approximately 3 percent was used for miscella- 
_ neous items. 

247 


Gallaudet College 


GALLAUDET CoLLEGE is devoted to the education of deaf persons who 
because of their handicap would have difficulty in schools and colleges 
for hearing students. The college, located in Washington, D. C., is 
the world’s only college for the deaf. It was accredited in May 1957 
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 
college proper. 
KENDALL SCHOOL 

Primary and secondary schooling is provided for deaf children in 
the Kendall School, which also serves as a laboratory school for teach- 
ers training in the college. The oral method of instruction is used 
for all pupils except those who make no progress under it. Enroll- 
ment last year was 70 of which 60 came from the District of 
Columbia. 


GALLAUDET COLLEGE 

The college, established in 1864 by act of Congress, offers the asso- 
ciate’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 Educa- 
tion offers a master’s degree and a professional diploma in the educa- 
tion of the deaf to students with normal hearing, and offers a 4-week 
training course to vocational counselors who wish to acquire a deeper 
understanding of deaf persons. Total enrollment in the college last 


u year was 347 with students from 42 States, Hawaii, and 6 foreign 


countries. In addition, there were in attendance throughout a part 
of the school year 51 students enrolled in (a) summer school graduate 
courses, (b) courses in “orientation to the deaf” for vocational 
rehabilitation counselors, welfare workers, etc., and (c) extension 
classes. 

4872705917 249 


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Howard University 


Howarp University, located in the District of Columbia, was 
chartered 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 receives 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 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 train- 
ing of Negro students. 


ENROLLMENT OF STUDENTS 


During the school year 1957-58, the university served a total of 
6,267 students as follows: 4,899 during the regular academic year and 
1,868 in the summer session of 1957. The net total enrollment, ex- 
cluding all duplicates, was 5,356, distributed in the 10 schools and 
colleges as follows: liberal arts, 2,466; graduate school, 542; engineer- 
ing and architecture, 751; music, 260; medicine, 317; dentistry, 539; 
pharmacy, 133; law, 107; social work, 190; and religion, 51. This 
enrollment included a larger body of Negro professional students 


251 


tie Department of Health, Education, and Welfare, 1958 ’ 


than in all universities of public support in all the Southern States - 
combined. 


GEOGRAPHICAL DISTRIBUTION OF STUDENTS 

Of a total of 4,899 students enrolled during the regular school year, 
4,393 or 89.7 percent came from 40 States and the District of Colum- 
bia, while 506 students or 10.3 percent came from outside the con- 
tinental United States. 

The 4,393 students who came from the United States were distrib- 
uted as follows: New England States, 69; Middle Atlantic States, 
674; East North Central States, 246; West North Central States, 74; 
South Atlantic States, 2,713; East South Central States, 313; West 
South Central States, 260; Mountain States, 7; and Pacific States, 37. 

The 506. students from outside the continental United States came 
from 438 foreign countries, including 10 countries in Africa, 11 coun- 
tries in Asia, 11 countries in Europe, 6 countries in Central America, 
3 countries in South America, and 14 island countries in the British 
and Netherlands West Indies. 


VETERANS 

There were 810 veterans enrolled at Howard University during 
the school year 1957-58. ‘They were distributed among the 10 schools 
and colleges as follows: 348 in liberal arts, 167 in engineering and 
architecture, 14 in music, 89 in pharmacy, 60 in dentistry, 36 in law, 
72 in medicine, 7 in religion, 12 in social work, and 60 in the graduate 
school. 


ARMY AND AIR FORCE ROTC 

Army ROTC—Three hundred and fifty-one students were en- 
rolled in Army ROTC during the school year 1957-58. Of this num- 
ber, 164 were in the first year course, 85 were in the second year, 62 
were in the third year, and 40 were in the fourth year. During the 
course of the year, 25 students were commissioned as Reserve Officers 
in the Army. 

Air Force ROTC—There were 304 students enrolled in Air Force 
ROTC. Of this number 139 were in the first year course, 139 were 
in the second, 13 were in the third, and 13 were in the fourth. Eight 
students received commissions as Reserve Officers in the Air Force. 


THE FACULTY 

During the year 1957-58, a total of 586 teachers served the univer- 
sity. Of this number, there were 333 full-time teachers and 253 part- 
time teachers. The full-time equivalent of the teaching staff was 
385.96. 

From the beginning of the university’s work in 1867, the founders 
invited to the faculty of the university learned and able people 


Howard University 253 


on the basis of their ability and character as individuals and without 
discrimination as to sex, race, creed, color, or national origin. It 
was a major purpose of the founders to employ Negro teachers, 
among others, on every faculty. Today the Negro members of the 
professional faculties of Howard University constitute together a 
group of professional teachers larger by far than all the Negroes so 
employed in all other American universities combined. The existence 
of this group of Negro university teachers at Howard University has 
been a standing inspiration to the Negro people for more than three- 
quarters of a century, and membership on one of these faculties has 
been the first employment of many of the outstanding Negroes in the 
public life of America. From them came the founder and operator 
of the first blood plasma bank in the world, the first Negro governor 
of an American possession, the first Negro in the Secretariat of the 
United Nations (Nobel Prize Winner), the first Negro member of 
the bench of the United States Court of Appeals, and the first Negro 
cultural attache in the diplomatic service of the United States to a 
major European nation. 


THE BUILDING PROGRAM 

At the beginning of the 1957-58 school year, the new building con- 
structed for the basic preclinical branches of medicine was occupied 
for the first time and remodeling work on the adjoining older build- 
ing was finished, so that now the university is fully prepared to ac- 
commodate all the basic premedical students required by the program 
of doubled enrollment in medicine and dentistry. 

By the end of the school year work was nearing completion on the 
new men’s dormitory. It was certain that this building would be 
ready to accommodate 304 men in September 1958. 

In April 1958 construction work began on the new auditorium-fine 
arts building, designed to provide an auditorium for 1,500 persons, a 
laboratory little theater with a capacity for 820 persons, complete 
classrooms and other facilities for the entire school of music and for 
the departments of fine arts and the drama. 


GRADUATES 

During the school year 1957-58, there were 631 graduates from the 
10 schools and colleges, compared with 560 graduates during the year 
1956-57. These graduates came from 30 States, the District of Col- 
umbia, the Virgin Islands, Puerto Rico, and the following foreign 
countries: Ethiopia, Liberia, Nigeria, India, Israel, Barbados, Ber- 
muda, Grenada, Jamaica, the Netherlands West Indies, Bulgaria, 
Russia, the Philippines, and British Guiana. 

These 631 graduates were distributed among the 10 schools and col- 
leges as follows: liberal arts, 284; engineering and architecture, 63; 
music, 16; the graduate school, 53; social work, 33; medicine, 67; 


254 Department of Health, Education, and Welfare, 1958 


dentistry, 47; dental hygiene, 8; pharmacy, 24; law, 27; and re- 
ligion, 9. 

Two of these graduates were persons receiving the degree of Doc- 
tor of Philosophy in Chemistry. These two graduates were the first 
students to be awarded the degree of Doctor of Philosophy at How- 
ard University. Three honorary degrees were also conferred. 

Since its establishment in 1867, Howard University has graduated 
20,454 persons. By far the large majority of these graduates have 
been Negroes. 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 nine hundred 
and forty have entered the practice of medicine; 2,420 have entered 
the practice of dentistry and dental hygiene; 2,355 have entered the 
field of law; 777 have entered the ministry; 848 have entered the 
field of pharmacy; 646 have gone into engineering and architecture; 
and 390 have entered the field of social work. 


SERVICE IN FOREIGN COUNTRIES 

In recent years teachers and students from Howard University 
have served in Burma, Brazil, Egypt, Ethiopia, Germany, India, 
Israel, Iraq, Italy, British Guiana, Japan, and Vietnam. Fulbright 
scholars from the university have worked in Egypt, Ghana, Iraq, 
Japan, Norway, Sweden, Denmark, 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. 

Among the most recent testimony from the Government is a letter 
from the Director of the International Educational Exchange Serv- 
ice concerning the contributions made by Dr. Walter M. Booker, 
Head of the Department of Pharmacology, who has just completed a 
year’s work (1957-58) as a Fulbright scholar at the Heymans Insti- 
tute of the University of Ghent in Belgium. 

“The Booker family adjusted easily to life in Belgium and made 
many friends among their Belgian hosts. In this way they contrib- 
uted effectively to the basic objective of the Department’s program— 
the promotion of mutual understanding and good will between the 
people of the United States and the people of other countries. . 

“The cooperation of your university in making it possible for Dr. 
Booker to participate in the program is very much appreciated.” 


f :, 
es 


Detailed Contents 
THE SECRETARY’S REPORT 


a) 
9 
i) 
@ 


PROGRESS AND COOPERATION FOR ECONOMIC SECURITY_______-_______- 
PROGRESS AND COOPERATION. FOR THE NEEDY__________-_---__-____~- 
PROGRESS AND COOPERATION FOR CHILDREN__________-_-----_-_-_-__-- 
PROGRESS AND COOPERATION FOR THE DISABLED____________--_____-- 
PROGRESS AND COOPERATION FOR EDUCATION____-______--___-_---__-- 
Matt OMnr errr ek ee ee ee eee 
PeOGkess AND. COOPERATION FOR H@BALTH.____2__--__.-_~-_---__ ie 
PROGRESS AND COOPERATION FOR PuRE Foop Aanp DRuGSs________---- 


POON & oF bo 


a 


~ Taste 1—Grants to States: Total grants under all Department of 


: Health, Education, and Welfare programs, fiscal year 1958____--_- 


SOCIAL SECURITY ADMINISTRATION 


pt 
for) 


Me PEICMOURITY: IN 19058211 som ina ae See eel 17 
: reer or, ACTIVITIES GULL 20g 2es_ pees eee Lees 21 
OLD-AGE, SURVIVORS, AND DISABILITY INSURANCE_-____--- 23 
: rere ROGRAm: 16DOING.v4seceee wee tte eee ee 24 
Poona TeRInG THE PROGRAM 2202205 0200 ool eon eee 28 
: LEGISLATIVE DEVELOPMENTS DURING THE YEAR_____________-_-_----- 31 
| ff fessiond 01 -the 1955. Amendments. oi Sublets 31 
Apvisory CoUNCIL ON SociaL SECURITY FINANCING______-_-______------- 35 
SPECIAL STUDIES REQUESTED BY THE CONGRESS___________--__-____--_- 35 
SURVEY OF RESOURCES OF OLD-AGE INSURANCE BENEFICIARIES_-____--- 36 
PEGCRAM GIMPLIFICATION PRogmorl: ooo. Se eee 37 
Pre CUP a ROGRAM 2a... ae ee eee eee eee eee Usk SU at 
RN ee ee 38 
| 1958 AMENDMENTS AFFECTING PuBLIC ASSISTANCE_____________-_-_-- 39 
TRENDS IN CASELOADS AND EXPENDITURES_-_____-____--------------- 40 
SIGNIFICANT TRENDS AND THEIR IMPLICATIONS_________________------ 43 
Peer WOR VELOPMENTS..... | 2 ee ee te ee eee ne 47 
| Strengthening Services for Needy People___________------------------ 47 
| ivelatearmocial Welfare Activities.._._.__.__.____....:_-:---.-.-L-_--_.- 50 
emiterRATIVE DEVELOPMENTS._._....-.---.- 2012.2 LE LULL 51 
Demet MAU a a ee 53 
SomE Facts anp Ficures ABsouT PARENTS AND CHILDREN___-____------ 54 
PREPARATION FOR THE 1960 WuitEeE Housre CONFERENCE ON CHILDREN 
RR Oe eee rests ae ne ee ce 55 
FEDERAL INTERDEPARTMENTAL COMMITTEE ON CHILDREN AND YOUTH-- 56 
Seer Mee OreTHE DURRAU....---ca-o2 oo teturol fh wo te eee DAR 56 
Meret id se. 8 we ed) titer) Do Quins 56 
| Seaternal and: Child Health Services._._----------suu2nle ly eeeueusLt 57 
255 


256 Department of Health, Education, and Welfare, 1958 


Crippled ‘Children’s Services. 2.9.22 2 2o 
Child: Welfare Services. .o.......--...5.2..22222.22-2.22- 4. 
Juvenile Delinquency Services- 22.22 ci Shs ee See 
International Cooperation... 2222. .ssieae cee. os 
Information for Parents and Those Working With Children_______-_---- 
FEDERAL CREDIT UNIONS= 2 Ut o> oo ee 


~ oh TaBLeE 1.—Social Security Administration: Funds available and obliga- 


ys 


« 
aK 
i 


/ 


tions incurred, fiscal years 1958 and 1957.....-.....--.225 ene 
TasBLeE 2.—Financing social insurance under the Social Security Act: 
Contributions collected and trust fund operations, fiscal years 1956—58_ 
TABLE 3.—Old-age, survivors, and disability insurance: Estimated num- 
ber of families and beneficiaries receiving benefits and average monthly 
benefit in current-payment status, by family group, end of June 1958 


TABLE 4.—Old-age, survivors, and disability insurance: Selected data on 
benefits, employers, workers, and taxable earnings, by State, for speci- 
fied periods, 1955, 1957,. and 1958_c._._. 2. ..2. 2 

TABLE 5.—Old-age, survivors, and disability insurance: Selected data on 
benefits, employers, workers, and taxable earnings for specified periods, 


TABLE 6.—Special types of public assistance under plans approved by the 
Social Security Administration: Number of recipients and average 
payment, June 1958, and total payments to recipients, by program 
and State, fiscal year 1958.2... eno dee cae ee ee 

TABLE 7.—Special types of public assistance under plans approved by the 


\.: Social Security Administration: Federal grants to States and total 


~. expenditures and percent from Federal funds, by program and State, 
fiscal year.1958_.. i 8 Ben ci ee ic cel ee ee le 
TaBLE 8.—Maternal and child health and welfare services: Grants to 
States for maternal and child health services, services for crippled chil- 
dren, and child welfare services under the Social Security Act, by program 
-and State, fiscal year 1958-0222. sclisecieeeci oe eee 
TABLE 9.—Federal credit unions: Number of members, amount of assets, 
amount of shares, and amount of loans outstanding, Dec. 31, 1935-57__ 
TasBLE 10.—Federal credit unions: Assets and liabilities, Dec. 31, 1957, 
and Dee. 31, 1956 


mm wm we we me a ee we ew ee ew ew ew ew mM eK ee we em we ew ew wm ew we ww ew ew ew ew 


CuHart 1.—Trends in recipients and assistance payments in OAA and ADC, 
Oct. 1950-Juneé 1958.2 2 ee a a 


PUBLIC HEALTH SERVICE 


HEALTH OF THE NATION 
Health Record). 2c sccn oo kee a a 
Births, Marriages, and Divorces 
Influengati.uiscl cu Sonneries) gee 2G] De ees eee 
WOMONIVCLUb IS Ee ne 
FUNDS AND PERSONNEL 


Improvement of Indexing Operations 
Foreign Language Materials 
New Building Program 


—_—_ ee ee ee ee ew eee ee eH Ke ee Ke Ke ee ee ee ee 


72 


73 


74 


75 


76 


78 


80 


$1 


81 


44 


| 
| 


Detailed Contents __ isla Yo. } 257 


Page 
i icra he SUL PET 20 F 89 
Sea Pe METHODS. ive ee Eee 89 
SIE ALG SULVCY cn ee eee eee SY Lie bese 89 
SenTecOuTee ulldies...< 2 ee ro Sere eee 89 
Peete, INGOT LOULES OF HEALTH... cliente ab Aegis 91 
eur een en sew OL Put See ld 92 
SSEVISION. OF DIOLOGICS STANDARDS. 20LU00 02. 2c ee elk 92 
PeIvVISION OF RESEARCH GRANTSLLULoUUL lee be lee ee 93 
eee eeCHS. Ce Lea Oo eee, ar biol sue 94 
INSTITUTE OF ALLERGY AND INFECTIOUS DISEASES___________-_-___-_---- 94 
mmemeermnorced Weseareh. in josie lived laud lebonla lire 95 
INSTITUTE OF ARTHRITIS AND METABOLIC DISEASES___________________- 95 
MEM A OTS ow ee SS TULA LL ANd gi) 26 _ee 96 
IN a Fae gg errr eraser oT E 97 
Ee twee od Seta 98 
Bee eemoorted. esearch... J Le te 99 
Peeerroreon DENTAL RESHARCH..........-—---<ncu<--.-) 220s gue i 99 
ERIS SE STURT atc REIS llr oe Se a a No ee, 100 
ee owe nen eenn ee eee 100 
Grant-Supported Research_______- eM I enim ae Us See 102 
ere et TI At eH INSTITUTE... 2... Less kL Lek oe ee 103 
UE tek PAN. ee eee ee UU 103 
ei een dase ebunrd. 104 
I AOC ee awk cea meee nee eae 104 
eI MOTNCEIICS. oc oe ce hoe we ne seen nde UL eee 105 
INSTITUTE OF NBUROLOGICAL DISEASES AND BLINDNESS_____________--- 105 
means oupporsed Wesearch _............J0220eT lel lee 106 
fe) Or MEDICAL SERVICES.......--...-eecre Ollie _eecus 107 
HOSPITALS AND OUTPATIENT FACILITIES___________________-_-___----- 107 
IE ROG a Soh OG OTIS TOr Wis) ode 8 be oi 108 
ee oc ek ee I Be 109 
I ng a be ce awn e SOUL DIES Boy) iy 110 
EMA 1GRG Oto. te Kee an uwaneun nen QU Lee 110 
Federal Employee Health Services. __.....______.___.--___---------- 110 
eee OCONEE Lae yal 
Dee PEUMBANTING £ 2c. u ek... 0 ldey SOMIUIe s soled See Voge 112 
rer Onat hranic Volume... ...2c2.2.2. <u ites) Pee Se 112 
IIS OI NOLIONS oo. od we coca ee ccc encaden ohio Te oe Bie 113 
Peer eransine Activities... 8Cyl Yeo iawel_ bee eld aveiee 114 
Pete maviCEs SOR INDIANS... ..<~<«+<+=-s-+-eeeeee- DS HOLL Ue 114 
RE OCW ICCB i wane eee ene ULL EO 115 
Beenie. tealth services... .. 1.202200. eeu eel 288 Seed 116 
IE CIGRC QOUETOM 2 ke ce eee neee SOS io oeoly as 117 
OAC ns oe hae neo ann ene eter IR 118 
rm miotnersiand Children 0... 22c keen ns ee cee eee SU 118 
ERICA es ed 2 ee eee damien oe OEMS LS JSC TOY 119 
ee ee i i ae ee Pe id a eek rene 119 
HEALTH FACILITIES CONSTRUCTION SS Seater tae wee 119 
(manging Needs. and Emphasis.......scu 2022.22. ee -.120 
feeeero in. Lospital Management.........-.<<.-.--.-<--++++-0109 ~ 120 
MIELAGTONG 20028072 Jk loos Seal eevee nase de eecertaceue wl 121 
TN ton ral a ca aic wow Phe VI 4 TATE AL BO KOITERS 
TES a dace wae ccbbancsens BOL 121 


258 Department of Health, Education, and Welfare, 1958 


Page 
Studies of Prepayment Plans__.___._----------- bee ete nen 122 
NURSING RESOURCES Ou ooo eee et enince vod. 5. LORS 123 
Nursing and Patient Welfare....._..-..-..-.....---. 2222 ee 123 — 
Do Nurses“*Know” Their Patients?__........2.....-2ciug ae 124 
Professional Nurse Traineeships... 0222021 2222 Lee ee 124 
Research Grants and Fellowships........------<--=.--<---4-~- see 125 
MEeEDICAL SERVICES FOR FEDERAL AGENCIES___.-..------------------- 125 
United States Coast Guard, Treasury Department___-_-_..------------ 125 
Maritime Administration, Department of Commerce-__----------------- 126 
Bureau of Prisons, Department of: Justice.i+_oo2 21 _b22 see 126 
Bureau of Employees’ Compensation, Department of Labor__.._-------- 127 
BUREAU OF STATE SERVICES... be) 200 oe 
Division oF GENERAL HEALTH SERVICES.._.._.-../----. ee ee 127 
State Granta es ee ee ee eee 128 
Arctic Health Research Center. 222.05 0-222. 128 
National Office of Vital Statisties__..- 2-2. > eae res aS 129 
Program Development... -.-- 2 Je eee ee 129 
PRATT i I ee oat a ea 129 
Public Health Education._o0.-- onl Le eee 130 
Public Health Nursing. -..---.--..--L.-2--2 2 130 
Division or Sprcitan HEALTH SERVICES... =..--.-u2l0i 282 Lape 131 
Accident Prevention... oo ee ee ee eee 131 
Cancer. Control. ooo ee 131 
Chroni¢e Disease Control. eee 132 
Heart Disease Control... encee oc bbcdececcccce see 132 
Occupational Health Program. 2ssi- oi2- as 422. 2 ee ee eee 133 
Radiological Health Medical Program.__._.-_------=l4--225_- D223 
Tuberculosis’ Control_-.. J eee eee 134 
DIVISION OF SANITARY ENGINEERING SERVICES_-_---------------------- 135 
Robert A. Taft Sanitary Engineering Center__-_____-_----------------- 135 
Air Pollution Engineering Program _..-_.------.-.----1-.) 222 135 
Engineering Resources and Training. ..-.....:--.-+-...-.-225225==—e 136 
General Engineering _..-...22220-222-24---2-22--22254e4eeeeee 136 
Milk and Food Sanitation Program. ...-....22.2.22) dee 137 
Radiological Health Engineering Program-_-_-_--..------------+---=---++ 137 
Water Supply and Water Pollution Control_-__---.----------- Beer Mites 138 
COMMUNICABLE DiskasEe CENTBR...-2---.---:---sesi¢d2¥_ eee Lec ee 
Epidemic and Disaster Aid__.......=..-.-.---..--.--. 392230 139 
Representative Field and Laboratory Studies____-___.-_---------------- 139 
Asian Influenza__._..- 2 sec-onne2--h- 2 see ee ee 139 
Venereal Diseases.._..-2 2-0-4 --e-2eceeee eee nce eee eee 140 
Poliomyelitis and the Polio-Like Diseases____.__------------------ 140 
Staphylococcal Infections... ....2-2-------+225+i--25 eee 141 
Viral Encephalitis... -- 2-2 --cse5 deo see eedeccne ole 141 
Rabies: i.e ob oe ere eee eek een ea be ee 141 
Diarrheal Diseases... eesoseceet eee scene ee ee 141 
ANENTEX ob Mee. BN ee ee ie icy hae 141 
Plagues eee een cee lcd ees etek. eee ee eee 142 
Laboratory Services and New Techniques__._._-______.-______--_------ 142 
Vector Control._ oil... +- ean eee ecede lL 
PUMP RAT Ye  Ns SO ee rack aol i ae te ye rrr 143 
Division or Dentau PusBLiic HEALTH... _-____-----------+-2-e2--- aul aie 
Fluoridation (i222 el babe ee eed ee oe 


Detailed Contents 259 


Page 
IRN CM rN Re Seo a bee oe ae 144 
PievisiON OF INTERNATIONAL HEALTH....___._..-_-_----_------o-c--u- 144 
TaBLE 1.—Statement of appropriations, authorizations, obligations, and 
emreseiiseal year 190582. Jes fol Ps 0 ee Sa eke 145 
TABLE 2.—Commissioned officers and civil service personnel as of June 30, 
ik gio AIR a ce Be Sele, adn 2, Ma nm a ee 147 
Taste 3.—Research grants and awards, fiscal year 1958________-------- 149 
TABLE 4,—Payments to States, fiscal year 1958____.____.-------------- 150 
OFFICE OF EDUCATION 
DUNNE RINGONRL 9 het nes oe ee ee ee ace Se OOO HOA 153 
Re eer HUCAUIONs 3 Acie c bee Meee eee ue de ce Beye ES 154 
oid DU CATIONAL OERVICHES..o222 5550205) o Cue oo Oye EL Ee 156 
Pet error ADMINISTRATION. 022 6cs02c0ee =. 6 lec ken PSOE 158 
ULIMIT ENG ee berate oe a ee epee se eee eeee cen eS Se 159 
een ete OIsTRICT ORGANIZATION 220) 82 Se SE oe Sue SB 161 
PAD IDUMGRENE ) Shir eltete o lo Se eee kde ne oe SON 162 
De ee DUCATION «<4 22-- 522 5i5eenlsatbeeenecucn SVP Dee 162 
Err R Pactice 24. ACU See, ae le ee STOOL LE TOUS 163 
ir hen. pe cee ee eee een ee UR. SET So FY 163 
mem ettonse-the-Gilted-or Talented.....2....225Y 03252 222400 lez 164 
fee ani (oradies;4>0-0.2. 220. < 2 PPP hs ee A 164 
MINA ne oe So ee enc eee beet cece ee cence uel 165 
Reem NOTOD £3 et koe eee ee ee A eS A eee 165 
Perurmen OED UOCATION <2... .<nccecceseccucusuen JULI TALS. FLY 166 
PROBLEMS, NEEDS, AND TRENDS IN SCIENCE AND MATHEMATICS---_------- 167 
meteat Tomien Areas and Needs..~- 0. ee ee 167 
Burvey o1 mcience and Mathematics Majors__..-_-2--_-2--_----2---_- 2. 168 
ee ne te ee ee ON Dea eae oat 169 
ee ene TUDENTS. o> eT te eee eee es Se ete ee 170 
SUE OUSeune 2. ee ee ee ee 7a 
Petar AIS TO MDUCATION..-~ .. it eR ae jr es! 
REreeImECuCALION- 2... 2-2-2 2-22 cee ee eee tle LLL LL 174 
MER UPS She en ee ee oe eee ee 176 
Sree SONAL IIDUCATION-3 4-2) 3 2.2 8 Bib AT eS Ue LL Rs Ware 
RR ets er i ie am eee S 178 
I OR TEON ee aN gee ee. ok, cg Do ei pelle wee yore see 182 
pera ctension- Of Facilities. oc 268 ce ee eet oe ee owed ogee eee 183 
Development and Modification of Educational Programs_-__------------ 183 
Improvement of Organization and Administration__._._._.__._____------- 183 
Assistance in Planning and Conducting Surveys__.__-.---------------- 184 
PEt TODOSAICN 8 wo ery rere OE acest - ye be 184 
Research and Studies in Higher Education.___._...._.____-------------- 185 
ASSISTANCE TO SCHOOLS IN FEDERALLY AFFECTED ARBAS_._------_------ 185 
RO ee eG EE EF Beth ee tee eB 186 
Eri ESE ARCH ccs gS. oS Be i i ce ear ohh ine 187 
INICIO, SS ee oy ee ee ee ete ee 188 
EE) Se lOmin ee ee ee eg ere ee ee 189 
a SR ae Oe es < ee ee ae eh ee eer eer rn 189 
Musreryepervices for the Aged... adn} ecw ct ewe awe: au wee yniee 190 


Bea OreADrary Ser ViCCSpeula ne. On os a8 enced! Jobe cut teles Be 190 


260 Department of Health, Education, and Welfare, 1958 


Page 
TABLE 1.—Enrollment in the continental United States, 1956-57 and 
195/-538.... eae on oe oh een eee Som ee see er 191 
TaBLE 2.—Supply and demand for elementary and secondary public and 
nonpublic school teachers, 1957-58... -s----<..3--Leese eee 191 
TABLE 3.—Grants to States: Office of Education, fiscal year 1958______-_ 192 
FOOD AND DRUG ADMINISTRATION 
Foon, Drue, ann Cosmuric Act! 20222. eo eee 197 
On the Food Fronti2s. 2.248 40 cs dace Sake Sa el 197 
Potential Health Hazards-~_2< = =. ..2 2 See 198 
To Keep Food Clean.2.. . 2.222 ae ee o-oo oe eee 199 
Pocketbook. Protection.......=.--2sce+--+-+- 2 2 oot 201 
Products of Special Dietary Significance____._._.___....._._._.------------ 202 
Drugs and Devices_.-.u_ 2. Jos eee ee ee ese ee 203 - 
Megal Saleso.s. fu... wesecseenccecse seee Le betes ee 203 
Adulterated and Misbranded Drugs and Devices_____-..__-.-_---- 204 
New obruge Cpl) ao ee ee ee eee |. a 206 
Cosmetics and Colors. .....-..-++.2--+kb-e2s-- 122 ee eee 206 
Certification Services...-...20) 22 2b Su2 cect cen eee 207 
ENFORCEMENT OF OTHDR ACTS....---.---2e>-+- eee see 207 
New Court. INTERPRETATIONS... ..-.-..-Letesuch 2. bo eee ee ee 208 
CHANGES IN THE LAW AND REGULATIONS. ..__.---s-l22-2d4226 see 208 
Reoulations.o0. 0 20s eee be he a eh 209 
ScIENTIFIC INVESTIGATIONS. ......--<---s+---2--+-+i...-l. 4eeeee ss eee 211 
ENFORCEMENT STATISTICS. 2. oe ol eco euaes ee eee 213 
TaBLE 1,—Actions on foods during the fiscal year 1958____._____----_- 200 
TaBLE 2.—Number of samples on which criminal prosecutions and 
seizures were based and number of court actions instituted during the 
fiscal year 1958.0... o2e- Sec e_ e 214 
TaBLE 3.—Import samples collected, examinations made, and lots detained 
during the fiscal. year 1958.20 20.2... --.- ne neemenn ee oe 214 


OFFICE OF VOCATIONAL REHABILITATION 


SERVICES TO THE DISABLED EXPAND THROUGH ENLARGED RESEARCH 


PROGRAM AND ATTACK ON SEVERE DISABILITY_________---_-_-_--_---- 215 
Rehabilitations in 1958220 2232 ee ee eon es, eee 218 
Economic Value-of the-Program 2-2 22 iL Ue olla eee 218 
DEMONSTRATION PROJECTS IN SELECTED CATEGORIES OF SEVERE Dis- 

ABILITY APPLY RESEARCH -FINDINGS-< -=252=-22222-52>°22 eee 219 
Selected Demonstrations. .22222222.J200222UL) Seu oe I eee ADI 
Research and Demonstration 2-2 ee SoCs 2 Ore eee meh 220 
TRAINING PRoGRAM Grows WitH EmpHAsiIs oN MEDICINE, SPEECH— 

HEARING THERAPY, PROSTHETICS, AND COUNSELING_____------------ 221 
Rehabilitation Medicine-==...-...2.22..2<22-.2_2i2-2.-22-J22eee 221 
Counseling .--2isc-ss2Se2ccacenclccdceceuces seen =) 222 222 
INCREASED State-LocaL Support BRINGS A GREATER NUMBER AND 

USEFULNESS OF REHABILITATION CENTERS_____________--_--_---_---- 223 


Detailed Contents 261 


i Page 

REHABILITATION SERVICES FOR THE AGING ASSUMING IMPORTANCE AS 
at hEveRRALS CoNTINUVE To Rise. 2..-.._.-.-_-..-5-4--.- 225 
EE se en ee ae 226 
SGmeEe et ett) TIN oo) oo ee ee eee DWP 
Pencineg stand Program_...___......-_-_.-_- ich Te i eI ee Nags eee te 237 
Pee eiiecs. 6 fae gets gt Fi ek ge ee Sb 228 
PooreraTion Wit Pusnic ASSISTANCE. _____..._....-- 2.2. .e 228 
PE EUS Ser ee cee ed ee echt. th geen 229 
STaTE ADMINISTRATION DEVELOPMENT. ______________ === 229 
Prate mtall [raining ___.__--2--------. CRANE Nore Og eee ghiee ae de eee 
MRP MerOw EP EDERAT, GRANTS... oo eco wee ee eee ewe doi ossed A hue 231 
NR eee ee he ower ahh eae ud a PM 231 
Study of Bridge Provisions for Matching Requirements_______________- 233 
Mn eC AGIOS i oie el eee eee ene BED 233 


TaBiLE 1.—Number of referrals and cases, by agency, fiscal year 1958____ 235 
TasBLeE 2,—Vocational rehabilitation grants, 1958, State divisions of 


PIN mic MAIILAWON Joo oo. Soe ee el ee eke 237 
,/TasLE 3.—Vocational rehabilitation grants, 1958, State commissions or 
meee INC) 20 oo ee 2 ck een 238 
Y Cuart 1.—Disabilities and major occupational groups_____-_-_-_------ 217 
i™ 


SAINT ELIZABETHS HOSPITAL 


Seette gt oe VEDICAL SERVICES... 52.2552 Le een skew een ee 240 
IE a ate ee a OR Le is 240 
Pree rene ourgiceal Branch... ese ee eae 242 
DNR PONC 6  oe at  o er S e ewe ee e 242 
IM TC eo oe Le Se 242 
Beret ome neraby branch. 90224 6 ee ee ee ek 242 
DeperreeeryaCes TO nClh 28 ol ee ee 243 
Bmemmeeretenerany Dranch.-. 22 eel hae eee ce 243 
CIEE SUN Clie coe ee ee oe Soe lee 243 
ES er iene ee te ee Ve a os 243 
PEE ITCOrds ranch 52. 3 he ea eee 243 
DETR ee ee 244 
Rupr cevaces Ierancho 2. (Jf oe oe ek Lc Le 244 
Bete omOw ADMINISTRATION. ... ..i..2. 2.2.2 L.-..-22- ui Ls. e 244 
DTS TOS EIT AT Oe eee eee 244 
TaBLE 1.—Movement of patient population, fiscal year 1958______-_--- 245 
TaBLE 2.—Consolidated statement of movement of patients, by classifica- 
ESS a, NG lg age AO ge Ee op 246 


AMERICAN PRINTING HOUSE FOR THE 
BLIND 


Services to Schools and Classes for the Blind____________.__-___------- 247 


262 Department of Health, Education, and Welfare, 1958 
GALLAUDET COLLEGE 

Page 

Kendall School... ooo. on Se ee ee 249 

Gallaudet: Colleges oe en ee ee ow ee 249 
HOWARD UNIVERSITY 

Enrollment. of Studentss: is. .L 55h liso 2... J. case 6s .2s es oe ee 251 

Geographical Distribution of Students_...._......._...-..---2 2s 252 

MOlCTANS sii cick duet gk ae ess Sg Gwen aE nem bs 252 

Army and Air Force ROTC... .......2---22-<.0-<20540.5 ee 252 

The Facuity...u. sc.cuss ousce naan anna om donate ee es 6 oe ae eee 252 

Tie Building. Program... 22122 ssU 22 Se ae 253 

PL, a a TOE 253 

Service in Foreign Countries_.......----.--....-.---.. 255-25 eee 254 


U. S. GOVERNMENT PRINTING OFFICE: 1959 


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