——— %) rat WQreee =—— i | —s see B fi yy, Bele = \\:\\' AZZ )\" la SS M.C. MIGEL LIBRARY ~ AMERICAN PRINTING HOUSE FOR THE BLIND US. Departmem Qucation, a For sale by the Superintendent of Documents, U.S. Government Printing Office Washington 25, D.C. - Price 75 cents (paper) U.S. DEPARTMENT OF HEALTH, EDUCATION, AND WELFARE As of June 30, 1959 ARTHUR S. FLEMMING, Secretary BertuHa 8. ApKINS, Under Secretary OFFICE OF THE SECRETARY Evuiot Lee RIicHARDSON . . Assistant Secretary (for Legislation). Epwarp Foss WILson. . . . Assistant Secretary. | Aims C. McGuinness... . Special Assistant for Health and Medical Affairs. Rospert A. ForsytHE .. . . Legislative Liaison Officer. JAROLD A. KignFFER ... . . Assistant to the Secretary. eee Arr ee Le Assistant to the Secretary (for Public Affairs). Ropert H. Hamuin .... . Assistant to the Secretary (for Program Analysis) . Paeen VM. BANTAS. \) YS 2°. General Counsel. Rurus E. Miues, Jr. . . . . Director of Administration. CHESTER B. Lunp. ... . . Director of Field Administration. Harvey A. BusH ... . . . Diérector of Publications and Reports. FrEeDERICK H.Scumipt .. . Director of Security. SOCIAL SECURITY ADMINISTRATION WiuuiaM L. MitcHett. . . . Commissioner of Social Security. Grorce K. Wyman... . . Deputy Commissioner of Social Security. VicToR CHRISTGAU .. . Director, Bureau of Old-Age and Survivors Insurance. Jay L. Roney ... . . Director, Bureau of Public Assistance. J. DEANE Gannon .. . Director, Bureau of Federal Credit Unions. KATHERINE B. OnTtrinceR. Chief, Children’s Bureau. PUBLIC HEALTH SERVICE Leroy E. BurNEY ... . . Surgeon General. JoHN D. PorTERFIELD. . . . Deputy Surgeon General. JAMES V. Lowry .. . . Chief, Bureau of Medical Services. CHARLES E. BurBRIDGE . Superintendent, Freedmen’s Hospital. DaAvyip HEH) Prick. . .. . Chief, Bureau of State Services. James A. SHannon . . . Director, National Institutes of Health. OFFICE OF EDUCATION LAWRENCE G. DerRTHICK. . . Commissioner of Education. WayNnE O. REED .... . . Deputy Commissioner of Education. FOOD AND DRUG ADMINISTRATION GerorcE P. Larrick. . . . . Commissioner of Food and Drugs. JoHN L. Harvey ..... . Deputy Commissioner of Food and Drugs. ili iv Department of Health, Education, and Welfare, 1959 OFFICE OF VOCATIONAL REHABILITATION Mary EH. Switzer... . . . Director of Vocational Rehabilitation. E. Emory Fereser.... . . Deputy Director of Vocational Rehabilitation. SAINT ELIZABETHS HOSPITAL WINFRED OVERHOLSER. . . . Superintendent. VACANCY #60, 2c lio we. RE PL Assistant Sm peritendent. FEDERALLY AIDED CORPORATIONS Finis Davis. . .... .». . «. Superintendent, American Printing House for the Blind. LEonARD M. Eustap. . . ... President, Gallaudet College. Morpecal W. JoHNSON. . . . President, Howard University. REGIONAL DIRECTORS LAWRENCE J. BRESNAHAN. . . Region I, Boston, Mass. JosEPH B. O’Connor. ... . Region II, New York, N.Y. EpmMunpD W. Baxtsr. .. . . Region III, Charlottesville, Va. RicoarpD H. Lyte... .. .. Region IV, Ailanta, Ga. Meuvitte H. Hoscw. . .. . Region V, Chicago, IIl. JAMES W. Doarn.. . .. . . Region VI, Kansas City, Mo. JAMES H: BOND: . > geetthatiwt ah OUIO7A ea as. ex ALBERT H. RosentHau. .. . Region VIII, Denver, Colo. Fay W. HUNTER.) 1.2 «den aleegion IX, San Francisco, Calef, Letter of Transmittal DrparRTMENT OF Heattu, Epucation, AND WELFARE, Washington, D.C., December 1, 1959. Dear Mr. Presipent: I have the honor to submit herewith the annual report of the Department of Health, Education, and Welfare for the fiscal year ending June 30, 1959. Respectfully, a) \ Secretary. THE PRESIDENT, Tue Wuitr Hovss, Washington, D.C. VuSVI1V as IIWMVH Bo i nnjouoy = » aseroyouy VNVISINO'T [ ~_— ee Al ! eae} SONV1Si NIDUIA “ODI OLWINd a Sere LEA r— ee SVSNV a Ayio sesury s+ < SVSNV™ TYNOSSIN \ H wa ee |! : x SSN wvnsd | SVXAL | VNOHVIMO ; we a an aasonorTne ~~ V xnonin f = / ( i \ 1 a SIONITHU vole Nd -————- osvotyd mh VuS Sa ERE IN NV DIHOIN —_ . ONTO x — Ms» VLOM : OAV HonOs e. NISNOOSIM ~ V LOSAUNNIN \ 4 SadIJjQ pue Salepunog jeuoisey JUVITIM ONY NOWWONGI HLIWIH 40 LNIWLYVd30 S$“ Contents Soria security Administration. ......... . None dHealth Service. . ..... aloes |: eases Ofeeo fiducation. ........ ie PO ae Food and Drug Administration Office of Vocational Rehabilitation. . . . . 1... Saint Elizabeths Hospital. . . . ... American Printing House for the Blind... ... . Gallaudet College . 7 Harmard University... 6.606 ao brn ieon nie) bitver % ve detailed listing of the contents of this report, by| topic headings, will be found on pages 261-268. ; . \ yi & 1 ' "he $. ¥ ro " end, F . 7 f ia a oi i, j re ot i y ' —- ‘Se a Ke ; im , Thin ; ‘3 ne 2 Af 5 a % a ee Pe ae iby 7 \, i } \ . ay Aitio: % Bec iJ “ ; i , é ) tv by ' n ‘ ‘ y ‘ ul ld : t ripe. \ ee > > ‘ “ y . a i : j i i! Cc ' \ . . ’ ; - “ + : h i . b . * , : ay ¢ 7 ¥ WP ei oa ‘ * re 43 RO th ater yer ae hy a Se ; ie MA) Le ria un imdohean hi ort eae rs { ee emeeell died alt ae ie po Re ie Taps “+ ie ’ a ar ri i | Gs a Bek ae fk t) Ame te, A x : ‘ A init hee . f t 7 ‘ ry. % 2 i. 26 se ioiiebe Rio ‘ Y ee i , ? ‘ L #4 x ; Y 4% 9 yer rip yay ky ah, se a. %e fa Why ' e 5? be: i P sy ‘ pe eo aay Oe ey j ce L nylttene oat, Fo aba tano'y Veh ae, teaeze rt lip Tiasie ‘ i ; « f oe us rai gS ; 54 fee) Bei Geary “qh ii sr ayant ‘ e fl i Py i ie ie Z f, ¥ 4 i im, a F ; , 4 ‘ rab ; i a’ y T ‘ 4 4 if ? Mel a hy met ui ie ‘ ' : \. . Py ye? 3 y 2 , oY Wtitis.. \ fi = iy y) : pal a: ‘ ; so PY sets oe Wn merit Fe > ‘ ; an hes Gono WAR ; ij ‘ . sap tae Ah ae, a) i f ( fk U / Me by. at ‘4 nl ) ¥ ivf 4 1, R ; a 14 f j ; Diecw Geile ois Taccart a Tas Senet , 3} « ¥ M ' ies | y “ . fh \ y t f j Ya i Social Security Administration Social Security in 1959 IMPLEMENTATION OF SIGNIFICANT AMENDMENTS to the Social Security Act that were signed into law by President Eisenhower on August 28, 1958, highlighted program developments in fiscal year 1959. Pro- grams were reviewed and evaluated in the light of current fluctua- tions in the national economy and the long-run rise in productivity. Studies of the ways in which they affect families and how the effects may be made most constructive, additional research and services which may strengthen families and communities, and technical studies relating to insurance protection against the costs of hospital and medi- cal care were carried forward with increasing stress on long-range national goals for social welfare. William Lloyd Mitchell, who joined the staff of the former Social Security Board in 1936 and who served for 12 years as Deputy Commissioner, was sworn in as Commissioner of Social Security by Health, Education, and Welfare Secretary Arthur S. Flemming on February 4, 1959, to succeed Charles I. Schottland. The 1958 amendments advanced long-range national goals for social welfare in a number of ways. Among the most important, old-age, survivors, and disability insurance benefit amounts were increased in recognition of rising prices, monthly benefits were inaugurated for dependents of disability insurance beneficiaries, and the financial soundness of the program was further secured. The new formula for Federal participation in public assistance payments provided ad- ditional funds to all States for aid to the needy, more flexibility in meeting medical care and other special needs of assistance recipients, and at the same time recognized the varying fiscal capacities of the States. Federal funds allotted for child welfare services were made 1 2 Department of Health, Education, and Welfare, 1959 available to urban areas, deleting the previous requirement that such funds be used in predominantly rural areas and other areas of special need. Under the schedule in the law, old-age, survivors, and disability insurance benefits payable beginning with those for January 1959 were increased by about 7 percent (more at the minimum) above the levels provided since the last increase in 1954. Primarily as a result of the increase, the average for retired workers receiving benefits at the end of June 1959 was $72.19 compared with $65.71 a year earlier. The average monthly benefit awarded to the worker coming on the rolls in June 1959 was $80.82 compared with $74.03 the previous June. The 7-percent increase largely restored the 1954 value of the bene- fits. At the same time, the maximum amount of earnings taxable and creditable toward benefits was increased from $4,200 to $4,800 effective in 1959 to restore the relationship between workers’ taxable and total earnings that existed in 1954. The new matching provisions effective October 1, 1958, in the four federally aided assistance programs were reflected in a $6 million increase in total payments under the programs for that month. Some States raised their average monthly payments. Others that had scheduled reductions in average payments because of larger caseloads resulting from the recession were able to maintain about the same average. After reaching a peak of $311 million in March 1959, total monthly assistance payments, including general assistance—available in some parts of all States and financed entirely from State and local funds—showed a net increase in June 1959 over the previous June of $18 million and amounted to $303 million in June 1959. Toward the end of the fiscal year, improved economic conditions and favorable seasonal influences were discernible in the monthly changes in general assistance caseloads in States where this aid is available to employable persons and in the number of persons receiving aid to dependent children. Total general assistance cases declined for 3 consecutive months from 480,000 in March to 388,000 in June. General assistance caseloads had reached a previous peak of 454,000 in April 1958, the same month that industrial production reached its lowest level during the recent recession. While part of the decline from that peak was attributable to improved economic activity, part was due to the temporary unemployment compensation program of 1958-59. ‘This program for persons who had exhausted their regular unemployment insurance benefits paid almost $92 million in Septem- ber. For June 1959, total benefits under the program had declined to $10 million. The June 1959 drop in the number of persons receiving aid to dependent children was the first monthly decline for this program Social Security Administration 3 in 2 years, although the 2,929,000 recipients that month was about 200,000 above June 1958 and 530,000 above June 1957. Total payments in June 1959 were made at an annual rate of $1,000 million, compared with $750 million in June 1957. Continuing important trends were apparent in the number of per- sons receiving both old-age assistance and old-age, survivors, and disability insurance benefits. The proportion of all aged persons receiving old-age assistance declined from 18 percent in mid-1955 to 16 percent in mid-1959. At the same time, the proportion of old-age assistance recipients whose payments supplemented old-age, sur- vivors, and disability insurance benefits increased. In mid-1959, 27 percent of old-age assistance recipients also received an old-age, sur- vivors, and disability insurance benefit, compared with 20 percent in mid-1955. The number of persons receiving monthly benefits under the old-age, survivors, and disability insurance program, which has made sub- stantial progress toward universal coverage of the labor force during recent years, passed the 13-million mark in May and stood at 13.2 million at fiscal year’s end. Of these, 10.7 million were age 62 or over, 275,000 were disabled workers age 50-64, 489,000 were mothers caring for a child beneficiary, and 1.7 million were entitled children. More than 2.4 million persons were receiving old-age assistance, 2.9 million children and their adult caretakers were receiving aid to dependent children, 339,000 persons were receiving aid to the per- manently and totally disabled, and 109,000 were in receipt of aid to the blind. Over the fiscal year, social insurance, related payments, and public assistance amounted to about $24 billion. Old-age, survivors, and disability insurance accounted for more than one-third of this total, unemployment insurance (administered by the U.S. Department of Labor and State employment security agencies) for over 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. In June 1959, social insurance, related pay- ments, and public assistance accounted for 6.2 percent of total personal income in the United States. The health and welfare service programs administered by the Chil- dren’s Bureau contributed to the well-being of children throughout the Nation. The Bureau administered grants to the States totaling $43,500,000 in the cooperative Federal-State programs for maternal and child health, crippled children, and child welfare. Preliminary figures from State reports indicated that in 1958 a new peak was reached in the number of handicapped children served 4, Department of Health, Education, and Welfare, 1959 rs rtm aang inant dia init under federally aided programs for crippled children. Some 325,000 children were provided services during the year. Most of the children, 955,000, were examined in clinics; about 71,000 received physicians’ services through home or office visits, approximately 53,000 were hospitalized, and 3,800 received convalescent home care. The infant mortality rate, which edged up again slightly in 1958, lent added importance to the extension and improvement of services for promoting the health of mothers and children. Under the 1958 program, 257,000 mothers received maternity medical clinic services and public health nurses served 554,000 mothers before and after de- livery. About 1,427,000 infants and other children received well-child conference services and over 3,018,000 received child health nursing service. Polio immunizations reached 5,100,000 children through ma- ternal and child health program grants. Further increases in the rate of unmarried parenthood and the grow- ing problem of juvenile delinquency were again major concerns of the Children’s Bureau. Within its capacity, Bureau staff provided expert consultant service and worked with a wide range of agencies in these problem areas. The Bureau of Federal Credit Unions marked its 25th year of self- help on the anniversary of the signing of the Federal Credit Union Actin June 1934, At the end of June 1959 there were more than 9,300 active Federal credit unions with 5.4 million members and assets total- ing $2.15 billion. | The Social Security Administration had 26,322 employees at the end of June. The great majority of these employees were in district offices and other offices of the Bureau of Old-Age and Survivors Insurance. Indicative of the constructive concern of the American people with questions of income security, health security and the adequacy of so- cial services were plans for the decennial White House Conference on Children and Youth in 1960; establishment under the Social Security Amendments of 1958 of advisory councils to review the status and financing of the public assistance programs and the extension of child welfare services beyond rural areas; the intensive study of hospitali- zation insurance for old-age, survivors, and disability insurance bene- _ficlaries made by the Department at the request of the House Ways and Means Committee; and preliminary planning for the White House Conference on Aging in 1961. The National Committee on the 1960 White House Conference on Children and Youth met for the first time in December 1958. They discussed preliminary plans and chose the theme of the conference: “to promote opportunities for children and youth, to realize their full potential for a creative life in freedom and dignity.” Social Security Administration 5 The Secretary of Health, Education, and Welfare in January 1959 announced the appointment of the 12-member Advisory Council on Public Assistance to serve with the Commissioner of Social Security as chairman. The 1958 amendments provided for the establishment of the council and directed it to review “the status of the public assist- ance program in relation to the old-age, survivors, and disability in- surance program, the fiscal capacities of the States and the Federal Government, and any other factors bearing on the amount and pro- portion of the Federal and State shares in the public assistance pro- gram.” The council is to report its findings and recommendations not later than January 1, 1960. The Secretary submitted the Department’s study of alternative ways of providing insurance against the cost of hospital and nursing home care for old-age, survivors, and disability insurance beneficiaries to the House Ways and Means Committee on April 2, 1959. The Secre- tary said in his letter of submittal that the report “attempted to pre- sent the most important factual information bearing on this subject in the most objective possible manner.” He also pointed out that although the report identified the arguments advanced both for and against Federal action in this area, it made no attempt “to present conclusions and recommendations based on this discussion.” Appointment of an Advisory Council on Child Welfare Services was announced on April 25. The council was established to study the effect of the 1958 amendments to the child welfare provisions of the Social Security Act and to report its findings and recommenda- tions on or before January 1, 1960. Members of the council, which held its first meeting in May 1959, include representatives of public, voluntary, civic, religious, and professional welfare organizations and groups, as well as the general public. The Advisory Council on Social Security Financing issued its report on January 1, 1959. The major finding of the Council was that the present method of financing the old-age, survivors, and disability Insurance program is sound and that no fundamental changes are required or desirable. At fiscal year’s end, preliminary plans were underway to observe during 1960 the 25th anniversary of the August 14, 1935, signing of the Social Security Act. International Activities Wider Social Security Administration participation in interna- tional social welfare matters was evident in many aspects of coopera- tive activities with United Nations and Organization of American States agencies, with nongovernmental international groups, and with 6 Department of Health, Education, and Welfare, 1959 the international committees of national social welfare associations. Staff participated in several important intergovernmental policy meetings or expert groups of intergovernmental organizations and voluntary international organizations. Greater U.S. emphasis on the social objectives of international programs resulted in more requests for technical advice on policy. Exchange programs expanded, with requests for services from non- governmental agencies showing an increase. More U.S. social workers sought study opportunities abroad. Prominent among the organizations to which the Social Security Administration furnished advisory and other service were the United Nations Social Commission, the United Nations Children’s Fund, the International Labor Organization’s Committee of Social Security Experts, and the Inter-American Economic and Social Council and the Inter-American Children’s Institute of the Organization of American States. The Social Security Administration also participated in planning for meetings of the United Nations Economic and Social Council; the United Nations Special Fund; the Commissions on Status of Women, Human Rights, and Population; and other assemblies. A highlight of the year was the Ninth International Conference of Social Work in Tokyo, with 42 countries represented. The Social Security Administration was represented by the Commissioner, the Chief of the Children’s Bureau, and the Chief of the International Service. Associated meetings included the Ninth International Con- gress of Schools of Social Work, the International Study Conference on Child Welfare, and the Pan Pacific Conference on Rehabilitation. During the fiscal year the Social Security Administration’s Inter- national Service planned training programs or conducted training sessions for 987 nationals of 72 countries. Applications for the train- ing came through the International Cooperation Administration, the United Nations, the World Health Organization, and increasingly through the Department of State exchange programs, various govern- ments and embassies, and various foundations and agencies. Applications through the United Nations for training reflected the major trends characteristic of the evolution of social services in various parts of the world. The United Nations Bureau of Social Affairs reported that these trends in 1959 were increased government responsi- bility, increased emphasis on the family, continued development of assistance toward self-support, and continued emphasis on the training of social welfare personnel. As in past years, the Social Security Administration cooperated with the International Cooperation Administration in the nomination and technical support of experts in the fields of social welfare, social in- Social Security Administration q surance, and maternal and child health. The number of experts on duty for all or part of the fiscal year was 14. Five officials of the Social Security Administration made a 30-day firsthand study of the social security system in the Soviet Union dur- ing August and September 1958. Officials of the Soviet Union, in turn, made a similar visit to the United States in November and December. The U.S. team consisted of the Commissioner of Social Security, the Director of the Bureau of Old-Age and Survivor In- surance, the Chief Actuary of the Social Security Administration, the Chief of the Division of Technical Training of the Bureau of Public Assistance, and the Assistant Director in charge of the Division of Disability Operations of the Bureau of Old-Age and Survivors Insurance. Old-Age, Survivors, and Disability Insurance Speaking at the ceremonies marking the cornerstone laying of the new headquarters building of the Bureau of Old-Age and Survivors Insurance, the Secretary of Health, Education, and Welfare referred to President Eisenhower’s characterization of the old-age, survivors, and disability insurance program as the cornerstone of the Govern- ment’s effort to provide for the economic security of the American worker and his family. Expressing his own belief that it is a corner- stone well-laid, the Secretary attributed the success of the program to the application of sound management principles and to the fact that, despite the size of the old-age, survivors, and disability insurance pro- oram, the Bureau has not lost sight of the individual whom the pro- gram is intended to serve. At the close of fiscal year 1959, the number of beneficiaries receiv- ing old-age, survivors, and disability insurance benefits reached nearly 13.2 million—about 1.3 million more than at the close of fiscal year 1958. Some of these new beneficiaries came on the rolls as a result of the Social Security Amendments of 1958, which, among other improvements, provided benefits for certain dependents of disabled workers and for some dependent parents who previously were in- eligible for benefits. The new legislation also increased benefits for all beneficiaries, raised the amount of earnings taxable and creditable for benefit purposes, and provided a stepped up schedule for con- tribution rate increases. During the year, the chairman of the Committee on Ways and Means of the House of Representatives appointed a subcommittee to 8 Department of Health, Education, and Welfare, 1959 study the administration and operation of the social security laws. At the request of the subcommittee, information for a “Fact Book on the Disability Provisions of the Old-Age, Survivors, and Disability In- surance Program” was prepared by the Bureau and the necessary background work was begun for public hearings scheduled to start in November 1959. The Advisory Council on Social Security Financing issued its re- port on January 1, 1959. The Council stated as its major finding that the present method of financing the old-age, survivors, and disability insurance program is sound and that no fundamental changes are required or desirable. Although the 1958 amendments created new and additional work- loads to which the Bureau had to give primary attention, it continued to make good progress on projects designed to bring about more effi- cient operations and improved service to the public. A major step forward in improving the Bureau’s service to the public was the open- ing of a new payment center in Baltimore for the centralized process- ing of disability claims and foreign claims. The biggest enterprise aimed at improving the Bureau’s operations is a critical examination and appraisal of the total claims process that is being made by a central study group, composed of people drawn from positions of leadership in the Bureau and a management con- sultant from private industry. Asa result of this project, the Bureau expects to make far-reaching changes in the mechanics of doing its job. Work on the new Bureau headquarters building proceeded on schedule. The move to the new building early in 1960 will improve communications between the many units of the Bureau and facilitate Bureau work. A more detailed report of the year’s significant events and accomplishments is given in the following sections. What the Program Is Doing Beneficiaries and benefit amounts.—During the fiscal year ended June 30, 1959, benefits paid under the old-age, survivors, and disability insurance program totaled $9,388 million. Monthly benefit payments during the 12 months were 17 percent greater than the amount for the preceding fiscal year and totaled $9,239 million; this amount in- cludes $339 million paid to disabled workers aged 50-64 and their dependents. Lump-sum death payments rose 5 percent to $150 million. The number and amount of monthly benefits continued to rise sharply. In June 1959 almost 13.2 million beneficiaries were receiving benefits at a monthly rate of $805.5 million—increases from June 1958 Social Security Administration 9 of 1.3 million in number and $145.9 million in amount. ‘The increase in number amounted to 11 percent, and the rise in the monthly amount to 22 percent. The sharp increase in the monthly rate was chiefly the result of the higher benefits provided by the 1958 amendments and the marked increase in the total number of beneficiaries. Among other contributing factors were (1) the repeal by the 1958 amend- ments of the “offset” provisions, under which disability insurance benefits were reduced by payments based on disability payable under certain other programs; and (2) the payment of monthly benefits, beginning with the month of September 1958, to wives, husbands, and children of disabled-worker beneficiaries. Men aged 65 or over and women aged 62 or over made up 10.7 million (81 percent) of the beneficiaries—7.3 million of them were re- tired workers and 3.4 million were the wives and dependent husbands of retired or disabled workers and the widows, dependent widowers, and dependent parents of workers who had died. Of the remaining 2.5 million (19 percent), 1.7 million were children, some 489,000 were mothers, and 275,000 were disabled workers aged 50-64. Almost 2.3 million monthly benefits were awarded in fiscal year 1959, only 200,000 less than the number awarded in the preceding year. New highs were reached for child’s benefits (868,000), mother’s benefits (91,000), and parent’s benefits (6,000). Contributing to the record number of child’s benefit awards were the 61,500 benefits awarded to children of disabled-worker beneficiaries. The record number of parent’s benefit awards resulted mainly from the changes in the 1958 amendments that provide benefits for the dependent parents of a deceased worker even though a widow, dependent widower, or dependent child of the worker also survived. Lump-sum death payments during 1958-59 numbered 757,000, about 20,000 more than the previous high established in fiscal year 1958. About 729,000 deceased workers were represented in these awards. The average lump-sum amount per worker represented in the June 1959 awards was $208.59. In June 1959, the average old-age insurance benefit paid to a retired worker who had no dependents also receiving benefits was $68.30 a month. When the worker and his wife both received benefits, the average family benefit was $120.60. Families consisting of a widowed mother and two children received on the average $166.50. Among beneficiaries on the rolls at the end of June 1959, whose benefits are based on earnings after 1950, the average for a retired worker with no dependents receiving benefits was about $77.60, for an aged couple about $131, and for a widowed mother and two children about $197. Disability provisions.—During the fiscal year, 170,000 workers of all ages were found eligible to have their social security records frozen; 530344602 10 Department of Health, Education, and Welfare, 1959 applications from about 165,000 workers were denied. When a work- er’s social security record is frozen, his insurance rights are preserved and the period when his disability prevents him from performing any substantial gainful work does not count against him in determining whether he or his survivors are eligible for benefits or in calculating the amount of the benefits. Disabled workers aged 50-64 receive monthly disability benefits calculated as though the worker had already reached retirement age at the time his disability began. Disabled workers aged 50-64 receiving disability insurance benefits showed the largest percentage increase in the fiscal year (87 percent) and numbered 275,000 in June. About 86,000 benefits were being paid in June to dependents of disabled-worker beneficiaries. Moreover, on June 30, 1959, there were an estimated 100,000 disabled workers under age 50 with an established disability freeze. By the end of November 1958, the latest date for which this infor- mation is available, about 56,000 persons were receiving old-age bene- fits that had been increased by an average $9.51 a month as a result of having had their social security records frozen for periods while they were disabled before reaching retirement age. The higher benefits were attributable to the exclusion of a period of disability and also to the dropping of as many as 5 years of lowest earnings in the compu- tation of the worker’s average monthly wage when eligibility for such dropout stemmed from the disability freeze. About 18,200 wives and young children of retired workers and about 15,700 widows, children, and dependent parents of workers who had their social security records frozen before death were also receiving larger monthly benefits be- cause of the freeze. For the same reason, lump-sum death payments during the 11 months ended November 1958 based on the earnings records of 10,600 deceased workers were increased by an average of $25.94 per worker. Child’s monthly benefits are payable to totally and permanently disabled persons aged 18 or over—dependent children of deceased, dis- abled, or retired insured workers—whose disability began before age 18. During the fiscal year 28,000 persons met the disability require- ments for child’s benefits and 5,000 applications were denied. By the end of June 1959 such child’s monthly benefits were being paid to 65,000 persons at a monthly rate of $2.8 million. About 10,700 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 69.5 million were insured at the beginning of the calendar year 1959. Some 82.0 million of these people were permanently in- sured—that is, whether or not they continued to work in covered jobs, they will be eligible for benefits when they reach retirement age, and Social Security Administration 11 their families are assured of protection in the event of their death. (Included in this total were some three-fourths of a million women aged 62-64 who were already eligible for old-age benefits but on a reduced basis.) ‘The remaining 37.5 million were insured but would have to continue in covered work for an additional period to make their insured status permanent. Nine out of ten of the mothers and young children in the Nation were assured that they would receive monthly benefits in case of the death of the family breadwinner. An estimated 44 million of the insured persons under age 65 also met the work requirements for protection against the risk of long-term and severe disability. Of the 15.4 million people aged 65 or over in the United States at the beginning of 1959, 70 percent were eligible for benefits under the program. Sixty percent were actually receiving benefits, and 10 per- cent were not receiving benefits because they or their husbands were receiving substantial income from work. The percentage of aged persons who are eligible is expected to rise to 75 percent by 1961. The coverage of the program.—An estimated 73 million persons will have worked under old-age, survivors, and disability insurance during the calendar year 1959. Furthermore, about 1.3 million persons em- ployed in the railroad industry had, in effect, joint coverage under the railroad retirement and old-age, survivors, and disability insurance programs. Altogether, including State and local government and non- profit employees for whom coverage is available on a group-election basis and members of the Armed Forces, nine-tenths of all persons in paid employment in the continental United States were covered or could have been covered by old-age, survivors, and disability insurance in June 1959. Of workers not eligible for coverage, about one-third were covered by other public retirement programs—Federal, State, or local. The remaining two-thirds—7 percent of the Nation’s paid employment— were not covered by any public retirement program. ‘Those without retirement protection under a public system consisted principally of self-employed persons whose annual net earnings were less than $400, and of domestic and farm workers who did not earn sufficient wages from any one employer to meet the minimum coverage requirements of the law. Income and disbursements.—Expenditures from the Federal Old- Age and Survivors Insurance Trust Fund during the fiscal year totaled $9,380 million, of which $9,049 million was for benefit payments, $124 million in transfers to the railroad retirement account and $206 mil- lion, including Treasury Department costs, for administrative ex- penses. Total receipts were $8,109 million including $7,565 million in net contributions and $543 million in interest on investments. Dis- 12 Department of Health, Education, and Welfare, 1959 bursements exceeded receipts by $1,271 million, the amount of the decrease in the trust fund during the year. At the end of June 1959 this fund totaled $21.5 billion. Total assets of the old-age and survivors insurance trust fund, except for $1,067 million held in cash, were invested in United States Government securities as required by law; $3.3 billion were invested in public issues (identical to Treasury securities owned by private investors), and $17.2 billion were invested in securities of varying maturities issued for purchase by the trust fund. The average interest rate, figured on the coupon rate and face amount of all investments of this fund at the end of the fiscal year, was 2.61 percent. The Federal Disability Insurance Trust Fund was created by the Social Security Amendments of 1956. Contributions to this fund first became payable in January 1957. Benefit disbursements began in August 1957. Expenditures from the Federal Disability Insurance Trust Fund during the fiscal year totaled $361 million, of which $339 million was for benefit payments and the remainder—some $21 mil- lion—for administrative expenses. Total receipts were $928 million, including $895 million in net contributions and $33 million in net interest. Receipts exceeded disbursements by $567 million, the amount of increase in the fund during the year. At the end of June 1959, the fund totaled $1,666 million. Assets of the disability insurance trust fund consisted of $1,607 million in U.S. Government securities and a cash balance of $59 mil- lion. The invested assets consisted of $73 million in public issues and $1,533 million in securities of varying maturities issued for pur- chase by the trust fund. The average interest rate figured on the coupon rate and face amount of all investments of this fund at the end of the fiscal year was 2.63 percent. Administering the Program Planning for fiscal year 1959 called for a reassessment of Bureau operations and administration with the objectives of improving their overall quality and of providing better service to the public. This preliminary planning was based on anticipation of a period of com- parative workload stability and relief from the operating pressures which have prevailed over the last decade, a period of rapid program expansion. However, enactment of the Social Security Amendments of 1958 precluded following through completely on original plans. The new amendments, containing significant and far-reaching changes, 1m- mediately increased the volume of work for the Bureau during the fiscal year. To absorb the added workloads and effectuate the changes Social Security Administration 13 in the law promptly and efficiently, the Bureau had to modify its im- mediate objectives. The recruitment and training of new personnel was the first problem to be met. Additional personnel requirements were measured against expected workload increases, workload carryover from the previous year, recruitment possibilities, Bureau capacity to effectively train and absorb the added staff, and anticipated workload levels after 1959. In balancing these factors, a recruitment objective of about 3,300 employees was established ; about 2,800 of these represented permanent staff. Employment at the end of the year was 25,283, a figure fairly close to the staff required to continue Bureau operations in subsequent years under the present program. Approximately 1,000 of the new personnel are district office employees who serve the public directly in the development of claims for old-age, survivors, and disability in- surance benefits. A major task resulting from the 1958 amendments was the conver- sion of benefit amounts for approximately 12 million old-age, surviv- ors, and disability insurance beneficiaries. Benefit rates had to be re- computed and adjusted quickly enough to permit timely issuance of the January benefit checks dated February 3, 1959. The Bureau was able to meet this conversion schedule because of a previous decision to record basic benefit data on magnetic tape which permitted develop- ment of statistical data by electronic equipment. The growing num- ber of beneficiaries had made it increasingly time-consuming and ex- pensive to process and tabulate benefit data by conventional methods. The use of magnetic tape provides a more rapid and economical way to obtain benefit data and greatly facilitates the processing of changes in benefit amounts brought about by new legislation. Immediately upon enactment of the new amendments, the Bureau was faced with the job of making the August checks (issued in September) of about 38,000 disability beneficiaries reflect the increased amounts brought about by elimination of the offset provision. (Under this provision, disability benefits had been suspended, or reduced by the amount of any periodic benefits payable to an individual on ac- count of disability under certain other Federal programs or under State workmen’s compensation programs.) ‘Through use of the mag- netic tape the Bureau met its deadline. To assist the Office of Hearings and Appeals in its efforts to process an extensive backlog of appealed cases which had developed during the year as a result of high initial filings under the amendments establish- ing the disability program, the Bureau recruited from its employees 34 individuals with law degrees and with experience in the adjudica- tion or review of old-age, survivors, and disability insurance claims to serve as referees in various cities throughout the country on a temporary basis. 14 Department of Health, Education, and Welfare, 1959 During the fiscal year, the Bureau received more than 2,507,000 claims for old-age and survivors insurance benefits and almost 424,000 claims for disability insurance benefits and the disability “freeze.” More than 3,236,000 new social security accounts were established and over 2,788,000 duplicate account number cards were issued dur- ing the year. In addition, over 255,000,000 earnings items were re- ceived for posting to individual accounts. The Bureau also processed about 2,514,000 requests for changes in records and issued approxi- mately 1,127,000 statements of earnings. The new payment center in Baltimore which was established for the centralized processing of disability and foreign claims was opened on September 2, 1958. The transfer of workloads from the other pay- ment centers was successfully carried out on a staggered schedule over an 8-month period. | Substantial progress has been made toward additional expansion early in fiscal 1960 in the use of electronic equipment in the earnings report process. A number of programs and procedures have been completed and tested on new high-speed Model III 705 machines at the IBM factory. When the new equipment is installed, virtually all the earnings records operations, with the exception of the initial keypunching, will be done electronically. The Bureau also continued its study in fiscal 1959 of the application of electronic data processing to its administrative operations, includ- ing the areas of payroll, procurement and property management, personnel statistics, and accounting. Since initial findings indicate that potential economies and improvements may be realized through the utilization of IBM Type 705 data processing equipment, plans have been made for fiscal year 1960 to develop conversion and pro- graming procedures for those areas most adaptable to automatic data processing. A magnetic tape file of approximately 4 million employer names and addresses was established for all Internal Revenue Districts early in the fiscal year; it will be updated on a quarterly basis. The major benefit of this magnetic tape file is a more efficient and less costly method of addressing correspondence to employers than was possible under the former Addressograph plate system. Estimated savings of $175,000 per year are anticipated. The Bureau continues to encourage employers who are using elec- tronic data-processing systems compatible with Bureau electronic equipment to submit quarterly wage reports on magnetic tape thereby eliminating the necessity for key punching the earnings items. Eight employers who report approximately 85,000 earnings items quarterly are now reporting all, or part, of their earnings information by this means. Another large industrial concern will submit tape for about Social Security Administration 15 36,000 of its salaried employees. Three additional employers will submit tape reports in the future. One of these is the Department of the Army which reports about 1 million earnings items each quar- ter. The magnetic tape reporting system was also discussed with officials of New York City. If necessary clearances are obtained, about 100,000 New York City employees will be reported on tape. During the year the National Employee Index File of account number holders was converted from flexoline strips to microfilm. This operation involved the removal and photographing of about 160 million flexoline strips. Less than 2,400 film cartridges are required to store the entire index file which formerly used over 1.8 million flexoline panels; space requirements for this file have been reduced by about 16,000 square feet. Plans were made during the year for the Baltimore Payment Center to use electronic data processing in its accounting and certification processes. Accounting and payment records for disability cases will henceforth be placed on magnetic tape. Data from the magnetic tape will be transferred to tabulating cards which the Treasury De- partment will use in the preparation of disability insurance checks for September 1959. The new tape not only provides an accounting control but also permits electronic updating of beneficiary rolls. It has enabled the Treasury Department to convert its disability pay- ment records from Addressograph plates to tabulating cards. A major development in improving Bureau operations is the carry- ing out of plans for a detailed study of the entire old-age, survivors, and disability insurance claims process from receipt of the application to certification for payment. A major objective of the study will be the development of new and improved clerical and mechanical systems and methods for acquiring and processing the data needed to complete aclaim. A Central Study Staff of Bureau officials and a management consultant from private industry was established to make an exhaus- tive examination of the claims process. The study began in January 1959 and will be continued in fiscal 1960. Bureau participation in international activities and meetings has been increasing over the last few years, particularly in providing pro- gram orientation to visiting officials of foreign social insurance systems and in developing and maintaining sources of information about the old-age, survivors, and disability insurance program abroad. In- creased attention will be given to this important and growing activity. During the fiscal year the Bureau received 141 visitors from 29 coun- tries. The visitors came as individuals and in groups for visits varying from one day to several weeks. The programs arranged for these visitors included participation by all parts of the Bureau. Early in the fiscal year the Director of the Bureau and the Assistant 16 Department of Health, Education, and Welfare, 1959 Director in charge of the Division of Disability Operations accompa- nied three other officials from the Social Security Administration to the Soviet Union to study their social security system under the East- West Cultural Exchange Program. In November 1958, a five-man Soviet team came to the United States in return, visiting the Bureau’s Central Office, several field installations, various State and local government and private social agencies, and other organizations throughout the country. A delegation consisting of six social security officials from France also visited the Bureau during a 5-week tour of the United States. They were here to observe and discuss old-age, survivors, and dis- ability insurance program operations and administration; their inter- est covered every phase of Bureau operations. After visits to the New York Payment Center and a district office in Chicago, the group: spent 7 days in the Bureau’s Baltimore offices. In June, two Bureau representatives went to Europe to conduct a 4-month examination of problems pertaining to the administration of the old-age, survivors, and disability insurance program in Greece, and to explore ways and means of facilitating the claims process and services to claimants and beneficiaries in Greece and other European countries. On March 9, 1959, the House of Representatives adopted H. Res. 182, which authorized the House Committee on Ways and Means to study or investigate matters which come under its jurisdiction. Acting upon the resolution, the committee established three subcommittees, one of which will study administration of the social security laws. In preparation for this study, the Director appointed an Assistant Direc- tor to serve as coordinator within the Bureau and as a liaison person with the subcommittee. He was assisted by a small staff in the devel- opment of information requested by the subcommittee, covering proc- essing times, pending loads, types of cases, rules and regulations, policies and procedures, and other materials, with emphasis on the disability program. Last year the Treasury Department advised the Bureau that it planned to revoke the delegation under which the Birmingham Pay- ment Center had been writing and issuing old-age and survivors insurance benefit checks since July 1955. The administrative problems connected with the change were solved and transfer of the check- writing function to the Treasury Department was accomplished in an orderly manner. During the year departmental approval was received for the es- tablishment of a new division in the Bureau; the Division of Public Information and Personnel Management, which became operative early in fiscal 1960. It was organized to consolidate functions relating Social Security Administration 17 to training, personnel, employee health, public information, and em- ployee communications. The new organizational grouping, designed to help the Bureau meet its greatly enlarged responsibilities, permits full coordination of the management areas affected. Work on the new Bureau Building on the outskirts of Baltimore has proceeded on schedule. Tentative completion dates of January 15, 1960, for the Operations Building, and February 3, 1960, for the Ad- ministration Building have been established. In May 1959, congressional approval was granted for an addition to the new building to house the Baltimore Payment Center and the Division of Disability Operations. The establishment of these organi- zations has increased space needs beyond the capacity of the new building as originally planned in 1953. Plans and specifications are being developed in preparation for requesting bids for construction. Total administrative expenses of the old-age, survivors, and dis- ability insurance program in fiscal year 1959 amounted to approxi- mately $216 million, exclusive of $11.6 million for costs of the new building. Of the $216 million, about $41 million was incurred by the Treasury Department for the collection of social security taxes, preparation of checks for beneficiaries, and related activities. These administrative expenses amounted to approximately 2.55 percent of tax contributions and 2.30 percent of benefit payments. Legislative Developments During the Year No major legislation affecting old-age, survivors, and disability insurance has been enacted since the Social Security Amendments of 1958 (Public Law 85-840) became law in the closing days of the 85th Congress. While a substantial number of bills were introduced during the ist session of the 86th Congress, only a single bill in the field of old-age, survivors, and disability insurance legislation has been acted upon in the Congress. This is H.R. 213 (Public Law 86- 284), approved on September 16, 1959. This new legislation would (1) reinstate, through 1961, an expired provision of law permitting nine specified States to cover nonprofessional school district employees under special circumstances; (2) add the States of California, Kansas, North Dakota, and Vermont to the list of States which may cover employees in policemen’s or firemen’s positions under a retirement system; and (8) permit the coverage, under special conditions, of a few policemen in Oklahoma who have erroneously been reported as covered. HEARINGS ON HOSPITALIZATION INSURANCE FOR OLD-AGE, SURVI- VORS, AND DISABILITY INSURANCE BENEFICIARIES In compliance with the request made by the Committee on Ways and Means of the House of Representatives in its report to accompany 18 Department of Health, Education, and Welfare, 1959 H.R. 13549 in July 1958, the Department submitted a report on “Hospitalization Insurance for OASDI Beneficiaries” in April 1959. The report included factual information resulting from a study of alternative ways of providing insurance to finance hospital and nurs- ing home care for old-age, survivors, and disability insurance bene- ficiaries, and a listing of arguments for and against action in this area. Shortly after the close of fiscal 1959, the Committee on Ways and Means held public hearings on H.R. 4700, the Forand bill, which would amend the Social Security Act to provide insurance against the cost of hospital, nursing home and surgical services for persons eligible for old-age and survivors insurance benefits and for depend- ents of disability insurance beneficiaries. Secretary Flemming pre- sented testimony for the Department. Representatives of more than 80 organizations testified, including representatives of the medical profession, business, labor and health insurance plans. The committee did not take any action on this or similar bills. However, the Depart- ment is making a thorough study of proposals to stimulate the ex- tension of voluntary health insurance coverage of the aged to determine whether it is possible to develop a practicable and desirable plan for Federal action to accomplish this purpose. RAILROAD RETIREMENT LEGISLATION The railroad retirement and old-age, survivors, and disability in- surance programs are closely coordinated. Amendments to the Rail- road Retirement Act enacted in May 1959 (Public Law 86-28) provided a 10-percent increase in the amount of benefits payable under the railroad retirement program, including benefits payable under the “social security minimum” provision of the Railroad Retirement Act. (Thus, this now guarantees that the total amount of the benefits payable to a railroad worker and his family will be at least 10 percent more than the amount which would have been payable if the worker’s railroad employment had been covered under the social security program.) The wage and tax base of the program was raised from $350 to $400 per month; this amendment placed the wage bases of the two programs at a comparable level. The amendments also increased the contribution rates of the railroad retirement program, and provided for increases in rates for years after 1964, geared to increases in old-age, survivors, and disability insurance tax rates. The Advisory Council on Social Security Financing The Advisory Council on Social Security Financing, appointed by the Secretary of Health, Education, and Welfare in October 1957, continued to meet during calendar year 1958 and issued a unanimous Social Security Administration 19 report on January 1, 1959. The Council’s major finding was that— The method of financing the old-age, survivors, and disability insurance program is sound, and, based on the best estimates available, the contribution schedule now in the law makes adequate provision for meeting both short-range and long-range costs. The Council endorsed the principle that employees, employers, and the self-employed should contribute toward the cost of the system. It recommended that increases in social security taxes now scheduled for 1959, 1960, and 1963 should go into effect and stated its belief that it will prove desirable to have the scheduled 1966 rate go into effect as well. The Council was doubtful whether the last scheduled rate increase—the one scheduled for 1969—should go into effect at that time; it did not recommend that any change be made now in the contribution schedule, but recommended that future advisory coun- cils study the question. The Council believed that after the contribution rate scheduled for 1966 goes into effect future decisions about rate increases, if any, should be guided largely by estimates of income and disbursements over the ensuing 15 or 20 years. However, the Council endorsed the present practice of including in the law a contribution schedule which, according to long-range cost estimates, places the system in actuarial balance into the indefinite future. The Council’s recommendations “. . . look toward a continuing re- view of the financial arrangements so that they, along with the other provisions of the program, can be kept sound and workable in a chang- ing economy.” ‘The Council said, “. . . we believe there is a need for periodic scrutiny of all factors which in any way affect the financ- ing of the program. These factors include the maximum earnings base for determining benefits and contributions.” As a result of the 1958 amendments, the maximum earnings base was increased from $4,200 to $4,800 on January 1, 1959. The Council did not recommend any further change in the base, but assumed that “. . . further consideration will be given to this maximum after the effect of the $4,800 figure has been evaluated.” The Council pointed out that the earnings base determines the proportion of the Nation’s payrolls available to finance the program and is a major factor in determining the extent to which the program pays benefits reasonably related to the past earnings of the individual. The Council recommended changes in the provisions governing the _ interest rate to be paid on Government bonds issued solely for pur- chase by the old-age and survivors insurance and disability insurance trust funds, indicating its belief that “. . . the rate of return on trust fund investments in special issues should be comparable to what the Treasury would have to pay for long-term money if borrowed from 20 Department of Health, Education, and Welfare, 1959 other investors. Such a rate of return seems to us the way to avoid either a financial advantage or disadvantage to the funds.” The Board of Trustees of the Federal Old-Age and Survivors In- surance and Federal Disability Insurance Trust Funds considered the recommendation of the Council and in their 19th Annual Report recommended adoption of a modified set of recommendations. Special Studies Requested by the Congress The Committee on Ways and Means of the House of Representatives had requested the Department to look into several problems concern- ing the old-age, survivors, and disability insurance program. One problem which the Bureau is studying intensively is how workers who get a substantial part of their work income in the form of tips can have those tips counted toward benefits. Another problem under study concerns what changes, if any, should be made in the retire- ment test provisions of the program, with particular attention to the provision which makes it possible for a beneficiary to receive benefits for some months in a year even though he may have had high earn- ings during the year. Surveys of Resources of Old-Age, Survivors, and Disability Insurance Beneficiaries In order to appraise the adequacy of old-age, survivors, and dis- ability insurance benefits, it is necessary to know what resources beneficiaries have in addition to their benefits. Beginning in 1941 and continuing through 1957 the Bureau of Old-Age and Survivors Insurance conducted a series of cross-section surveys of persons on the rolls in a given month to obtain information on the source and amount of their other income, home ownership, miscellaneous assets and liabilities. In addition, information is obtained concerning family composition and living arrangements, and on expenditures such as those for housing and medical care costs and health insurance coverage. The cross-section surveys provide a picture of the economic situa- tion of beneficiaries in a given year, but they do not tell what hap- pens to retired people over the course of years. To determine how the socioeconomic situation of beneficiaries changes after they come on the benefit rolls, the Bureau is embarking on a retirement history study in which a sample of persons will be interviewed shortly after they come on the benefit rolls and information will be obtained on their situation in the year before they filed for benefits. They will be interviewed a year later to obtain a record of their first year’s Social Security Administration 21 experience after filing for benefits. Subsequent resurveys will be made every 2 or 8 years over a period of 12 years in order to learn how their situation changes with time and what adjustments they make to these changes. The initial survey in the retirement history study is planned for the spring of 1960 and the first resurvey for the fall of 1961. Little is known about the economic situations of persons drawing disability benefits and persons under age 50 who have been awarded a freeze of their wage records. A field survey of disabled persons is scheduled for the fall of 1960; it will provide not only current infor- mation on their economic situation but also the data required for planning and carrying out a longitudinal study of a sample of disabled persons. Because of the importance of beneficiary surveys in connection with proposed legislation and use of the findings by persons outside the Department, the program of surveys of the socioeconomic situa- tion of old-age, survivors, and disability insurance beneficiaries and potential beneficiaries is being expanded. Program Simplification Project The Bureau continued to make progress in developing legislative proposals which would make the old-age, survivors, and disability insurance program easier to understand, accept, and administer. Proposals developed last year for simplifying benefit computations and the retirement test were enacted into law in the 1958 amend- ments and, subsequent to the amendments, proposals were developed to simplify: (1) the coverage provisions for State and local employ- ees; (2) lump-sum death payments; and (8) the dependency requirements for auxiliary beneficiaries. As a result of an extensive line-by-line review of the law, which was begun last year, proposals were also developed to simplify other areas of the program. In conjunction with the line-by-line review, the first steps were taken towards a comprehensive recodification of the law to make it more readable and easier to work with. Two subjects brought under study late this year will be further examined during the next year—the family relationship requirements for auxiliary beneficiaries and the insured status requirements for entitlement to benefits. Financing the Program In modifying the schedule of contributions under the old-age, sur- vivors, and disability insurance program at the time it enacted the amendments in 1958, Congress again made clear its intent that the 22 Department of Health, Education, and Welfare, 1959 program be self-supporting from contributions of covered workers and employers. The revision in the schedule was arrived at after careful review of long-range actuarial cost estimates prepared for use of the congressional committees in their legislative considerations. Old-age and survivors insurance benefits—The level-premium cost of old-age and survivors insurance benefits after 1957, on an inter- mediate basis, assuming interest at 8 percent and earnings at about the levels that prevailed during 1956, is estimated at 8.27 percent of pay- roll (after adjustments to allow for administrative expenses and inter- est earnings on the existing trust fund). The level contribution rate, equivalent to the graduated rates in the law, is estimated at 8.02 per- cent of payroll, leaving a small actuarial insufficiency of 0.25 percent of payroll. In view of the very long range over which these projec- tions are made, and the many variable factors included, the insuffi- ciency 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 which is entirely separate from the financing of old-age and survivors insur- ance benefits. ‘The level-premium cost of the disability benefits and the applicable administrative expenses on an intermediate basis is 0.49 percent of payroll. Contribution income has been specifically allo- cated 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. Continuing review of cost estimates.——The difficulties involved in making exact cost estimates as to 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. The Department, in carrying out its policy of continually reexamining the long-range cost estimates of the program in the light of the latest information available, is now in process of a complete review and revision of its cost estimates. Public Assistance The establishment by the Congress in 1958 of an Advisory Coun- cil on Public Assistance to review the status of the public assistance programs, and the approach of the 25th anniversary of the Social Security Act, made 1959 a year of thoughtful evaluation of progress under the public assistance programs in helping meet needs of the American people over the past quarter century. Study of many Social Security Administration 23 facets of the program to provide basic data needed by the Advisory Council has also helped to clarify the role of public assistance within the economic and social framework of the Nation, and to delineate more sharply the problems ahead. The influence of both self-evaluation and study was reflected in other activities of the Bureau of Public Assistance and State public assistance agencies during the past year. Trends in Caseloads and Expenditures About 6.8 million people in the United States were dependent on some form of public assistance in June 1959. These people—about 4 out of every 100 in our population—were ineligible for benefits pro- vided by other public programs, or, if eligible, received amounts in- sufficient to meet minimum needs. The total number receiving public assistance under federally aided programs included 2.9 million dependent children and their care- takers receiving aid to dependent children—the largest assistance group since 1957; 2.4 million persons receiving old-age assistance; 339,000 receiving aid to the permanently and totally disabled; and 109,000 receiving aid to the blind. In addition, about 1.0 million persons (in 388,000 cases) received State and/or locally financed general assistance. The total number of persons receiving assistance in June 1959 was about 100,000 more than in June 1958. General assistance and old- age assistance were the only programs with smaller caseloads in June 1959 than in June 1958. The larger decline—13.2 percent (153,000 persons)—occurred in general assistance programs, the type of aid most sensitive to seasonal factors and changes in economic conditions. The decline in old-age assistance from June 1958 to June 1959 was 1.6 percent (40,300 persons). The increase in aid to the blind was only slight. In aid to the permanently and totally disabled it was 8.5 per- cent. In aid to dependent children the increase of 195,800 recipients (including 154,800 children) from June 1958 to June 1959 represented a 7.2-percent increase in total recipients and a 7.4-percent increase in children. The increase, however, was less than three-fifths of that occurring in the previous year. Why they are needy.—Most people receiving public assistance are struggling not only with problems of inadequate income, but also have other serious personal difficulties contributing to their depend- ency. For example, half the 2.4 million persons receiving old-age assistance are over 75, an age when only a few are likely to be em- ployed. Three out of five are women; many are widows who have never been employed. While two out of three of the aged recipients live in their own homes and most of them are able to be up and about, 24 Department of Health, Education, and Welfare, 1959 some are seriously ill. One in thirty is confined to bed at all times; and 1 in 20 lives in an institution, usually a private nursing home. The 214, million children receiving aid to dependent children are needy because of the death, disability, or absence of a parent. The typical family consists of 3 young children and a mother in her mid- dle 30’s. Many suffer from emotional conflict, hardship, and insta- bility in their family life, for most of the children live in homes where one parent has deserted or where the parents are separated, divorced, or never married. Of persons receiving aid to the blind, half are over 63 years of age. Most have been blind about 20 years and are totally blind or have very limited vision. About 5 out of 8 blind recipients are men. All persons receiving aid to the disabled have disabilities defined as both permanent and total. Most of them have more than one impairment, with heart disease the most frequent. About 2 in 10 are so seriously disabled that they cannot leave their homes. Women slightly out- number men. Of the 1.0 million persons who receive general assistance, an esti- mated 76 percent are in family cases, and 24 percent are single person cases. Need is usually related to unemployment, ineligibility for or exhaustion of unemployment compensation benefits, wages or un- employment compensation benefits insufficient to meet basic family needs, temporary illness or partial incapacity, inability to meet State residence or other eligibility requirements of other assistance or social insurance programs, or to special needs which cannot be met within these other programs. The number of general assistance recipients does not reflect the full extent of need not covered by federally aided assistance programs; it represents only the portion which States and localities are able and willing to meet. In most States general assistance is provided only to unemployable persons; nonresidents are aided only in emergencies with arrangements made for return to their State of residence as quickly as possible. Some States provide no financial assistance to employable persons and their families. How much assistance they receive-—The Social Security Act re- quires that in determining the need of each individual requesting assistance consideration be given to any other income and resources he may have (except that in the aid to the blind program the first $50 of earned income must be disregarded). Each State is responsible for determining who are “needy” people and how much they will re- ceive under a given program. States differ both in their definition of need and in the degree of responsibility they accept for meeting need as determined under the various assistance programs. One State may provide for some medical needs in its old-age assistance program, but | | Social Security Administration 25 not in its aid to dependent children program, while another State may make no provision for medical needs under any of its assistance pro- grams. Thus the amount of assistance provided to a needy person may vary from State to State and among programs within a State. For example, the national average payment per recipient of old-age assistance in June 1959 was $64.76 but average payments ranged from a low of $29.83 in Mississippi to a high of $110.17 in Connecticut (ex- . cept for $8.20 in Puerto Rico and $23.40 in the Virgin Islands). The national average payment per recipient of aid to the blind was $69.04, with payments ranging from a low of $35.33 in Alabama to a high of $117.85 in Massachusetts (except for $8.25 in Puerto Rico). For aid to the permanently and totally disabled, the national average pay- ment was $63.37 per recipient with payments ranging from $29.95 in Mississippi to $134.95 in Connecticut (except for $8.85 in Puerto Rico and $25.64 in the Virgin Islands). The national average payment per recipient of aid to dependent chil- dren, $28.39 (with State averages ranging from $7.02 in Alabama to $47.53 in Connecticut, except for $4.09 in Puerto Rico), is much less than national average payments in the other federally aided pro- grams; e.g., as indicated above, the national average payment per recipient of old-age assistance is $64.76, with a range from $29.83 to $110.17. The relatively lower national average payment of $65.79 per case in the general assistance program in June 1959—41 percent are family cases including an average of 4.5 persons per family—compared with the national average payment of $64.76 per recipient in old-age assist- ance is undoubtedly indicative of the difficulty some States have in financing general assistance programs without Federal aid. Average payments per case in the general assistance program ranged from $12.43 in Alabama to $99.40 in New Jersey (except for $7.06 in Puerto Rico). Limited funds and stringent standards applied in determining the degree of destitution before general assistance is granted result, in many instances, in a level of subsistence far below even a minimum standard of “health and decency.” Total assistance payments in fiscal 1959 were $323 million higher than in fiscal 1958 ($3,574 million compared with $3,251 million). But average payments per recipient in June 1959 compared with a year earlier showed increases of only $3.38 in old-age assistance, $2.32 in aid to the blind, $2.68 in aid to the permanently and totally disabled, $1.11 in aid to dependent children, and $4.22 per case in general assist- ance. Some of the increase in total expenditures was due to the in- creased number of persons receiving assistance, but part of it was related to the availability of additional Federal funds under amend- ments to the Social Security Act in 1958. 530344603 26 Department of Health, Education, and Welfare, 1959 Use by States of additional Federal funds in 1958 —Most States used the additional funds to increase individual payments, and more than half the States with maximums on individual payments in old-age assistance, aid to the blind, and aid to the permanently and totally disabled either increased or removed their maximums; fewer States took similar action in aid to dependent children. A few States elimi- nated reductions that had been applied to payments or made the reductions less stringent. Most States also revised their cost standards to reflect current prices to a greater degree, and a few States added new items to their assistance standards. This use of additional Federal funds available October 1, 1958, was reflected in increases in average payments per recipient from September 1958 (the month immediately preceding its availability) to December 1958 of $2.87 in old-age assist- ance, $1.28 in aid to the blind, $1.66 in aid to the permanently and totally disabled, and $.82 in aid to dependent children. Many receive both assistance and social insurance benefits —Public assistance is used to supplement social insurance benefits that are not large enough to meet the beneficiary’s basic needs. It is also used to meet special needs, such as medical care, of those whose insurance bene- fits and other personal resources are insufficient to meet this additional expense. The number of beneficiaries receiving old-age assistance to supple- ment their social insurance benefits continued to increase. About 27 percent or 660,000 persons were receiving old-age assistance to supple- ment social insurance benefits in June 1959. The average assistance payment supplementing benefits in March 1959 (the latest date for which data are available) was about 25 percent lower than payments to other aged persons ($51.97 compared with $68.74). Similarly, the insurance benefit received was about 35 percent lower than the average benefit for all aged beneficiaries, with a considerable number getting no more than the minimum benefit. A survey in 1957 of beneficiary resources shows that, for the beneficiaries studied, it was only when assistance was added to their benefits and other resources that the total income per beneficiary-recipient approached the average for all aged beneficiaries. The same survey reveals that in comparison with other aged beneficiaries, more of those also receiving assistance were in poor health and therefore more likely to have high medical costs and a higher incidence of hospitalization, but had little or no income from earnings, assets, or contributions from relatives. In contrast to old-age assistance, however, the percentage of recipi- ents of other types of public assistance who also receive old-age, sur- vivors, and disability insurance benefits is considerably smaller. Although the number of families receiving both insurance benefits and aid to dependent children has increased in the last year, the Social. Security Administration 27 proportion they represent of all aid to dependent children families remained the same. The 41,900 families receiving both insurance benefits and aid to dependent children represented 5.4 percent of all families receiving aid to dependent children in March 1959. Similarly, the number receiving both assistance and insurance bene- fits is estimated to be only about 8 percent of those receiving aid to the blind and 5 percent of those receiving aid to the permanently and totally disabled. Although many of the assistance recipients in these two programs meet the disability requirements for insurance benefits, very few have the necessary work experience to qualify for benefits. Also, since half of the needy blind are 65 years of age or over, the majority of the 8 percent also receiving insurance benefits are undoubtedly receiving benefits for reasons other than disability since the age requirement for disability insurance is between 50 and 65 years of age. Source of funds for public assistance —Of $3,574 million expended for public assistance in fiscal 1959, about 52 percent or a little over $1,848 million in Federal funds supplemented 36 percent, or $1,281 million from the States and 12 percent, $445 million, from the local- ities for old-age assistance, aid to dependent children, aid to the blind, and aid to the permanently and totally disabled. The States and lo- calities alone paid the estimated $426 million spent under general assistance programs. For the special types of public assistance, the Federal share of total costs was 59 percent; the State share, 33 percent; and the local share, 8 percent. Program and Administrative Developments Program developments in public assistance are closely related to public concern with economic and social factors contributing to de- pendency and to the increasing recognition of the long-run economy of activities directed toward prevention and rehabilitation. ‘These objectives are emphasized in the 1956 amendments to the Social Secu- rity Act which reaffirmed the importance of providing other social services to help needy people make fuller use of their capacities for more independent living; and in the 1958 amendments which made possible increased Federal participation in financial assistance to needy people. Through joint Federal-State efforts during the past year consider- able progress has been made in utilizing the 1956 and 1958 amend- ments to strengthen State public assistance programs and thus to serve needy people more effectively. These efforts are reflected espe- cially in activities directed toward extending medical care to public assistance recipients. 238 Department of Health, Education, and Welfare, 1959 Improving medical care for public assistance recipients —A large proportion of persons receiving public assistance have unusually heavy medical needs resulting from disability, chronic illness, or the infirmi- ties of old age. Some are forced to seek assistance primarily because they need medical care. In June 1959, the federally aided public assistance programs were helping 1.6 million persons whose need was attributed primarily to disability, chronic illness, or severe infirmi- ties of old age. This number included 339,000 persons receiving aid to the permanently and totally disabled; 109,000 persons receiving aid to the blind; 756,000 persons receiving aid to dependent children because of need due to the incapacity of a parent; and some 481,000 old-age assistance recipients—nearly a fifth of the total—who were bedridden or required a substantial amount of care from others be- cause of some physical or mental impairment. In addition, a sub- stantial proportion of the other 2 million aged recipients caring for their own daily needs no doubt had health and other problems related to advanced age. Traditionally, public welfare agencies have provided some medical care to needy persons through staff or “county” physicians, by operat- ing institutions, or by paying for medical care. Until 1950, medical care costs could be paid in part from Federal funds only if these costs were included in money payments made to recipients. In 1950, an amendment to the Social Security Act also permitted Federal finan- cial participation in costs of medical and remedial care paid on the recipient’s behalf to suppliers of services—hospitals, doctors, drug- gists, nursing homes, etc. The quantity and quality of medical care that could be provided to assistance recipients, however, were affected to some extent by State and Federal maximums on individual assist- ance payments. An amendment in 1956 provided Federal financial participation in vendor medical payments separately from money payments up to one- half of the sum of $6 multiplied by the number of adult recipients and $3 multiplied by the number of child recipients per month. This proved an impetus to extend medical care provisions for needy people. Some States began to pay the cost of some medical services, and others expanded their existing medical care provisions. The use of an average in determining the amount of the Federal share also made it possible to meet larger medical care expenses in individual cases. Of special significance are the 1958 amendments which changed the basis of Federal financial participation in State expenditures for public assistance by relating the Federal share to an average expenditure per recipient including both money payments to recipients and direct payments to vendors of medical care. This is resulting in further increases in the availability of medical care. Social Security Administration 29 Although demands for medical care are very great, in developing medical care provisions States have had to exercise caution so as to maintain a balance between expenditures for basic maintenance and for medical care. Among other considerations, they had to decide whether to provide funds for medical care for all recipients or only for those receiving assistance under specified programs, the items of medical care for which they would pay, whether the care would be limited to one or two items or cover the cost of a full range of medical services, whether all or only a portion of the medical needs of a recipient would be met, and whether payments would be made to recipients or directly to suppliers of medical care services. The de- cisions made were heavily influenced by the availability of funds. In addition to technical assistance given by Bureau staff in develop- ing a plan of administering provisions for medical care, some States, often with the help of State medical societies, made studies to de- termine the areas of greatest need. Others were assisted by advisory committees including professional medical people. Many State agencies consulted organized groups of suppliers of medical care services. All jurisdictions but Arizona and Puerto Rico provided for some medical care under their public assistance programs in January 1958; in Puerto Rico medical care needs were met by the Health Depart- ment. The items of medical care provided include practitioners’ services, hospitalization, drugs, nursing-convalescent home care, dental services, nursing services, clinic services, prosthetic appliances, ambu- lance (or other transportation), laboratory, and X-ray services. However, not all of these services were provided by all States. Relatively comprehensive medical care was provided in only 10 States; in most of these, payments were for remedial rather than pre- ventive services. The other jurisdictions paid for only a few medical services—some, for example, provided for hospitalization only for life-endangering conditions. In January 1958, nursing-convalescent home care was the item included most frequently for adult categories, and drugs, the item most frequently included in the aid to dependent children program. Nursing services provided by registered or practi- cal nurses in the recipient’s home was the item supplied least often. In June 1959, 42 States provided for medical care services through the vendor payment method. Most of these agencies paid the sup- pliers of the care directly, but a few had arrangements with other agencies, such as the State public health department, Blue Cross, or Physicians’ Service organization, to act as their agents. In June 1959, 16 States used a “pooled fund” to make vendor payments for medical care under one or more of the special types of public assistance. In fiscal 1959, $314 million was paid directly to the suppliers of 30 Department of Health, Education, and Welfare, 1959 medical care services on behalf of recipients of the four State-Federal programs. The average vendor payment for all recipients (both those receiving money payments and those having only vendor payments made in their behalf), by program, in June 1959 was $8.94 for the aged, $5.34 for the blind, $9.93 for the disabled, and $1.66 per recipient for aid to dependent children. Since most medical payments, except for costs of nursing home care in some States, are made to vendors, the following analysis of vendor payments for fiscal 1959 is indicative of the items of medical care being provided. Hospitalization costs represented by far the largest part of medical care expenditures; costs of nursing and convalescent home care, the second largest share; drugs and supplies, third; and practi- tioners’ services, fourth. About 52 percent of the expenditures for vendor medical care payments in the five public assistance programs were incurred for the aged, 23 percent for general assistance cases, 14 percent for aid to dependent children families, 9 percent for the disabled, and 2 percent for the blind. Although considerable progress has been made in recent years in providing medical care services for needy persons, both in quality and quantity, the need is still considerable. Further study is also needed on how best to utilize the money now available for medical care pur- poses. For example, nursing home care is a very costly kind of medical care service, and according to national and State studies, at least half the persons in nursing homes and homes for the aged are public assistance recipients. Yet studies conducted by the Public Health Service and by individual States indicate that close to 50 per- cent of the aged in nursing homes could be cared for more appro- priately in their own or in foster homes. The many aged persons who are In nursing homes, however, will probably remain there until pro- vision can be made for other living arrangements more suited to their needs. To make more effective use of nursing home care, the Bureau has been working with the Public Health Service in planning and con- ducting regional meetings on nursing homes and homes for the aged for representatives of State welfare and health departments to discuss ways of achieving common objectives. Other Bureau activities have included participation in a joint Social Security Administration-Pub- lic Health Service Committee to plan for providing technical assist- ance to States in other areas of mutual concern, participation in the Medical Care Committee of the American Public Welfare Association in the development of a statement on “The Physician in the Public Welfare Agency,” and working with its Subcommittee on Medical and Medical-Social Recording in developing a guide for public welfare agencies on the recording of medical and medical-social information. Social Security Administration 31 A 2-day meeting of an ad hoc Medical Advisory Committee to the Bureau was also held in Washington, including representatives from 15 State public welfare agencies and staff from other constituent units of the Department, to develop a definition of “medical care” and “remedial care” in the administration of the medical assistance pro- visions of the public assistance programs. Consultation in the medical care area and other medical-social eligibility aspects of the public assistance programs was given during the year by Bureau staff both to State agencies and other groups concerned with provisions of med- ical care for assistance recipients. Strengthening other social services—Progress made in strength- ening other social services is reflected in the provisions of the States’ services plans developed in 1957, following the 1956 amendments to the Social Security Act reaffirming the importance of providing social services to help needy persons make fuller use of their own capacities for more independent living. The problems most frequently identified for which States would provide services, in the order named, were those health, employment, housing, family relations, and children’s problems which required short-time or tangible services. The problems least frequently identi- fied for which services would be provided were those emotional prob- lems of members of broken families, unmarried parents, or the ill which required more intensive casework service or other help over longer periods of time. Almost all emphasized the use of other com- munity resources, with particular emphasis on cooperation with State vocational rehabilitation services and employment services. Many States recognized special responsibility for children and other persons in hazardous situations, and for community planning although only a few assigned staff specifically to the latter area. Because of limitations in staff qualifications and time, many States attempted to define responsibility for services realistically, either by limiting the problems for which services would be provided, limiting the scope of services to those required in the determination of eligibil- ity for money payments, or limiting services to those that could be provided during regular contacts for eligibility purposes. With better administrative planning, some States are gradually offering services to larger numbers of families and individuals. In addition to the help given through the day-by-day activity of reg- ular staff, a few States have also developed special services, such as homemaker services, volunteer service units, and foster home care for the aged. Some States are augmenting the skills of their casework staff with consultant services from medical social workers, home economists, and other specialists. Special projects in a few agencies are demonstrating the potential value of providing appropriate serv- 32 Department of Health, Education, and Welfare, 1959 ices, and the benefits of cooperative effort among public and voluntary agencies and other community groups. There are also other evidences of increasingly effective utilization of community resources. Broad guidelines have been established by the Bureau to help the States strengthen the service aspects of their programs. Emphasis has been on administrative planning to assure statewide provision of services, as well as development of policies and guides that are realistic in view of workloads, skill of staff, and the availability of support- ing functions of consultation, supervision, and staff development. In addition, a plan was initiated for discussion with each State to deter- mine specific areas in which further Bureau help was needed. The Bureau has also been working with other units in the Department and with national voluntary social agencies both in the utilization of available resources and in the development of additional needed services. During the past year, for example, in developing services for the aging, Bureau staff worked with the Department’s special committees in planning for the White House Conference on Aging, and participated in the National Leadership Training Institute held at the University of Michigan in preparation for the Conference; with the American Public Welfare Association’s Committee on Aging in developing statements on social service needs of older people and on the community planning responsibilities of public welfare; and with the National Social Welfare Assembly’s Committee on Aging in developing a project directed toward protective service needs of older persons, and in planning a seminar on social services for older people in the fall of 1959. There was also participation in a meeting of all national agencies concerned with aging called by the National Social Welfare Assembly. Continuing effort to promote the use of homemaker service is evi- denced in the Bureau’s cooperative work with the National Com- mittee on Homemaker Service, and in its participation in the second National Conference on Homemaker and Related Services held in February 1959 under the joint sponsorship of constituent units in the Department and many national voluntary social and health agen- cies. To deal more effectively with emotional problems of needy per- sons and strained relationships, the Bureau has initiated work with the Department’s National Institute of Mental Health, and joint ef- forts have continued with the Family Service Association of America. Further work has continued with the Children’s Bureau toward utilizing the full potentials of both aid to dependent children and child welfare services programs in dealing constructively with the factors contributing to the dependency of children. A policy state- ment has been developed clarifying the functions and responsibilities Social Security Administration 33 of each program in providing services to children in their own homes, the ways in which the two programs work cooperatively in providing these services, and the allocation of costs of services to children in families receiving public assistance. A working group from both bureaus is also developing a plan of cooperative activity to promote better understanding of the factors involved in illegitimacy and to identify State administrative planning essential to provide effective services in dealing with the needs and problems of unmarried mothers and their children. In addition, the two bureaus are planning to provide joint consultation to State agencies in areas of mutual concern. Similarly, joint planning by the Bureau and the Office of Vocational Rehabilitation continues to strengthen the relationships between these two programs in the States and to make more extensive use of voca- tional rehabilitation resources. Bureau staff also participated in the departmental consideration of proposals relating to extension of programs for rehabilitative services and in developing proposals for extending such services through public welfare agencies, as well as in departmental consideration of program goals on community planning. Material was prepared on the considerations involved in working with individuals and families whose condition seriously affects their ability to manage their personal affairs, and in clarifying the role of public assistance in providing services to older people. Study of many facets of the broad range of problems contributing to dependency, the pooling of the knowledge, skills, and resources of many related professions and disciplines, and emphasis on the broad rehabilitation potentials of public assistance programs are beginning to show results in many States. But low assistance standards, heavy workloads, lack of professional training of most staff, and the dearth of community resources limit opportunities to provide extensive serv- ices. States are therefore giving more attention to methods for improving staff competence and other administrative planning that will facilitate the provision of services. Efforts to improve staf training and. skill—Since 1937, some States have made limited use of Federal funds for sharing costs incurred in granting educational leave to employees; others have not. In 1950, only about 23 percent of the 30,000 persons employed in social work positions in State and local public assistance agencies had some social work training, but less than 4 percent had completed graduate work. Although Congress, in 1956, authorized appropriation of Federal funds to better assist the States in meeting the costs of training, funds have not been appropriated to implement this amendment. At first, anticipation of specific Federal funds for training resulted in changes in some State laws and increased State appropriations to 34 Department of Health, Education, and Welfare, 1959 enable participation in the new Federal training provisions and evaluation of staff needs and long-range planning for staff develop- ment in many States. Efforts to improve the skill of some personnel were increased. By 1959, 39 State public assistance agencies had 402 people on educational leave (283 with and 119 without pay) at schools of social work. With no funds available under the 1956 authorization for training, other alternatives of increasing staff competence and making more effective use of professionally trained staff are being explored. An example of the latter is the work initiated on the Educational Stand- ards project to define appropriate job functions in relation to the educational background of public assistance staff. To further this effort, Bureau staff have been working with an advisory committee representing State public welfare agencies, schools of social work, the Department’s Division of State Merit Systems, national social welfare organizations, and other Federal agencies to consider differen- tial use of staff with varying educational background, and how best to test the use of workers with full graduate professional training and those with an undergraduate academic degree. In addition to providing technical assistance requested by 15 State agencies and 5 schools of social work, the Bureau issued a report on ‘Staff Development as an Integral Part of Administration.” Bureau staff participated in the consideration given to the training needs of staff in providing services for the aging by the Council on Social Work Education and the American Public Welfare Association’s Com- mittee on Social Work Education and Personnel, as well as other as- pects of training by these groups and the National Association of Social Workers’ Commission on Education. Bureau staff also partici- pated in an interbureau training committee with the Chil- dren’s Bureau in clarifying basic principles relating to staff development and other areas of common concern. Efforts to wnprove administrative and fiscal methods.—Heavy workloads limit the opportunity to provide services in many instances. For example, in the old-age assistance program in 1958, 27 States had average caseloads per worker of more than 200 (in 19 of these States they ranged from 255 to over 500) ; and in aid to dependent children, 20 States had average caseloads of more than 100 (in 6, they ranged from 158 to 237). Continuing attention was therefore directed to working with States on needed improvements in organization, staffing patterns, and workload management to permit the best service possi- ble within staff time available. A number of States also attempted to simplify their standards of assistance. In addition to providing technical assistance requested by 11 States and making 6 management surveys of specific State situations, a con- Social Security Administration 35 ference on workload standards and management was held in Wash- ington, D.C., with State agencies in Region III; and a biregional conference (Regions VIII and IX) on administrative management of large urban agencies in San Francisco, with representatives from 5 States and 7 large urban areas, focused on workload distribution and staffing patterns, workload management, and analysis and simpli- fication of procedures. A conference was held in Washington, D.C., with a group of State welfare finance officers on the use of mechanical processing equipment and other methods for efficient fiscal operations in public assistance administration. Bureau staff also participated in regional conferences of the American Public Welfare Association In sessions on administrative management methods and procedures for work improvement. Guide materials are being developed for State agency use in (a) developing a State system of written instructions, (b) case recording, and (c) conducting organization and management surveys of State and local agencies; and a statement is being prepared on State super- vision of local agencies. Two publications were issued in the “How They Do It” series: “Guides for County Boards,” using material from Indiana and Iowa, and “Simplification of the Caseworker’s Job,” using material from Maine. Other administratwe developments.—To assure that Federal grants were spent by the States for the purposes for which they were ap- propriated, Bureau staff made administrative reviews of State and local operations in 25 States. Significant review findings were sum- marized for administrative use by Bureau and State agency staff. Also, technical assistance was provided to several States in making their own reviews of administration and in using their findings. Growing interest in public assistance and concern especially with the social problems highlighted in the aid to dependent children pro- gram. were evidenced by an increasing number of requests for infor- mation from individuals, organizations, writers, journalists, Mem- bers of Congress, and other agencies. An exhibit, “Your Whole Com- munity Benefits,” was prepared for use at national and State meetings. Materials interpreting aspects of the program were developed and made available to schools of social work, State and local agencies, and other interested individuals and groups. Related Social Welfare Activities As part of the Bureau’s broad public welfare responsibilities, par- ticipation has continued (1) in international social welfare develop- ments, and (2) in planning for emergency welfare services, services to repatriated American nationals and to refugees from other parts of the world. 36 Department of Health, Education, and Welfare, 1959 International activities—The Bureau Director continued to serve as chairman of the Interdepartmental Committee on International Social Welfare Policy. Bureau staff also participated in the preparation and review of technical materials for use at United Nations and other international meetings, such as the United Nations expert group on social welfare meeting in January 1959; in planning the National Social Welfare Assembly’s international workshop in Washington, D.C., in October; and in preparing a fact sheet relating to voluntary and public agency activities in resettling refugees and immigrants. A Bureau staff member was one of the Social Security delegation (part of the East-West Exchange arranged by the Department of State) to the U.S.S.R. to study the Soviet system of social security. She also participated in conferences with the Soviet team on their return exchange visit. Bureau staff in regional offices provided consultation and planned or arranged observation programs in cooperation with State and local public and voluntary welfare agencies for visitors from 34 countries. In the central office, staff specialists continued to provide consultation to foreign visitors and to international groups referred by various Government agencies. Emergency welfare services—An allotment of limited funds to the Department by the Office of Civil and Defense Mobilization under Reorganization Plan No. 1 of 1958 and the Independent Offices Ap- propriation enabled the Bureau to resume activities on previously delegated defense programs of emergency financial assistance and emergency clothing; and to participate with the OCDM in activities and resumption of negotiations relating to the Social Security Ad- ministration’s assumption of basic responsibility for the full range of emergency welfare services. Bureau staff worked with the OCDM in the development of an Annex on Emergency Welfare to the National Plan for Civil and Defense Mobilization; and with the OCDM and the SSA in drafting proposals for Department responsibility in emergency welfare serv- ices. Staff participated in Civil Defense Operation Alert 1959 (re- gional relocation phases) and in planning for the national relocation phase in August. Services to refugees and immigrants——A Bureau staff member served on the departmental Committee on Refugees and Immigrants which is planning for the implementation of the report of the depart- mental 'Task Force. The Bureau representative attended a meeting with an ad hoc committee of national voluntary agencies concerned with refugees held in New York City in February 1959, and assisted in the development of statements and position papers on legislation and program planning for services to refugees and immigrants. Social Security Administration 37 Repatriation of American citizens—The Bureau has continued to assist the Department of State in arranging for the reception and care of repatriated American nationals who need special help upon arrival in this country. During fiscal 1959, services were requested for 215 such persons. Their most pressing needs were for funds for transportation beyond the port of entry and provisions for hospitaliz- ing mentally ill repatriates who have no State residence. Culminating a long period of program development and interde- partmental negotiation, draft legislation was submitted to the Con- gress to provide a statutory base and appropriation authority to enable the Federal Government to assume its proper share of the ex- pense of these services. Similarly, interdepartmental negotiations have facilitated joint work between the Bureau’s regional staff, Army Port Commanders, and selected State and local public welfare authori- ties in implementing program and maintaining standby readiness. Children’s Bureau Some Facts and Figures About Parents and Children Since 1954 the annual number of live births has exceeded 4 mil- lion. The number decreased very slightly in 1958 and the provi- sional crude birth rate also dropped to 24.5 per 1,000 population. Nevertheless, both numbers and rates are well above the level of the 1930-40 decade. The estimated number of children under 18 in the civilian popula- tion of the United States in 1958, excluding Alaska and Hawaii, was over 61 million, or 35.7 percent of the total population. Provisional statistics indicate that the infant mortality rate increased again slightly in 1958. Thirty-one States experienced an increase as compared with the previous year. For children age 1 year to 20, accidents are the leading cause of death at all ages; for children age 5 and over, cancer is second among leading causes. _ Births out of wedlock continue to increase. The reported number for 1957 was 201,700; the ratio per 1,000 live births increased from 46.5 to 47.4 and the rate per 1,000 unmarried women age 15-44 years from 20.2 to 20.9. Forty percent of the unmarried mothers in 1957 were under 20 years of age. In March 1958, nearly 7.5 million mothers with children under 18, about 29 percent of such mothers, were in the labor force. Nearly 3 million had children under 6, a little over 20 percent of such mothers. 38 Department of Health, Education, and Welfare, 1959 Most children under 18, at least 87 percent of them, have a home with both parents. But in 1958 of the 25.8 million families with children under 18, about 11 percent or 2.8 million were broken homes. Most of these, 2.4 million, were homes in which only the mother was present. Juvenile delinquency court cases more than doubled between 1948 and 1957 while the child population in the vulnerable age group— 10 through 17—increased by only 28 percent. In 1957 there were more than 600,000 cases of delinquency involving about 520,000 children. Major Bureau Trends In fulfilling its special charge from Congress to be the focal point of Federal concern for child life and the well-being of the Nation’s children, the Children’s Bureau marked 1959 as a year of peak activity In many areas. In the cooperative Federal-State programs for maternal and child health, crippled children and child welfare, for which the Bureau administered grants to the States totaling $48,500,000, the burgeon- ing child population placed capacity demand upon all forms of services. Through its publications and reports the Bureau provided a maximum volume of information about child life and services to children. Congress voted the Bureau a supplemental appropriation of $1,500,000 in crippled children’s funds for services for children with congenital heart disease. The year 1959 was also marked by events which forecast significant developments in the future. Planning for the 1960 White House Conference on Children and Youth occupied a major portion of Bureau effort and staff time. Under congressional mandate, the Bureau was actively participating in the preparation of two wide- reaching reports due in Congress by January 1, 1960—that of the Advisory Council on Child Welfare Services and the Joint Children’s Bureau-National Institute of Mental Health Study of Juvenile Delinquency. The Bureau participated in the presentation of testi- mony on a number of important legislative proposals, such as those relating to the protection of children from abroad who are adopted by American citizens, a program for international health research, and juvenile delinquency. At the request of Congress, the Bureau was exploring means to further aid the immunization of children against polio. As statistics showed a continuing rise in illegitimate births, the Bureau undertook, with the Bureau of Public Assistance, to draft a plan which would promote better understanding of factors involved in the problem and to improve public welfare services for unmarried parents. At the same time, it gave renewed support to strengthening Social Security Administration 39 two relatively undeveloped social instruments—homemaker service and day care. The National Conference on Homemaker and Related Services climaxed a 2-year joint effort of public and voluntary agencies to promote this program. With the Women’s Bureau, Department of Labor, the Children’s Bureau made a joint survey of the resources of national organizations with day-care services. 1960 White House Conference on Children and Youth In May 1958 the President announced March 1960 as the date for the Sixth White House Conference on Children and Youth and asked the Secretary of the Department of Health, Education, and Welfare to invite State and Territorial Governors to appoint special commit- tees to begin a stocktaking on problems of the young. Such a con- ference has been held every 10 years since President Theodore Roose- velt convened the first in 1909. The President asked the Children’s Bureau to serve again as the focal point in the Federal Government for the conference planning. The Council of National Organizations, the National Council of State Committees on Children and Youth, and the Interdepartmental Committee on Children and Youth are among the organizations cooperating with the White House Conference staff. Hundreds of thousands of citizens, both adults and young people, have been enlisted to work on State and local committees for the 1960 White House Conference. They are making it clear that they see the Conference also as a forum for an exchange of critical views on American values and on the American way of bringing up children. The material coming to the White House Conference staff from the States reflects a general concern with the effects of rapid change on children and youth—change both in the past decade and in the years tocome. Reports of State Committees reveal that to help children and youth “realize their full potential for a creative life in freedom and dignity” responsible adults feel the need to define and maintain the moral and ethical values of our society as against the material ones; to raise our educational standards and to broaden and improve educa- tional opportunities for all kinds of children and youth, whether gifted, handicapped or average. They are particularly concerned with the need for strengthening family life. Increasing concern is being given to groups of children with special problems which seem to have increased and to have been aggravated in the past decade—youth in conflict with society; children and youth who are physically, mentally, emotionally, or socially handicapped; children who are neglected or deserted; children who drop out of 40 Department of Health, Education, and Welfare, 1959 school for lack of adequate training or adequate guidance. There is concern also about youngsters who marry too young; and about young- sters who seem to have little sense of responsibility, few values or goals, and few interests other than themselves. State Committees see the White House Conference as a great opportunity for focusing public attention on these needs and for building mechanisms to meet them. In an address to the National Conference on Social Welfare, May 25, 1959, Mr. Ephraim Gomberg, Director, White House Conference, said : ... We refer to the White House Conference on Children and Youth as a process rather than a 6-day series of meetings—a process in which citizen preparation, citizen financing, citizen participation and citizen followup underpin every bit of the comprehensive planning now underway. The 6 days of meetings in Washington are not the Golden Anniversary Con- ference. Rather they are the focal point of interest in 1960—the view from the mountain top after 12 months of preparation and climbing. Those 6 days are intended to provide a memorable view, a perspective, a forum for discussion, a classroom of learning. But they will be followed by 10 years of preparing for and of scaling other mountains of achievement in communities and States.... Federal Interdepartmental Committee on Children and Youth The Interdepartmental Committee on Children and Youth, estab- lished in 1948 to provide an opportunity for the exchange of informa- tion among Federal agencies with program interests in children, has held regular monthly meetings during the past year. Among the subjects presented for discussion were: the cooperative extension pro- gram, marriage and divorce trends in the United States, the program for aid-to-dependent children, and research progress in mental subnormality. The Interdepartmental Committee was requested by the President’s National Committee for the 1960 White House Conference on Children and Youth to serve as the main channel for Federal agency participa- tion in the forthcoming White House Conference. This assignment involves providing Federal agency participation in policy and pro- gram determination for the Conference, in keeping Federal agencies informed of developments in Conference planning, in making avail- able to the White House Conference the knowledge, resources and ex- perience of Government agencies and in post-Conference followup activities. One of the major activities of the Interdepartmental Committee has been the development of a chart book on children and youth to be published for use at the 1960 White House Conference. The National Council of State Committees for Children and Youth, with which the Interdepartmental Committee has a close relationship, held a workshop in Washington, D.C., January 15-16, 1959, on State Social Security Administration 41 preparation for the 1960 White House Conference. One hundred four representatives of 41 State Committees participated along with mem- bers of the Children’s Bureau, the White House Conference staff, and representatives of many of the ICCY agencies. Programs of the Bureau RESEARCH IN CHILD LIFE Research activities of the Children’s Bureau take a variety of forms. One study concerns situations, conditions, or processes to furnish in- formation—and sometimes ammunition—for promoting the welfare of children. An example isa study, begun in 1959 in cooperation with National Office of Vital Statistics, on the incidence of cystic fibrosis. The first phase provided national estimates of hospitalized cases during 1952-53. The second phase is a pilot study to develop method- ology for a national survey (Phase 3) of cases known to physicians in their private or clinic practice. Other special studies completed or in process in 1959 were the fol- lowup of 500 nonagency adoptions; the analysis of staff turnover in child welfare and family agencies; a study, made‘in cooperation with the Bureau of the Census, of child care arrangements by working mothers; the application of “performance budgeting” reported in Cost Analysis in Child Welfare Services. In this same category are plans now under way for community studies to fill a yawning in- formation gap about the beliefs and behavior of American teenagers who do noz¢ present acute problems—as a basis for more effective ap- proaches to juvenile delinquency and other youth difficulties. Another type of activity draws on research done by others. A preliminary roundup of research bearing on the effects of having mothers work outside the home was issued in 1959 for staff use only, pending final editing. An analysis of efforts to evaluate psycho- social change in individuals was presented in Some Guide Lines for Evaluative Research. More strictly on the reporting end, Bulletins 8 and 9 of Research Relating to Children carry on the Bureau’s run- ning inventory of current nonmedical research. The Bureau also gathers or compiles statistics for use by a wide public, inside and outside of Government. Seven numbers of the ongoing Statistical Series (Nos. 48-54) were completed during the fiscal year, covering various aspects of juvenile delinquency and child health and welfare. Zrends in Programs Administered by the Chil- dren's Bureau was revised and an edition issued for the 1960 White House Conference. Major staff assistance was given to the chart book for the Conference, a compilation of statistical data about children, prepared by the Interdepartmental Committee on Children and Youth. 530344—60——4 42 Department of Health, Education, and Welfare, 1959 Staff members also worked with States and national organizations in improving data-gathering methods and reporting forms relat- ing to such concerns as maternal and child health, mental retardation, police reporting of juvenile delinquency, institutional child popula- tions, etc., and gave research consultation or participated in working groups for State and local departments and for national organizations concerned with the welfare of children. Impetus to research developments was given by staff members through more than a score of articles, papers and reports published in professional journals widely circulated among the many practi- tioners, teachers, and scholars who look to the Bureau for informa- tion about what is done, learned, and needed with regard to the well- being of children. MATERNAL AND CHILD HEALTH SERVICES All States, the District of Columbia, Puerto Rico, and the Virgin Islands receive Federal funds to extend and improve services for promoting health of mothers and children. For the fiscal year 1959, the appropriation for maternal and child health remained the same, that is, $16,500,000, with $1 million ear- marked for services to mentally retarded children. Ongoing programs of the State maternal and child health agencies continued to make major contributions to the health of the Nation. State maternal and child health reports showed that about 257,000 mothers received services at maternity medical clinics in 1958. In addition, public health nurses served 554,000 mothers before or after delivery. About 601,000 infants and 826,000 other children received health supervision through well-child clinics. In addition, health depart- ment programs provided nursing service for over 3,018,000 infants and other children. Over 2,700,000 children were vaccinated for smallpox, and over 38,100,000 were immunized for diphtheria by State and local health departments through grants provided by the maternal and child health programs. Polio immunization through these programs reached 5,100,000 children. Activities and services of maternal and child health programs on behalf of mentally retarded children and their families continued to expand in 1959. Of 44 State health departments offering special services to the retarded, 36 reported serving 6,704 children and their families during the past calendar year. There was a steady move- ment toward earlier casefinding and identification; 30.3 percent of the new cases seen during the year were under 4 years of age and 74.6 per- cent were under 9 years of age. Applications continued to exceed the capacity of the centers to accept children for diagnosis, evaluation, and Social Security Administration 43 treatment, but new methods of reducing waiting lists are resulting in services to a larger number of families. More selectivity and flexibil- ity in the use of diagnostic approaches, more efficient use of local resources, greater stress on training local generalized personnel, and assignment of preliminary screening responsibility to local services are some of the techniques being used. During the year three biregional conferences were held. These in- volved the administrative and technical clinical staff in six regions and afforded an opportunity for exchanging information and sharing ideas and experience. A highlight of the year was a meeting of the Children’s Bureau’s Technical Committee on Clinical Programs for Mentally Retarded Children called primarily to discuss an action program to prevent the mental retardation associated with phenylketonuria. As a result guides for screening and treatment of affected children are being developed. The recommendations made by this Committee were sub- sequently endorsed unanimously by the American Association for Mental Deficiency. Pilot studies to identify affected families are already in progress in several States, among them Michigan, Oklahoma, and California. After 22 years of decline, infant mortality rates rose from a record low of 26.0 in 1956 to provisional rates of 26.4 in 1957, and 26.9 in 1958. Concern over this increase in infant mortality has resulted in efforts to pinpoint specific causes, or at least to determine whether cer- tain areas or groups in the population are chiefly responsible for the rise. Asa result of several studies which show an association between lack of prenatal care and increased neonatal mortality, a number of States and cities have established new clinic facilities for maternity patients in areas inadequately covered. Partly as a result of higher neonatal mortality and partly because of interest in controlling hospital-acquired staphylococcal infections, consultation by maternal and child health personnel to hospitals is increasing. Some States have been able to employ new staff for this service. A number of States report that the number of requests for hospital consultation exceeds their ability to meet these requests. A number of State health departments have published new hospital manuals emphasizing the care of newborn infants and the control of infections in nurseries. A number of institutes on this subject were held in the States during the past year. Interest in special problems of the adolescent has taken concrete form in the development of services for this age group. A number of new clinics for adolescents were started during the year. Although all these clinics are essentially medical clinics, a very broad service to adolescents is being offered, including help with social, emotional and intellectual problems. 44, Department of Health, Education, and Welfare, 1959 Since a high percentage of accidents involve children, a number of State maternal and child health divisions now employ personnel specifically assigned to accident prevention and poison control activi- ties. During the year a number of studies of childhood accidents were made by these States to find clues for prevention. As in former years a great deal of attention has been given to train- ing professional persons who serve mothers and children. Two im- portant conferences were held at schools of public health. An Institute on Perinatal Casualties was held at the University of Minnesota in cooperation with the University of Michigan and the maternal and child health and crippled children’s agencies of the two States. A regional conference on child growth and development was held at the Johns Hopkins University School of Public Health in cooperation with the Maryland State Department of Health. Institutes for physicians and nurses on the care of premature in- fants were given at the New York-Cornell Medical Center. The fac- ulty from this Center also led institutes in neighboring States. Other courses in the care of prematures were given in various parts of Flor- ida by the staff of the premature center in Miami. CRIPPLED CHILDREN’S SERVICES All the States (excepting Arizona), the District of Columbia, Puerto Rico, the Virgin Islands, and Guam are participating in the crippled children’s program. Although the State agency auspices vary, the objective is uniform, namely: to locate children who require care and to provide restoration through diagnosis, medical and surgical treat- ment, and alleviation of unfavorable social and psychological influ- ences which adversely affect the degree and duration of the disability. The appropriation for crippled children’s services is $15 million, $5 million less than the amount authorized. A new peak was reached in 1958 in the number of handicapped chil- dren served under federally aided programs, preliminary figures from State reports indicate. Of the 325,000 children cared for during the year, 255,000 were examined in clinics; about 71,000 received physi- clans’ services through home or office visits. About 58,000 children were hospitalized. Convalescent home care was given to the smallest group, around 3,800. Shortage of funds continued to plague the crippled children’s pro- gram. Not only were medical care costs higher but caseloads were heavier due to an increasing child population, to relatively larger num- bers of children in low-income families, to extension of services to new categories of children, to improved casefinding, and to advances in therapy making a larger number of children amenable to treatment. In a few States a larger number of families were unable to pay for private care because of unemployment. Social Security Administration 45 In many States crippled children’s programs have had to be cur- tailed because of insufficient funds at the very time demand for serv- ices is increasing, particularly in areas where programs have been improved, where services provided have not been available previously, and where new developments in medical diagnosis and treatment are being applied. These include such diagnostic categories as congenital heart disease, speech and hearing defects, cleft lip and cleft palate, and neurological impairments. Among the States where services have been curtailed, except for the most urgent or severe problems, are Colorado, Idaho, Montana, Wyo- ming, Kentucky, and North Carolina. Three States established wait- ing lists for surgery beginning in the third quarter; Missouri, Puerto Rico, and West Virginia have long waiting lists. Should this trend continue, the number of children whose severe and permanent dis- ability could have been prevented or alleviated will undoubtedly increase. Further, extension of services to children with malignancies, cystic fibrosis, nephrosis and other metabolic diseases will not be possible. The pressing need for crippled children’s funds was alleviated somewhat this spring when Congress earmarked $114 million for fiscal years 1959 and 1960 for care of children with congenital heart disease. Beginning in 1939, when the increased crippled children’s appro- priation was made in part so that rheumatic fever programs could be developed, Congress has shown a preference for appropriations given for specific purposes. This was also demonstrated in 1957 when $1 million of maternal and child health funds were earmarked for programs for mental retardation. States are increasingly aware of the needs of multiple handicapped children such as the deaf-blind. During the year the Children’s Rehabilitation Unit of the University of Kansas Medical Center evaluated nine such children and through their efforts the State legislature passed a bill providing out-of-State education for severely handicapped children such as the deaf-blind for whom special educational opportunities are not available in Kansas. During the year a conference was held at the Child Amputee Center, Grand Rapids, Mich., sponsored by the National Research Council’s Committee on Children’s Prosthetics Problems, and the Children’s Bureau, to which were invited the directors of 12 major child amputee clinics. Agreement was reached on areas of clinical program studies to be carried out cooperatively by all 12 clinics. This includes testing a new artificial leg, studying problems of fitting artificial arms, and studies of the optimal age for fitting babies with artificial arms. The Harvard School of Public Health, in cooperation with the 46 Department of Health, Education, and Welfare, 1959 ine eee Children’s Cancer Research Foundation and the Massachusetts De- partment of Public Health, sponsored an institute on leukemia and other malignant neoplasms in childhood for maternal and child health and crippled children’s directors. The importance of early diagnosis was stressed and the newer medical and surgical treatments which have improved prognosis for cancer in children were discussed. The availability of services in the congenital heart programs has led to the discovery of many children previously unrecognized. In 1950, 2,207 children received physicians’ services for congenital heart disease under State crippled children’s programs; in 1958, 12,164 (preliminary), nearly 6 times as many. The rapid and brilliant scientific advances which have occurred in the diagnosis and treatment of congenital heart disease have created widespread interest. The past 2 or 3 years have seen the development of professional teams and facilities for care of children with congenital heart disease in medical centers and hospitals in many States. This development of State centers has resulted in fewer children leaving their own State for care in regional centers. Increasing interest with resulting development of programs for children with cystic fibrosis has been taking place, especially in the northeastern States. The caseload for children with this condition has been increasing. Many training institutes have included the subject of cystic fibrosis. CHILD WELFARE SERVICES The year 1959 stands out as a momentous one for the child welfare services program. The potentially far-reaching and challenging ram- ifications of the 1958 amendments to the child welfare provisions of Title V, part 3, of the Social Security Act for strengthening services for all children in this country is increasingly evident even in the relatively short period of time since their Presidential approval on August 28, 1958. With child welfare funds now available to urban as well as to rural areas, States have an opportunity to participate in improving community living for children and families in a dimension not heretofore possible. In addition, the amendments: 1. Broadened the provision with respect to return of runaway children to their own communities to permit use of funds for children up to 18 years of age and to maintain the child pend- ing his return for a period not exceeding 15 days. 2. Increased the authorization of Federal child welfare services funds from $12 million to $17 million. 8. Authorized reallotment of these funds. In accordance with this provision, reallotment was made to 15 States (February 1, 1959) of funds released by 4 States. That States have made Social Security Administration 47 effective use of these additional funds is evidenced by the fact that the amount of Federal funds on hand in the Federal Treasury on June 30, 1959, was only $166,701.34. This repre- sents 1.4 percent remaining in the Treasury in 1959 as con- trasted with 4.6 percent in 1958. 4. Added a new requirement for matching Federal child welfare services funds with State funds, beginning July 1, 1959. 5. Extended the program to Guam, as of the same date. The Bureau’s regional child welfare representative was in Guam before the end of the 1959 fiscal year to confer on the develop- ment of the basic plan and 1960 annual budget. Another 1958 amendment to the Social Security Act (Title IX) established an Advisory Council on Child Welfare Services to report to the Secretary and the Congress by January 1, 1960. At its first meeting, May 4 and 5, the Council concerned itself chiefly with deter- mining the scope of future deliberations and procedures for carrying out the congressional directive. Plans were made for a maximum of three future meetings before the end of 1959. A working paper pre- pared by the Bureau was requested by the Council for consideration at its next meeting. The Bureau has requested from States and national voluntary agencies information on developments and needs in child welfare programs as well as suggestions for future changes in Federal legislation. As the fiscal year ended, plans were underway for an evaluation of the effect of the 1958 amendments. ‘They have opened a new era in the grant program for child welfare services. Their effect in strength- ening State and local child welfare programs along with recommen- dations anticipated from the Advisory Council on Child Welfare Services, will lay a foundation for the future of public child welfare services throughout the Nation. A meeting with State Welfare Administrators and Child Welfare Directors, in October 1958, afforded opportunity for a discussion of draft materials on new procedures to carry out the above provisions. A report of the Conference is included in Zhe Changing Scene m Child Weilfare—Child Welfare Reports No. 9. Subsequently, these revised procedures were issued in official form, and prior to the fiscal year’s end were incorporated along with procedures for implementing the requirement for “matching” in the Handbook for Child Welfare Services. Revised regulations were also in draft. Uniformly, reports from the regional offices and from the States themselves have indicated a positive reaction to the new legislative base. A great deal of thought and care has gone into considering the most effective utilization of combined State and Federal funds to strengthen child welfare programs; State agencies have received new impetus for program expansion and development. 48 Department of Health, Education, and Welfare, 1959 Demonstrable progress was made in 1959 in advancing knowledge of children’s needs through joint planning between levels of govern- ment and between citizens and voluntary and public agencies in de- termining optimum ways of providing needed services. Particular stress was laid on strengthening family life and services to children in their own homes. 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Se tee. cre: Ls eed Se sk 1, 694. 8 f, 571.9 1, 427.4 Wi GS OD Dare ter ie Dy ae 258, ease. seas [Pe a mks eS Bere Or WIGOWE! Sos eee en 1, 322.0 I alee aes: 1, 020. 5 RE ne ee eee a ts ee ee 33 da a Se 366. 5 344. 9 314.9 fe LOTS Seat. ete pe ew ee ee CW eg eS 3257 29. 4 28. 1 Total monthly amount (OASI and DI)__________________- $805, 545 $659, 684 $554, 637 Motalimonthly amount(OASI)_ i203) 22g $778, 404 $644, 773 $554, 637 ELOLal mMOncM y.anrOumtt neo: eee moe yn $27, 141 S14 OLA: eRe ee ee ot Ol@-age (retired-worken) oe os oN $526, 701 $436, 244 $373, 230 Disability (disabled-worker)___....._......----._-_--_- $24, 324 $14 901) Loa ge aa Wife’s or husband’s (OASI and DI)__-____-_--_--__=- $81, 295 $67, 821 $58, 749 Wiate’s-or husband's. (Q ASD ses-sesseseseen soeese $80, 096 $67, 821 $58, 749 Waite sor husbands (DT)imss ok Bee SU a1 OG) || Se bee Be ogee oh ae ee Chiesa Land, 1 )2 3 a2 sas i ee nee $76, 209 $61, 471 $54, 283 Cmidis(O AST) 26 cee eel eee sS re. Sieh ee a ee $74, 591 $61, 471 $54, 283 Cinidis((D1) 22. 1 I RRA RR he eS Ee Bie ae At SE OU Sh lire? ae cee s(n 2 ee We DNACOWs SOL WICOWeU'Ss suas 20 i ye $74, 359 $60, 457 $51, 707 MV Heri GrGiee es ee ee ee ee ee Se Pe he $20, 760 $17, 241 $15, 224 [ZAnGDiaSeet a Sie Sete Sse ere os aes eR $1, 896 $1, 538 $1, 445 Average monthly amount: Olaeager(retired=woOrken) 2222220522) Seat does $72.19 $65. 71 $63. 99 Disability. (disabled-worker)/2- v2.22 ee eg $88. 40 $7442 hs see ot ae Wife’s or husband’s (OASI and DI)________2-_______- $37. 96 $34. 83 $34. 18 Warezsonmusband:s (OASH) se. 1 ee $37. 99 $34. 83 $34. 18 Wate sor nusbandis-(D Lemmas beers 5) Sigs S36" O95 | eee ee Us ee eee eee (Chats! andj 4s 2 it go $438. 61 $39. 11 $38. 03 Oiuidsn (OVAL) seers se abe $44. 01 $39. 11 $38. 03 CLNTIGUS (GDI D2 2 Sate Se ei ets See eiekin em sen ees S308 62) || Se ae se le ae ee ee Waidow’s:or Widow er’S2.c2secoe ones swore sees oes $56. 25 $51. 55 $50. 67 OU eT cemese! 02 On ra ok Ry Gregg Flt | Paha ee oe ee $56. 65 $49. 99 $48. 35 1] OVEN CELT ASL 2 caret Mam es Re Sea me Ge $58. 02 $52. 34 $51. 38 Benefit payments during period: Mionthiyabenerits: (O:AST and DI)... 22.2 =e. 8 = $9, 238, 753 $7, 900, 638 $6, 391, 690 Monthivzhenents (OAST) $8, 899, 522 $7, 732, 218 $6, 391, 690 Wionthiys benefits @D])ssso 45 i eee ge $339, 231 $168,420 |= 22 2 Old-ace-@etired-worker) 2°. 5.2 Se $6, 041, 417 $5, 245, 777 $4, 340, 271 Disability (disabled-worker) ___...__-_2.---.----2_----- $311, 105 S1LGS;.420)i eter teee eee oes Supplementary (OAS and D])__2° 5 a5 2. te $1, 007, 142 $860, 488 $679, 289 Supplementary, (OAST) 22 202 ee ee ee $979, 016 $860, 488 $679, 289 Supplementary (Dl) seas ee ee et $2812.65 | ees ek ee ne, Le ae PUBALVO een | ee eee eee ee od ay eer wee ee $1, 879, 089 $1, 625, 953 $1, 372, 130 HmnTp-stimdeath: DPayMentse.2 se i a $149, 625 $142, 714 $122, 891 Insured workers (midpoint of period—Jan. 1):3_______________- 77, 310 76, 210 74, 140 RCIA SURC Ge 2 een ee a ee 75, 810 76, 310 73, 860 Currentiy put mot fully insureds... -22.}-=2s2--- es 1, 500 900 280 Estimated number of employers reporting taxable wages, Ist MfAnLCMOlMISCal Veal- ns oe et Re oe ee 44,090 44, 060 44,052 Calendar year Estimated number of workers with taxable earnings_________-_ (4) 70, 000 70, 500 Estimated amount of taxable earnings.._..._._.....-__-_____- (5) $181, 000, 000 | $181, 300, 000 mverapeiaxapocarmings 6.5 28 224. 5.8 eo ee (5) $2, $2, 570 1 Benefits under the old-age and survivors insurance (OASI) parts of the old-age, survivors, and disa- bility insurance program are payable from the OASI trust fund to old-age insurance (retired-worker) bene- ficiaries and their dependents and to survivors of deceased workers. Benefits under the disability insurance (DI) part of the program are payable from the DI trust fund to disability insurance (disabled-worker) beneficiaries and their dependents. 2 Includes benefits payable to disabled persons aged 18 or over—dependent children of disabled, deceased, or retired workers—whose disability began before age 18. 3 Estimates of insured workers have not been adjusted to reflect changes in insurance status arising from: (1) provisions that coordinate the old-age, survivors, and disability insurance and railroad retirement pro- grams and (2) wage credits for military service. Estimates are only partially adjusted to eliminate duplicate count of persons with taxable earnings reported or more than 1 account number, 4 Excludes agricultural employers. 5 Not available. 6 Rounded to nearest $10, Department of Health, Education, and Welfare, 1959 64 688 ‘T 68°02 TFS ‘6 LES¢ £86 ‘E IL ‘$F 930% | 6418 | 8 ese ‘ZT | o9°TL 982 8¢ “69 268 T8 ‘TZ €28 ‘OL | S6°TS 820 ‘¢ 61 “09 68I ‘% €9 ‘PL CHS ZS “F9 91g ‘g G6 ‘PST 601 ‘F 08 °¢9 G18 ‘F 08 98 996% | 2998 £28 ‘Fb Te “ee 499 ‘FFZ | LE°E9 602 ‘21% | 69°09 FPS ‘S8T$] OL “6S$ | O16 ‘E8Z| OT9 ‘OS$] 28 E9$ (Sspuvs | ouner -noy | ‘yueur Ul) reoA| -ABd jeosg 038 {e1O,T, | -IOAV squerd1oe1 0} squeurAe perqestp AlTe}0} pue A[jueueUlIed 04} 03 PIY ses ‘T 1 T9E €1°69 | SOF gce ‘ct | o1e‘z | Te°92 | E19 ‘% T00‘8 | 299‘T | SOF | 29T‘e £02 ‘F | Z19 Z0°S8 | 909 Ter ‘tT | 19°28 | Lob ‘T €6¢‘T | F0'bL | T16‘T 082 ‘21 | €66'% | 42°84 | 660‘ 666 SFI 88°89 | ELT LOT [ik 89°99 | &6 618 ‘8ST | O9T‘Z | HE°%o | SHE ‘e Get‘s | SLLZ‘T | €6°8¢ | LHe ‘Zs oro ‘S | T6L OT 89 | 82% 9¢¢ LZ CLCL | $9 ser ‘Z | S6e TS ‘ZIT | £08 O19 ‘¢ | 88z ZG °9L | ZI 198 ‘9 | SIS ‘ZT | S8‘EOT | 280 ‘FT £60‘2Z | 88c‘T | P9°S¢ | 270% CF G0°89 | 218 pies fata LL SIL =| ¥6 ¥02 ‘ZI | cc9 gece | 19 ‘T eez ‘6ee] 990 ‘68 | 70°69 | OFF ‘GOT oge ‘zIg] L6e ‘es | 22°99 | 988 ‘SOT TPP ‘801 (spues euner -noy} | “yuour eunr jut) IweA| -Avd eune ‘squoy | [eosg ese *SqUOT -dyool | ‘[ej0., | -loAY | -dtd01 Jo 10q Jo 10q -UInN -WnN s}usTdyae1 0} SJUSTIABT PUul[q oq} 03 PIV 6IT ‘9 629 ‘Gz 996 ‘LT £98 ‘8 182 ‘SI 199 ‘eT GPL ‘19 6e8 ‘E 820 ‘F OCF ‘OT 126 ‘8T T80 ‘9 GoL ‘T 868 ‘ET LST ‘OT ESb ‘ZET ZOP ‘G 620 ‘8 SPS ‘T 122 ‘2 088 ‘996 96T ‘ST8 692 ‘002$ os (spues -noy} Ur) e904 jeosg T21O.L S}ueTdi9e1 0} sjyueTI ACT Of 22 | 8L°S6 | S69 ‘FT CFs ‘61 61% | 28°68 | 699 ‘9Z T&8 °86 ZL 02 «| 6E°ZL =| 692 ‘99 968 ‘FL c$"es | 8o°ZST | TZ ‘ZT 406 ‘TZ 10°9E | 62‘ZET | S02 ‘Fz £02 ‘Ze 108% | €8 "TOT | 20¢ ‘Te C88 ‘TF GE"L8 | 89 CST | 169 “L0T 98I ‘OFT 0€ ‘OF | IE ‘8hI | 9FZ‘C SSI ‘2 OI ‘PE | 66°ZET | 186 ‘2 ¢¢0 ‘OT 288% =| 99°88 | 616 FF 08€ ‘8¢ 1Z‘9T | 09°69 | 646 ‘82 908 ‘TOT 8S | OF SFT | 86 ‘eT ZBL (91 Le€% | L9°18 | FI8 > Cz ‘9 eo Zp | Zo °9CT | Se8 ‘ZT 966 ‘EZ 6 SE | 60 FET | 9EB ‘TZ L0G 1LB 82° | €€ OT | OLT ‘LET 8th ‘ES 99°ST | 08°69 | ZeZ ‘Ez b8z ‘OF €L°82 | Sh'SIT | $88 ‘6T FCO ‘9Z G8°sz | 69°00T | $90 ‘Ee 180 ‘F Z0°L 06°22 | 896 ‘69 182 ‘68 68 °8% | £6°90T | 200'24Z‘% =| Lee ‘826 ‘% 8Z°2Z | 68 ‘COT | 91% ‘260% | OPT ‘eer ‘2 40 92$ | 79 °96$ | O98 ‘TES‘T | Szz ‘s6E‘Z eune ‘VUey eunr -dyoo1 | ‘Ayrurey aod red quem | juour | uoIpTTqO 1 [8}0.L -ked | -sed e238 938 -I8AWY | -IoAV WeIpTIyo Juepuedep 0} PIV ggg ‘¢ AS BE L08 “0% 18 “¢ 082 ‘8 90¢ ‘TT OLE ‘FE 16 ‘T E89 ‘Z 902 “GT &69 ‘2B ces ‘E 619 ‘T 186 ‘L 620 ‘2 80F ‘TL 186 ‘2 86 ‘9 TAI ‘'T 009 ‘2 089 ‘212 GOS '8EL GSI ‘249 €2L ‘8 &69 ‘16 606 ‘8 819 ‘Lz PL ‘08 190 ‘IZ O19 ‘eg 968 ‘¢ 600 'T COP ‘FG C6L ‘$F FIb S 088, P98 ‘0% L¥9 ‘6G T86 ‘99z 400 ‘ZE T6E 6 980 ‘I 19% ‘ZG ¥00 ‘8¢g ‘T PLE ‘862 ‘T F0°S9 £199 LG 80 GE LL 89 GL L9 “6 99 69 90 79 SP 8G OF LY €8 “e¢ GE “V9 60 ‘67 LT OIT T0 “86 98 “8 99 “8h GI “LG Lg °09 G0 “SP 91 °¥9 88 19 682 ‘PZL ‘TE | 99°8C$ (spuesnoy}4 Ssoljueq | Ut) 0h euns ‘syueTdyoe1 Jo JoquinN Teosy TeIOL, eune ‘“ueuked ose1lOA VY sy uetd1de1 0} SquomIART 288 ‘IT FI9 ‘FZ G02 ‘2¢ GES ‘6 PL8 ‘ce GPP ‘6% 198 ‘22 66S ‘2, 88F ‘T SCT ‘86 960 ‘OL 122 ‘E CIP ‘T 1¢8 ‘$1 SPL ‘TS L09 ‘19% 692 ‘9g 288 ‘ST 89% 'T 9TS ‘O0T 696 ‘ETF ‘% 662 ‘09% ‘2 062 ‘0 ‘2 i i if | | | eune ‘squerd1oe1 Jo 1oquInN Q0UBISISSB 938-PIO pp ee eee LS6T :Ie0A [COSl qT oy819 [6S6T ‘9T 390 0} poeqJoe1100 eyep {syusuMIABd YONS ATUO SUTATIIOI SOS PUB OIRO [BOTPOU IOJ SyUOTAAGd IOPUeA SepNnyoUT] 6S6I 4ned pos 6a1n1g pun wyss0id XLqQ ‘squaid19a4 0] syuawutnd 1010] pun ‘6cg, aunf ‘yuawAvd asniaav pun squaidiza4 fo saquiny] :uoI1DAIsIMIWUpP A}14NIAG 1D190G ay? 4q paaoisddy sunjd sapun azupqsissp 9139qnd fo sadk} o1I9adg—) 2]q¥ J, 65 istration Social Security Admin *sqUdTdood 0G UBT} SSoT JO oSvq TO pojndurod you yUoTIAe OSVIOAY ¢ “90UVISISSV JO JUNOUIB 9Y} SUTUTULIOJOp UT Pelop|suoo OOM 4INPB YONs T 4Seoy 78 Jo sjuetMoeTNboed oy} YOIYA UF SOFUILy Uy SATIVIOL I[NPB Jey4O Jo JuoIed [ pus UOIP[IYyo 94} SJus{djoo1 se sepnfouy] 1 a a SSS TOF 1S ‘FL 922 ‘T 68 ‘OZI 688 ‘S €8 ‘SS Teh ‘2 08 ‘90T PLI‘S £0 “LF 0g 49 GZ 21g 68 “69 CPL ‘T 62 SL 799 ‘Z GL °Zo 0&2 ‘8 08 ‘Sh ZOL LI‘19 12% ‘E 6L PE CEP ‘S ce 08 FEI ‘Z c8 °8 ro0 ‘IL | &1'6¢ G00 ‘¢ GZ ‘%8 Teg ‘8 SL °S8 LL6 ‘2 88°19 Oct ‘T 46 26 G&Z ‘6 Lb LF cor ‘cp | 98 ‘ZO 029 ‘T ¥0 69 FLT 9 90 ‘96 6LE 79°18 PS ‘T ZE OL TES ‘T 92 ‘OL Tz¢ ‘OL | F6°L9 LLG ‘% G6 6 12g ‘T 02 19 $26‘ G8 “G8 Gcr ‘SI | 90°9IT vOl ‘V 80 “S9 ge 118 ‘I SGP ‘L 610 ‘9 680 ‘9 TOL 118 661 ‘S 9ZI ‘S 668 ‘L 260 ‘T 928 ih 9CL ‘S GSP ‘TZ T&T ‘OL €10‘¢ 026 '8 909 ‘OT 190 ‘T 788 ‘LT 766 ‘LE GBS °G PIO ‘9 8g 796 Tg °69 T9 68 v8 6E 06 ‘SOT GS OP (z) €€ 09 rE OL v0 LS 98 “LP 66 “LS 61 GP 96 SL GZ '8 Zo 29 98 ‘18 96 "£6 OI 79 Gg “89 $6 T9 Go “ITT Zo 9 VP P8 LO CL TS 86 G6 G8 v9 FL 00 °¢9 €¢ 8E bY 96 GE OL Ge °LTT 86 ‘29 99 220 ‘T 60 ‘T Shr SOT ‘T £19 ‘ST TES ‘TZ LOF ‘ZS 029 ‘8 COT TGP ‘T 08z “¢ GLE ‘1G QSL ‘LT 769 '§ $62 ‘9 Z6L ‘9 SIP ‘8 460 ‘19 LSY ‘6 80S ‘TZ 602 ‘62 P16 ‘% 699 ‘ZS GZ9 ‘631 FOP ‘6 O19 ‘LT 988 ‘T 820 ‘T 82S ‘E G8L ‘% SEB ‘SZ L6r ‘8 LEP ‘OT 66S ‘OF OF8 ‘GZ G18 ‘OL GL 9E 80 VP OL GS GO ‘OF GS 0G 10 GI LG ‘0& It LE 80 LT 60 “61 GT “6% ¥0 FI 88 SE 60 7 8 OE G6 SE OL “TE G9 “LE 9€ '8E OF ‘6I GG GP 9T OE GT OP 9% IF 78 9% G9 “Lz 0z € 06 &% ¢9 OI eh VP ZI ‘8E 10 ‘¥P 9 °8Z 6P “CET ST 69ST LE “18 96 ‘O9T 8h 28 LI 8? 8€ “SOT vy TEL 06 ‘OL vy OL 62 66 68 Gg 82 “LOT 70 ‘ST TL 611 78 ‘821 8% ‘OT 06 “LOT 08 ‘GI ZL OL 90 F9T Ly S11 70 FST OF “SST OL “88 G8 “GOT TI ‘G61 9T 06 v0 TP €6 ‘TST 8h PEL GL LPL 96 °LIT 901 ‘% 79S ‘SZ ers ‘19 STL ‘Oe Z9Z ‘6 879 | 288 ‘€ eat 6 ¥¥0 ‘84 SOT ‘T9 190 ‘8 PPS ‘0 v8 ‘CI £96 ‘ZST 8PZ ‘EST LIZ ‘9T 796 ‘Sp Lg ‘ZL, ¢20 ‘¢ 696 ‘08 CEP ‘E61 GLE ‘IZ $91 ‘LZ S61 ‘S $29 °% 996 ‘2 STE ‘S CCl ‘PL 968 ‘9g 08g ‘cz 180 ‘TZ 610 ‘9 GTS ‘12 692 % 109 ‘g8 978 “BL £00 ‘Th 266 ‘LE 082 OI¢ ‘F 682 ‘ZT PvE ‘COT 280 ‘T8 169 ‘OT 09F ‘88 6SF ‘OT 026 ‘O6T 692 ‘SLT 69F ‘TZ F6 ‘09 189 ‘$6 SLi ‘9 6£0 ‘SOT ZrO ‘LEZ G89 ‘LZ €9¢ ‘9g GCS ‘FP 188 ‘8 I8P ‘OL 028 ‘9 880 ‘86 678 ‘TL 296 ‘ZS SZ ‘16 S6I ‘SP ZOl ‘SE 891, 708 ‘6 28h ‘Oz ZEL ‘TT 612 ‘6 LIZ. 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See puels, spoyry ea wk --ooly oVong eae ie ial elueA[ASuueg 2 eros igi ea cialis U0801O Wie. tere es eulouelLyO se ae eee ~ OIO posag oo = saa OOTXOT, MON ee AQSIOC MON Ty ee Be SPCAoN So eee Se cee T @yselqoN Soe Bote ae TLO ALT Pi ee ea ---TLIMOSSTTAL ae ates es aie es Id CISSISST AL ag ea et cg ea e10SOUUL IAL ple ashi na Near UBSINOIVL T=" >= =-==---Gn 1 OSNYIVSse [AL aa ee ge puelAle pl 68 Department of Health, Education, and Welfare, 1959 Table 9.—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 1959 * [In thousands] Maternal and} Crippled Child State child health children’s welfare services services services United: Statesi22. 2330 ae ee ee eee $16, 494. 1 2 $15, 170.6 $11, 833. 3 Alabamasio Sicsc- ob ete Soe Se wt ek Se oa ee 547.8 462. 5 369. 6 Alaska. on See ce ee ee A ee ee eee oe 163. 6 208. 7 57.4 Avizona 22: = see Po ea ee Se 148575 | oe eee 130. 0 ATKANISOS he. Ses es ea ee ek a eee een cee 292. 6 249. 2 249.9 QOaliforniau. ee eee a ee ee eee rece eee eee 795. 8 759.9 415.2 COlOPAGO! eae ese ae eee ee 329.3 176.8 146. 8 Connectiqute s.422 a 2 eee ee ee ae 246. 3 21357, 116.1 Delaware.25 02. ces sco 8s oS Ree a eee 104. 3 95.7 63. 4 Districtiof: Colimbia +: 2 sea ee ae ee ee eee 246. 5 Liatiad 40.0 Plorida ak ee See ee ee ee ee eee nS 449.7 302. 7 252. 8 Georgia 2.256. 4-. | ? ¥ ‘ - 7 1 i th WPT ’ : : han CHA of t ; : 4 : 4 y Le « : + r 1 i’ L . ‘ mh 1 , y fer ¥ : Ny ‘ : ca “” | BD ' ‘ 4 i d "4 ‘rt > ae : Hy 4 Sy ay ’ , yes Gy ate ial dae } whee bP & , * a4 “4 x hia Uy ¥ * My v 4 > t 4 4: i ¥ ", \ : r ‘ o h j : : D ig'y t » ‘ » \ i ‘ oy é i ¥ r ry A eT Kee at a ' . dy n . ie de 9 ” \ - t } ‘ vaat re, i rryth - Ds grd yb Sae iw PAE wun rt , ry ye on. ane | or } g's ° 4 ' , , ‘- rn oer j ‘ | Tae 1 2 -we 5 ‘ i 4 4 ay j 1 xe f ‘Vo peat é oreo ote ae teh te fn 2 4 ’ mer re i ee. te 1 - { th « vs ‘ q t aa ° a ite ads — « . re SR ee nS pr SAR! as i at : wr a 9 TA AN Ayn et ly tn thm = i m “erat cd Nn me: osenpeobee! fi: ee Hg rv Kon Sy ante ah r ra ( “\ Pri ;. Public Health Service Health of the Nation Cooperative effort is the key to American health. Private practi- tioners, universities and medical schools, hospitals and research labora- tories, voluntary organizations and foundations, civic and community groups, and official agencies of government—these and other groups contribute their combined skills and resources to the struggle for bet- ter health in the United States. During the past year this vast part- nership continued to grow, both in size and in strength. The result was progress on many fronts. Disease and disability are stubborn enemies and yield ground slowly. Moreover, the character and tempo of modern life often create new health problems, even as solutions are found for the old ones. Action in behalf of health must rest on a solid base of public interest, understanding, and support. The record of the past year indicates heightened public interest and the pursuit of measures designed to illuminate and strengthen every segment of the health front. The Federal Government, through its principal health agency—the Public Health Service—was an active partner in these enterprises. Appropriations for PHS programs increased. New programs were established, and a number were expanded. Renewed emphasis was given to the health problems related to the modern environment; health research continued to grow; and continued attention was given to the development and training of health manpower. The pages that follow describe in detail these developments and other significant actions of the past year. HEALTH RECORD The health of the American people remained at a high level during the past year. The general death rate for 19581 was 9.5 per 1,000 1 All vital statistics are given for the calendar year. 71 G2 Department of Health, Education, and Welfare, 1959 population, slightly under the 1957 rate of 9.6. The rate has been below 10 per 1,000 population since 1948, reached its lowest level of 9.2 in 1954, and has varied between 9.2 and 9.6 since then. The infant mortality rate for 1958 was 26.9 deaths per 1,000 live births, virtually unchanged from the 1957 rate of 26.8. The ma- ternal mortality rate for 1958 was 3.5 per 10,000 live births, compared with 3.9 in 1957. The average length of life for the entire population, based on mortality rates for 1957, was 69.3 years. The average life expectancy was 67.1 years for white males, 73.5 for white females, 60.3 for non- white males, and 65.2 for nonwhite females. Chronic diseases continued to cause the majority of deaths in the United States. Together, diseases of the heart and blood vessels and cancer accounted for 70 percent of all deaths in 1958. The death rate for the major cardiovascular-renal diseases in 1958 was 524.0 per 100,000 population, and the cancer death rate was 145.6 per 100,000 population. The mortality trend for accidents, with the exception of motor- vehicle accidents, has been downward since 1949. The death rate for motor-vehicle accidents remained at a high level. It was 22.3 per 100,000 in 1958, compared with 22.7 in 1957. For all other acci- dents, however, the rate continued to drop—from 33.2 per 100,000 in 1957 to 31.4 in 1958. Deaths from most communicable diseases continued to decrease. The tuberculosis death rate was 7.0 per 100,000 population in 1958, compared with 7.8 in 1957. The principal diseases of childhood— scarlet- fever and streptococcal sore throat, diphtheria, whooping cough, and measles—which caused about 4 deaths for every 100,000 youngsters in 1949, were responsible for only about 1 death per 100,000 in 1958. BIRTHS, MARRIAGES, AND DIVORCES An estimated 4,250,000 live births occurred in 1958, only 1.3 percent below the record high of 4,308,000 reached in 1957. The decline in the birth rate per 1,000 population, however, was somewhat larger, 3.2 percent. The birth rate dropped from 25.3 in 1957 to 24.5 in 1958. Since there were 9.5 deaths per 1,000 people in 1958, or a total of 1,647,000 deaths, the rate of natural increase came to 15.0 persons per 1,000—slightly lower than last year’s rate of 15.7. The estimate of marriages performed in 1958 was 1,445,000, or 4.7 percent less than the figure for 1957. The marriage rate was 8.3 per 1,000 population, compared with 8.9 in 1957. The estimated number of divorces granted in 1958 was 380,000, less than 1 percent below the figure for 1957. Public Health Service 73 INFLUENZA AND POLIOMYELITIS Although a recurrence of Asian influenza, which struck the United States in epidemic proportions in the fall and winter of 1957, was expected in this country in 1958, there were no reports of confirmed cases until February of 1959. Sporadic outbreaks of both Type A2 (Asian) and Type B influenza began to occur during that month, and continued to be reported for several months. In 1958, the incidence of paralytic poliomyelitis was almost 50 per- cent higher than in 1957. This ended the steady downward trend in incidence since 1954. The total number of paralytic cases reported in 1958 was 3,697; in 1957, it was 2,499; in 1956, it was 7,911; and in 1955, the year the poliomyelitis vaccine first became available, it was 13,850. About 50 percent of the paralytic cases in 1958 occurred in children under 5 years of age, the group with the least amount of protection from the vaccine. By the end of 1958, about 50 million people under 40 years of age had had three injections of poliomyelitis vaccine, and some had had a fourth injection. About 40 million people under 40, however, had had no vaccine at all. Therefore, the Public Health Service, in co- operation when the American Medical Association and the National Foundation, continued to promote vaccination programs. Funds and Personnel In 1959, there was a total of $894.2 million available to the Public Health Service (see table 1, page 186). Of this amount, about $755.8 million was in appropriations and authorizations. The balance was made up of reimbursements for services rendered to other agencies and in unobligated balances from previous years. Grants to the States for health programs and for the construction of health facilities and sewage treatment plants amounted to 30 per- cent of the total funds obligated. Research, training, and construc- tion grants to medical, dental, and research institutions represented 40 percent of the total. Thus, about 70 percent of the total amount available to the Public Health Service was allocated to agencies and institutions outside the Federal Government. The remainder sup- ported the operation of Public Health Service hospitals, foreign and interstate quarantine, Indian health services, and other direct activi- ties of the Service. There were 25,050 full-time employees in the Public Health Service at the close of fiscal year 1959 (see table 2, page 188). This number included 1,564 members of the regular Commissioned Corps of the Service, 1,925 members of the Reserve Corps on active duty, 97 mem- bers of the Commissioned Reserve on temporary training duty, and 530344—60—6 74, Department of Health, Education, and Welfare, 1959 21,464 full-time Civil Service employees. The Service continued its extensive recruitment program for professional personnel. A wide variety of measures were employed to create interest in permanent careers in the Public Health Service. National Library of Medicine On June 12, 1959, ground was broken for a new lbrary building at the National Institutes of Health. This event brought to fruition a forty-year effort to secure adequate quarters for the National Library of Medicine. A number of new sources for the procurement of publications from marginal areas of the world were located during the year, and the acquisition of Russian materials continued to improve. At year’s end the steadily expanding collection of the Library numbered 1,028,296 pieces. INDEXING SERVICES Work neared completion on mechanization of copy preparation for publication of the Library’s monthly index. Arrangements were con- cluded for participation with the American Medical Association in the joint provision of a comprehensive indexing service for the world’s current medical literature. Under the new arrangement, beginning in January 1960, the Current List of Medical Literature will become the /ndex Medicus with annual cumulations published by the Ameri- can Medical Association from copy provided by the Library. PUBLICATIONS PROGRAM The Library added a new title to its list of publications when it undertook the preparation of Film Reference Guide to Medicine and Allied Sciences. An annual publication prepared under contract with the Interdepartmental Committee on Medical Training Aids, the 1959 edition lists 1,800 films of interest to the medical programs of one or more of the member agencies of the Committee, which includes Army, Navy, Air Force, Veterans’ Administration, and the Public Health Service. Other major publications issued or in press at the close of the year included: National Library of Medicine Cata- log; Bibliography of Medical Reviews; Current List of Medical Literature; Guide to Russian Medical Literature; Bibliography of Space Medicine; Staphyloccocal Infection; Psychopharmaca; Fun- gus Infections; Bibhography of Military Psychiatry. PROGRAM STATISTICS During fiscal year 1959, the Library acquired 11,690 books, 68,532 serial pieces, and added 1,296 new serial titles. It purchased 828 old and rare items for its History of Medicine collections, cataloged 20,757 Public Health Se site 45 titles, and added 958 pictures and portraits to its art collection. ‘There were 111,822 volumes circulated to users of the Library; 9,390 ref- erence questions were answered ; 326 bibliographies were prepared on special subjects; 21,272 main entries were published in the National Library of Medicine Catalog; 117,378 items were indexed and pub- lished in the Current List of Medical Literature from 1,633 journal titles. Almost 1.5 million pages of medical literature were micro- filmed in response to 69,595 requests. An additional 1.5 million pages were microfilmed for preservation purposes. Public Health Methods The Division of Public Health Methods provides staff assistance to the Surgeon General, conducts studies on needs and resources which affect public health programs, and participates in cooperative projects with public and private agencies. The Division edits and publishes Public Health Reports and the Public Health Monograph series as a means of disseminating information about public health research, practice, and administration. NATIONAL HEALTH SURVEY The U.S. National Health Survey is designed to obtain health statistics needed by users in many fields, such as medicine, hospital ad- ministration, and health insurance. It is a continuing program of surveys which includes household-interview surveys, special surveys, and methodological studies. During the past year, two methodological reports were published and six reports based on household-interview data for the year 1957-58. Major attention was given to the de- velopment and pretesting of a standardized health examination to pro- duce data which can be obtained in no other way—specifically, precise diagnostic information on certain chronic conditions and distributions of physical and physiological variables. Health examination pilot studies were conducted in Allen County, Indiana and Howard County, Iowa in preparation for the launching, in fiscal year 1960, of a series of examinations on a sample of the national population. USS. National Health Survey figures show that during the year July 1957—June 1958, illness and injury caused 3,370 million days of re- stricted activity among the civilian, noninstitutional population of the country. This amounted to about 20 days per person per year. Of the restricted activity days, about 1,310 million—or an average of 7.8 days per person—were bed disability days. About 438 million acute illnesses involving either restricted activity or medical attention occurred during the same report year. Such ill- nesses average 2.6 for every person in the population. 76 Department of Health, Education, and Welfare, 1959 During the same period, 46.9 million persons sustained injuries involving medical attention or restricted activity. This was an aver- age of 27.9 persons injured per 100 persons in the population. The disability resulting from the injuries totaled 424 million days of re- stricted activity including 114 million days spent in bed. STUDIES OF HEALTH RESOURCES The Division provided the executive secretary and staff for the National Conference on Homemaker Services. Nearly 300 persons at- tended this two-day conference which was sponsored by 8 govern- mental agencies and 26 national voluntary organizations. Prior to the conference, the Division issued three publications on homemaker services—a directory of existing agencies, a statistical study of services, and a collection of descriptions of typical programs. The executive secretary and staff have the major responsibility for preparing and publishing the final report with the advice of an editorial committee chosen from the sponsors. Another activity was the preparation of a chapter, “Health in Middle and Later Years of Life,” for the forthcoming book, “Hand- book of Social Gerontology.” This handbook was developed for the Inter-University Training Project in Social Gerontology sponsored by the University of Michigan. Factual data from many sources on health status, resources, utilization, cost, and need for services for the aged were compiled and analyzed for use at various conferences and for program planning at both Federal and State levels. For the past several years, the Division has maintained a “Clearing- house” on sources of morbidity data. The six published listings are at present being coordinated and consolidated into a cumulative volume on morbidity statistics projects. Division staff members are coordinating and editing a volume, “Guide to the Administration of Community Health Services,” spon- sored by the City Managers Association and the American Public Health Association. This volume, which consists of chapters written by some 28 different authorities in the field, will cover all phases of community health services. The Surgeon General appointed a group of 22 national leaders in medicine, education, and public affairs as consultants to appraise existing data, plans, and proposals concerned with medical education and to recommend action which must be taken to achieve reasonable and acceptable goals in the next decade. The Division is providing the staff services for this consultant group whose report will be com- pleted in the fall of 1959. Background information assembled for the Consultants has been prepared for publication in the Division’s Health Manpower Source Book series. This publication shows cur- rent numbers, distribution, and educational facilities for physicians, Public Health Service 77 dentists, and nurses. Estimates of the future supply of personnel in these health professions are included. Studies were also conducted by the Division staff in the broad area of health economics—medical care expenditures, health insurance, and economic costs of illness, for example. The National Institutes of Health In addition to conducting research in its own laboratories at Bethesda, Md., the National Institutes of Health supports research projects, training, and construction in institutions throughout the Nation. Its grants are awarded after careful review by non-Federal study sections composed of technical experts, and by advisory coun- _ cils composed of leaders in science and public affairs. In fiscal year 1959, Congress appropriated $294.4 million for the Institutes’ research and training programs and $30 million for grants to finance the construction of research facilities. An unprecedented total of 9,166 research-project grants and 5,271 training grants and fellowships were awarded, totaling $20 million (Table 3). During the year, increased efforts were made to appraise the present programs and their impact on the Nation’s total research and training effort. The first in a series of staff studies surveyed the research needs and NIH support in 20 selected medical schools. The study revealed trends toward increasingly productive research through such measures as stronger training programs, balanced research support, and atten- tion to the broader needs of institutions. To meet growing responsibilities in training and international health programs, three major positions were established on the NIH Director’s staff—Deputy Director, Associate Director for Training, and Special Assistant on International Affairs. Substantial progress was made in such large-scale collaborative operations as the search for better chemical] agents to treat cancer and the evaluation of drugs for the treatment of mental illness. After several years of preparation, a collaborative study of 40,000 mothers and their babies was activated in the search for causes of cerebral palsy, mental retardation, and related disorders. Cooperation among NIH scientists in various fields led to new basic knowledge of neurostructural bases of behavior. Clinical studies in progress are designed to evaluate promising new compounds for the dietary control of dental caries and for the treatment of high blood pressure. Among the more important achievements of the year were dis- coveries pertaining to the cancer-virus relationship. The induction of leukemia in mice by means of a virus extracted from a mouse sar- 78 Department of Health, Education, and Welfare, 1959 coma lent further stimulus to investigations of the possible viral origin of some human cancers. In an effort to accelerate progress in the increasingly important field of physical biology, 126 leading scientists attended a four-week study program sponsored by NIH at Boulder, Colo. The Center for Aging Research, now part of the Division of Gen- eral Medical Sciences, established at Yeshiva University the second of a series of long-term programs to coordinate aging studies, and increased its support of research projects in gerontology. The mounting volume of grant applications in certain fields re- sulted in the creation of seven additional grant review boards. Through grants, research was stimulated in environmental health, gastroenterology, cystic fibrosis, schizophrenia, and staphylococcus infection. Clinical Center During fiscal year 1959, action was taken to keep physicians ap- prised of the mission, methods, and diagnostic needs of the NIH clinical program. Maximum utilization of the Clinical Center’s 516 research beds was continued, with an average daily census of ap- proximately 400 patients. As a result of the national expansion of basic medical research during the past decade, the volume of clinical research is increasing rapidly throughout the country. Each year more hospitals become involved in evaluating the new concepts, devices, and compounds de- rived from laboratory study. Thus, the Clinical Center is assuming greater importance as a major national resource to other hospitals for knowledge concerning the techniques, problems, and safeguards involved in the large-scale study of sick people. To this end, intensified efforts were directed toward making avail- able to other hospitals knowledge which the Clinical Center has de- veloped during its six years of existence. Management of the NIH Visitor Program was assigned to the Clinical Center on January 1, 1958. Approximately 9,000 profes- sional and pre-professional visitors were registered during the year, and individually planned schedules were arranged for more than 5,000 of these. In addition to regular annual lectures and symposia, a number of closed-circuit TV programs for the interchange of sci- entific knowledge were conducted. Division of Biologics Standards The Division is responsible for administering the control of biolog- ical products in interstate and foreign commerce. This regulatory Public Health Service 79 function is carried out through issuance of establishment and product licenses, following a determination that prescribed standards of safety, purity, and potency have been met. At the end of the year, 176 establishment licenses and 1,220 product lcenses were in effect, the latter covering 275 specific products. Tests continue to be performed at the rate of approximately 3,400 a year, ranging from relatively simple sterility tests to potency de- terminations involving both animals and tissue culture. In addition, approximately 4,000 vials of physical reference standards are pre- pared and distributed annually to manufacturers and to laboratories engaged in biological standardization. An integral part of the Division’s control activities is its research program, essential for the continuous improvement of licensed prod- ucts and the licensing of new ones as they develop. During the year, Division scientists reported: the determination of ultraviolet inactiva- tion rates of viruses as a potential aid to their identification; the dis- covery of a blood serum that can be used to test for the rare blood group Cellano; evidence that the biological material which experi- mentally transforms fibroma virus into myxoma virus is nucleic acid; a method using chicks instead of monkeys for measuring potency of killed polio vaccine; and determination of the comparative virulence for monkeys of the oral polio vaccines under study in field trials. Division of General Medical Sciences The Division of General Medical Sciences was created on July 16, 1958, to strengthen support of biomedical research and research train- ing. A new organizational framework was thus provided for the con- duct and continued development of NIH extramural programs in the general preclinical and clinical sciences, public and environmental health, medical care, and aging. At the same time, the NIH Center for Aging Research was transferred from the National Heart Institute to the new Division. As the fiscal year closed, the Division was supporting more than 1,000 research projects at medical schools and other private research institutions. These projects are seeking basic information ‘about biology and medicine under the following program headings: Chem- istry of Life Processes, Fundamental Genetics and Human Develop- ment, Research in Public Health and Medical Care, Fundamental Clinical Investigations, Environmental Factors in Health and Disease, and Additional Fundamental Biomedical Research. Program benefits are illustrated in several areas. In the Chemistry of Life Processes, for example, scientists are probing deeper into the origins of life. Primitive proteins have been made with amino acids 80 Department of Health, Education, and Welfare, 1959 in experiments following the steps that probably led to formation of the first living substances. This work opens the way for further study of the processes by which living matter is formed, and suggests the possibility of producing synthetic proteins for dietary supplements. In another field, Human Development, investigators are studying the processes by which antigens, antibodies, and nutrients are passed from the mother through the placenta to the fetus. This work is im- portant in understanding congenital abnormalities. In related work, a grantee has chemically isolated relaxin, a hormone that assists women during childbirth. The Division administers research grants in the area of environ- mental health, which includes accident prevention, air and water pollu- tion, food toxicology, and occupational health. This work has become increasingly important in man’s complex and rapidly changing en- vironment with its many implications in health and disease. One of the first tasks is to measure the extent to which man is ac- tually endangered. Studies in air pollution, for example, have re- vealed that certain air pollutants can limit the reproduction rate of mice. In food toxicology, scientists have found that combinations of certain commercial insecticides on food products can pose serious haz- ards, not only for consumers but also for workers in food processing. Programs of research training and fellowships in the sciences basic to medicine and biology underwent a marked growth during the year. In accordance with the original plan set forth by Congress, the pro- gram of Senior Research Fellowships increased an additional $1 mil- lion to a total 1960 level of $3 million supporting advanced training for 165 scientists over a 5-year period. The Division’s research training program has expanded during the past year from 88 projects to 176, providing training for nearly 1,000 scientists. The number of different training programs has grown from one, in Epidemiology and Biometry, to a total of nine, including Biochemistry, Genetics, Pathology, Dermatology, Pharmacology, Physiology, the Anatomical Sciences, and Experimental Embryology and Development. CENTER FOR AGING RESEARCH The NIH Center for Aging Research coordinates PHS research and training activities in the field of aging. During the year, grants for research on aging in the Nation’s research institutions increased from 274 to 404, The aging programs include nearly all disciplines and areas of interest, from studies of body tissues to research in nursing. In studies of the total human organism, it has been found that many health problems of the aged have an early origin, and that preparation for old age should therefore begin in youth. Other studies have shown ) : | | | i { } Public Health Service 81 that a factor resembling the juvenile hormone, known to control the growth of insects, can appear in the human being. Still other findings pertain to the relation between age and reproduction, particularly among lower forms of life. Division of Research Grants The continued growth of NIH programs necessitated a major reorganization within the Division of Research Grants. Responsi- bility for administering the research and training grants program in areas basic to the biological and medical sciences was transferred from DRG to the newly created Division of General Medical Sciences. The realignment permitted DRG to strengthen and broaden its central services in extramural affairs to all NIH research programs. Specifically, the reorganization enabled DRG to increase the num- ber of study sections to process the increasing volume of research grant applications without sacrificing the traditional high quality of application review. The procedure for fellowship application review was changed to provide an expanded and more detailed appraisal of fellowship applications. In 1956 the Congress authorized a three-year program of grants to aid in the construction of health research facilities. The program has awarded $90 million in grants in its three years of operation. In August 1958 the Congress extended the program an additional three years. The program to promote the international exchange of scientific information and techniques through postdoctoral fellowship awards to promising scientists proved eminently successful during the year and was extended to include 80 countries. Central Services The Division of Business Operations provides central business management and plant safety services for the National Institutes of Health. The speed and accuracy of payroll and financial report- ing activities were increased by transfer to an electronic computer. A simplified grants-payment system was installed, permitting issu- ance of a single monthly check to each grantee institution, regardless of the number of individual grants in effect. Further studies were under way at the year’s end to develop similar improvements in such areas as large-scale storage and retrieval of research-grant information. The Division of Research Services supports the NIH research programs by providing a wide range of technical, scientific, and 82 Department of Health, Education, and Welfare, 1959 other skills. In 1959, the Division helped plan, build and maintain new research facilities on the grounds of NIH. Construction was begun, for example, on a new laboratory building for the National Institute of Dental] Research; a research greenhouse was completed ; and progress was made in developing special facilities for the care of germ-free animals. A study was undertaken of factors affecting microbial content in patient-care and operating areas. The number of laboratory animals was increased, and several new species were added. Computer technology was applied increasingly to medical research problems. Institute of Allergy and Infectious Diseases One of the major areas of emphasis in infectious disease research continues to be the common respiratory infections, still the most prevalent illnesses. During the past year, virologists of this Institute defined two new agents among the para-influenza viruses and found them related to a large proportion of childhood respiratory illnesses ranging from mild febrile symptoms to croup and pneumonia. Co- operative studies with the Department of Agriculture provided evi- dence for a relationship between the para-influenza viruses and dis- eases in cattle, particularly shipping fever. With the development of new virological techniques, Institute in- vestigators studied for the first time the natural history of a mouse tumor (polyoma) virus. The distinction between this and other vi- ruses was rigorously defined, and its presence in enormous amounts was demonstrated in infected mice. The recent disclosure by the Institute’s Rocky Mountain Laboratory of an alarming increase in the number of dairy herds infected with the rickettsia of Q fever implies a growing reservoir of human disease. Future studies are contemplated in several Western States, especially with regard to associated human infection. In the field of immunology, laboratory scientists studying immune mechanisms demonstrated the precise conditions necessary for the maintenance of skin grafts among inbred guinea pigs. Other scien- tists from the same laboratory worked out a new technique for study- ing anaphylactic reactions. Institute investigators in the Northwest, almost coincident with a California report of a human death due to bat rabies, revealed an instance of rabies transmission from bats to mice by biting. The renewed emphasis on tropical medicine led to an intensified investigation of the arthropod-borne viruses. In one such study, field scientists of this Institute collaborated with research workers in Panama to elucidate many of the factors involved in an outbreak of eastern equine encephalitis among horses, | Public Health Service 83 GRANT-SUPPORTED RESEARCH Studies by an Institute grantee at the University of Miami resulted in an announcement of what may be the first successful systemic treatment of the superficial fungus infections in man. Response to _ oral therapy with the antibiotic griseofulvin was uniformly favorable, and infections of many years’ duration seemed to respond readily. Grantees at the University of Llinois obtained promising results in long-term clinical studies of the broad spectrum antibiotics. Oral ad- ministration of tetracycline has sharply reduced the number and duration of attacks of bronchitis and bronchiectasis. At the Alabama Polytechnic Institute, a grantee reported the first systemic insecticide capable of eliminating certain disease-carrying parasites in domestic animals. The compound, DOW-ET-57, when administered in the food of cattle, circulates in body fluids and de- _ stroys common cattle grubs. Long-term studies by grantees at Maimonides Hospital, New York, have resulted in findings that discredit the long-held view that can- - didiasis, a sometimes fatal fungus infection, may be transmitted by airborne means. As a result, the investigators suggest that spread of the disease may be prevented when infants are segregated within the general nursery and handled with strict aseptic techniques. Other grantees studying fatalities associated with Asian influenza report that the influenza pandemic of 1957-58 was the first in which staphylococci played the dominant role almost universally in the complicating pneumonias. The fatal cases of staphylococcal pneu- monia observed in these studies were generally marked by severe and rapidly progressing illness, less accurate diagnosis, and relatively in- effective antibiotic treatment. Institute of Arthritis and Metabolic Diseases One of the most significant and striking accomplishments of the year was the development, by Institute scientists, of a new synthetic pain-killing drug that is 10 times more powerful than morphine and 50 times more powerful than codeine. The new analgesic, which has been named phenazocine, was synthesized from simple coal-tar deriva- tives and gives promise of freeing this country from its present dependence on morphine-producing areas of the world. Experience with phenazocine in over four thousand patients, at NIH and in other institutions, has confirmed its high pain-killing activity. More importantly, the drug is less addicting than morphine, although longer-term studies will be needed to determine exactly its addiction hability. In addition to high potency, the new analgesic causes less respiratory depression than morphine, has low toxicity, and gives 84. Department of Health, Education, and Welfare, 1959 excellent results against certain forms of severe pain which morphine does not relieve. An important phase of arthritis research at the Institute continues to be the clinical and metabolic evaluation of new antirheumatic steroid drugs. In recent years, Institute scientists and grantees have tested an increasing number of synthetic steroids developed by the pharmaceutical industry. One is dexamethasone, an antirheumatic drug that is found to be several times as potent as its chemical relative, prednisone. The first long-term trials of dexamethasone at the In- stitute have shown that the drug can relieve the painful symptoms of rheumatoid arthritis in patients who received little or no benefit from other steroids. Since it is not completely free from side effects, however, it must be used with the same caution employed with the older drugs. The Institute is collaborating with the American Rheumatism Asso- ciation and the Arthritis and Rheumatism Foundation in organizing a chain of arthritis clinics throughout the country to evaluate new drugs like dexamethasone. The continuing results of this program, expected to operate over several years, will provide reliable informa- tion about the relative merits and limitations of both old and new antirheumatic agents. An improved treatment for gout has derived from basic studies of the metabolism of zoxazolamine, a drug that has been in use for several years as a muscle relaxant. At Mount Sinai and Goldwater Memorial Hospitals, New York, Institute grantees studying the breakdown of the drug in the body noticed that it also promoted the rapid excretion of uric acid. The drug was then tested in gout patients (since a characteristic of their diseases is the overproduction of uric acid), and it proved to be a more potent uricosuric agent than any others avail- able. Another such drug, sulfinpyrazone, has also been clinically studied at the Institute and appears to be equally potent. Basic research in rheumatic disease has highlighted the possibility that rheumatoid arthritis may be the result of an immune reaction to an as yet unidentified substance. This possibility is strengthened by the fact that the rheumatoid factor, which is present in the blood of arthritic patients, is apparently a gamma globulin, a type of blood protein known to contain antibodies. In diabetes research, one of the most promising developments has been the use of the small-dose cortisone test for predicting diabetes susceptibility in relatives of known diabetics. An initial screening of the test, developed by grantees at the University of Michigan Medical School, indicates that it will provide an extremely reliable index of “pre-diabetes.” A 5-year follow-up is now planned. Diabetes research continues to be influenced by the new oral anti- | Public Health Service 85 LT — —_~ —— = | diabetic drugs, which have replaced insulin injections in one-third of _ the diabetics in the United States. The first of the new drugs was tolbutamide (Orinase), which became available in June 1957 after ex- _ tensive trial by Institute grantees and other physicians. ‘Two others, | chlorpropamide (Diabinese) and phenformin (DBI), have also come _into use. How these drugs act to lower blood sugar is not fully _ understood, but most evidence indicates their principal action to be | stimulation of the beta cells of the pancreas to produce more insulin. The Institute has continued to expand activities in new research | areas—gastroenterology and physical biology. In gastroenterology— _ the medical specialty dealing with such disorders as peptic ulcer and | ulcerative colitis—grantees at Cornell Medical Center and New York _ Hospital have developed a radio “pill” that broadcasts information _ about pressure changes inside the intestinal tract. Grantees at North- | western University Medical School have developed a technique for _ taking motion pictures of fluoroscopic examinations. Further developments in the field of physical biology—the research | area utilizing the principles and methods of the physicist in studies | of biology—have been stimulated by more than 80 research grants ' and nine training grants awarded by the Institute. Notable progress | has been made in such studies as the biological effects of radiation, | energy transfer in photosynthesis, and coding and information theory. | Cancer Institute Among the major research accomplishments reported by scientists "and grantees of the National Cancer Institute were results of studies dealing with viruses as cancer-causing agents, cytologic tests as an aid in the detection of malignancy, and chemotherapy—the treatment _ of cancer with drugs. Virology assumed an increasingly important role in cancer research. A cancer virus was discovered in mice, as was a technique for prevent- ing other animal virus tumors by vaccination. If further effort along _ these lines reveals that some human tumors result from viruses, it may be possible to develop vaccines against them. Exfoliative cytology, the examination of cells that collect in body : fluids, is now a well-recognized method for detecting uterine cancer prior to the appearance of symptoms and at a time when adequate treatment nearly always results in cure. Efforts to detect other forms _ of cancer by similar means have been encouraging and are being pur- sued. The Institute, moreover, has initiated a program to accumulate basic information that may facilitate the evolution of one or more generalized tests for cancer. A number of contracts have been signed providing for biochemical analyses of blood from both normal and 86 Department of Health, Education, and Welfare, 1959 cancerous persons. This program is stimulating renewed scientific interest in the whole area of cancer diagnosis. The broad program of the Cancer Chemotherapy National Service Center has attained full operation. Scientists and physicians throughout the United States and abroad are striving to find new and better drugs and to perfect techniques for using anticancer agents. Of the thousands of drugs screened, more than 100 were being evaluated in studies involving nearly 5,000 patients. Heartening results were reported, adding support to the belief that powerful drugs for the lasting control of cancer will be developed. The progress in these three areas was made possible in part by the steady advance of knowledge concerning the biochemistry of cancer, the relationships between tumor and host, the mechanism of carci- nogenesis, and other fundamental aspects of the cancer problem. INSTITUTE RESEARCH Scientists of the National Cancer Institute and the Division of Biologics Standards have continued their collaborative investigation of the agent that causes multiple tumors in mice, rats, and hamsters. In one study they demonstrated that the agent, polyoma virus, is a single organism rather than a group. They also reported that the development of such tumors in hamsters can be prevented with injec- tions of a “neutral” mixture containing the virus and specific anti- bodies against it. Ninety-seven percent of hamsters so treated failed to develop tumors during a six-month period, whereas two-thirds of those that received the virus alone died of tumors within five months. In another virus study, an Institute scientist extracted from the experimental mouse tumor, sarcoma 37, a virus that produces leu- kemia when inoculated into mice. The disease appears within 10 weeks in all mice injected on the first day of life. In contrast to other leukemia-producing viruses that affect mice, this agent elicits the disease in several different strains, is active in adults as well as newborns, and produces a disease indistinguishable from spontaneous mouse leukemia. Research is under way to determine the relation- ship, if any, between this agent and other mouse leukemia viruses. An epidemiological study of lung cancer showed that the risk of this disease is as excessive in women who smoke cigarettes as in men smokers. This study, which confirmed the work of other investi- gators, suggests that there is no factor peculiar to men which con- tributes to the development of cancer of the lung. Epidemiological research also produced valuable information on the declining rate of stomach cancer in the United States. Institute scientists reported: (1) the trend is observed in some foreign coun- tries; (2) stomach cancer occurs more frequently in members of the lower socio-economic groups, but does not seem to be associated with Public Health Service 37 occupation; (3) there is no significant variation in the stomach cancer rate for urban and rural residents; and (4) stomach cancer rates are higher in the northern United States, paralleling the international distribution of this malignancy. The investigators suggest that future studies in this area might profitably be concerned with the role of heredity and diet in the etiology of gastric cancer. Institute scientists reported continued progress in their study | of the significance of tumor cells in the circulating peripheral blood. | Specimens of blood from 100 diagnosed cancer patients and 200 pre- _ sumably well persons were examined cytologically. Malignant cells | were detected in 39 percent of the cancer patients, and the findings were considered suspicious in another 10 percent. Among the well _ persons, on the other hand, cells considered to be cytologically malig- nant were found in only one person, or 0.5 percent of the control group. The scientists suggested that this technique may help in establishing a primary diagnosis and in postoperative followup. Staff scientists reported their observations of the use of the drug | methotrexate in 27 patients with choriocarcinoma, a rare, highly _malignant uterine tumor. All but five of the women were gravely _ ill on admission to the Clinical Center. Most of them showed spread | of the disease to the lungs, and a few presented evidence of central _ nervous system involvement. Complete remissions, with no evidence _ of recurrence for 8 to 29 months, were observed in 5 patients. Eleven _ patients showed remission with persistent manifestations of disease, and the remaining 11 died. | GRANT-SUPPORTED RESEARCH An Institute grantee at the Sloan-Kettering Institute for Cancer Research published a report on the effect of combustion temperature of tobacco on the production of suspected carcinogenic agents. Mate- rials obtained by burning tobacco at temperatures of 880° C. to 560° C. were administered to mice and rabbits. The most highly carcinogenic _ material studied was that formed at 880° C., the approximate burning temperature of cigarettes. Tobacco burned at decreased temperatures was progressively less carcinogenic, and no activity was obtained from the 560° C. material. The author suggested that lowering the burning temperature of cigarettes to a range of 700° C. may provide a lead to a solution of the tobacco-cancer problem. Another grantee, at Columbia University College of Physicians and : Surgeons, reported the results of a study leading him to suggest that _ tobacco smoke and air pollutants may act in combination to produce lung cancer, thus accounting for the higher incidence among urban, as compared with rural, residents. In a two-year study, the backs of _ mice were treated with various combinations of tobacco tar and known carcinogens—croton oil and the air pollutant benzpyrene. The ani- 88 Department of Health, Education, and Welfare, 1959 oe mals were observed for the development of benign and malignant tumors. All procedures eventually yielded benign skin papillomas that sometimes progressed to malignancy. However, the combination of tobacco tar and benzpyrene produced a greater percentage of malig- nant carcinomas than did any other treatment. ‘The problem of lung cancer and the various environmental factors that appear to be asso- ciated with it are being studied by a number of grantees. A team of Institute grantees at the University of Wisconsin School of Medicine reported the results of clinical trials with 5-fluorouracil (5-FU), an anticancer agent first described in 1957. Of 35 patients who received an adequate therapeutic dose of 5-F'U, 9 showed regres- sion of tumors of the breast, liver, rectum, and other sites. The majority of the treated patients reported subjective improvement and lessening of pain. This study is being continued as part of the na- tional cooperative program of chemotherapy research. In another of the cooperative clinical studies, a grantee at the Mayo Clinic undertook to evaluate a derivative of testosterone propionate in the treatment of advanced breast cancer. Previously, testosterone propionate had been the most effective of the male sex hormones. The derivative, however, produced a significantly higher percentage of temporary regressions. In addition, the new drugs appeared to pro- duce less masculinizing effects than did testosterone propionate, sug- gesting that therapeutic value may not be directly correlated with male hormonal activity. Institute of Dental Research The program of the Dental Institute is concerned with research in- vestigations and training in matters relating to the cause, prevention, diagnosis, and treatment of disease and abnormalities of the oral cavity and its associated structures. The continuing high prevalence of oral diseases, particularly dental caries and periodontal disease, and the lack of basic knowledge concerning their cause, gave impetus to broad-spectrum laboratory and clinical studies in 1959. Investigations using the germ-free technique in the testing of patho- logical effects of microorganisms on oral soft tissue have demonstrated that tartar-like deposits can occur on the molar teeth of germ-free animals. This challenges the recognized concept that bacteria cause, in some way, the formation of tartar, a suspected causal factor in periodontal disease. In studies of nutrition and oral disease, certain dibasic phosphates have proved effective as dietary additions for the control of experi- mental dental caries, A clearer understanding of this relationship Public Health Service . 89 and its possible application to dental public health practices is being explored in large-scale cooperative clinical tests. In the field of epidemiology, group population studies of periodontal disease continues in many parts of the world, including most recently Ethiopia, Peru, and Ecuador. Preliminary findings point to a periodontal disease profile somewhat different from that seen in this country. ‘The differences are being fully evaluated from an environ- mental, nutritional, and biochemical standpoint. Studies with experimental animals have produced data suggesting that dental caries is closely related to the establishment of a specific bacterial flora. It might therefore be considered a transmissible dis- ease under certain conditions. Clinical studies of dental caries continue to advance knowledge of the types of microorganisms involved, the chemical aspects of the disease process, and the relationship of caries to the body as a whole. Other study areas include biologic effects of high-speed instrumenta- tion procedures, periodontal disease, psychosomatic factors in oral disease, and oral and facial abnormalities. The Institute increased its support of dental research projects in in- stitutions in this country and abroad. Further extension of awards in the area of training continued in an effort to meet the urgent need for scientific manpower oriented in dentistry. Heart Institute Fundamental and clinical research, at the Heart Institute and in the institutions it aids through grants, continued to reveal facts es- sential to the understanding and control of cardiovascular disease. Programs aimed at increasing the number and quality of skilled in- vestigators, teachers, and physicians were initiated. The application of existing knowledge was expanded in many areas. Atherosclerosis still receives a major share of Heart Institute efforts. In this disease, fatty materials accumulate in the walls of blood vessels and narrow them. Complete obstruction of a vessel frequently results in a blood clot. When atherosclerosis obstructs blood vessels supplying the heart, it is responsible for coronary oc- clusion, or heart attack. Obstruction of blood vessels supplying the brain leads to strokes. Because fatty deposits are primary to these conditions, the Heart Institute is studying fats in the body, including the processes by which they enter and leave the blood. A new technique now being applied to this problem is vapor phase chromatography. Heart Institute laboratories have made substantial contributions to instrumentation and methodology in this field. The 530344—60——7 90 Department of Health, Education, and Welfare, 1959 technique permits minute amounts of chemical substances to be sep- arated and their components to be identified and measured. ‘Thus fatty components of blood and atherosclerotic lesions are being in- dividually examined. The effect of various diets on blood cholesterol are a continuing interest. Attempts, as yet unsuccessful, have been made to diminish the cholesterol-elevating properties of the fatty acids in milk, In other studies the purported beneficial effects of certain margarines are being evaluated. In the field of hypertension, intensive efforts are being made to de- velop and clarify the role of drugs for controlling the blood pressure. Certain derivatives of reserpine, the active component of Indian snakeroot, can lower blood pressure as does reserpine, but without producing tranquilization, Institute scientists have found that these derivatives deplete peripheral nerve endings of their supply of norepinephrine, the transmitter substance for blood vessel constric- tion, while leaving relatively unchanged the concentrations of trans- mitter substances in the brain. This indicates that the effects of reserpine on blood pressure are due to action at peripheral vascular sites and are unrelated to the tranquilizing activity in the central nervous system. A striking example of a therapeutic advance derived from basic studies arose during the year in the treatment of hypertension. Bio- chemical research undertaken several years ago was aimed at clarify- ing the mechanisms by which certain physiologically active substances are produced and destroyed in the body. ‘Thus the chemical pathways by which serotonin and epinephrine are produced and metabolized were defined. Heart Institute workers showed that an enzyme known as monoamine oxidase plays a central role in the destruction of these substances. It was also observed that chemicals with ability to in- hibit the enzyme markedly lower the standing blood pressure. Trial of a highly active monoamine oxidase inhibitor in Clinical Center patients has indicated that unless unpredictable side effects develop, the drug should prove valuable in the treatment of severe hypertension. In the past few years, as more and more congenital and acquired heart defects have become amenable to surgical correction, various methods of catheterizing the chambers on the left side of the heart have been developed. Left heart catheterization is frequently es- sential to precise diagnosis and evaluation of patients to determine the advisability of surgery. In right heart catheterization (for which a Nobel prize was awarded in 1956) a catheter is simply intro- duced into a vein and passed directly into the right heart chambers. But easy access to the left heart has not been available. The safest ap- A Public Health Service 91 proach hitherto in use—puncture of the windpipe through a broncho- scope—entails considerable discomfort for the patient, and other pro- cedures involving puncture of the heart wall are not without hazard. During the past year a new and promising procedure was developed in the Heart Institute’s Clinic of Surgery. First a right heart catheterization of the usual type is made, and then a needle is passed through the catheter and through the thin partition separating the right and left auricle to reach the left side of the heart. The pro- cedure is performed without discomfort to the patient and appears to carry even less hazard than the bronchoscopic approach. GRANT-SUPPORTED RESEARCH Data from a number of studies have indicated that substitution of vegetable oils for most of the animal fats in human diets reduces the serum cholesterol level. Dietary regimens based on these findings, in which the substitution is made essentially as medication, are being evaluated. Also under investigation are the effects of varying the protein-fat ratio, types of protein ingested, caloric balance, and intake of certain vitamins. Research investigators at several institutions are exploring the possibility of augmenting the body’s clot-dissolving mechanism as an approach to disorders in which blood clots obstruct the circulation. Considerable evidence indicates that the normal balance of coagula- tion and dissolution is upset in blood-clotting diseases. Ways of en- hancing the dissolving mechanism by use of plasminogen, plasmin, streptokinase, or other activating enzymes are being investigated. Studies in animals have shown promising results, and limited trials in human patients have been encouraging. Further clinical studies with more potent and more purified agents are in progress. A valuable diagnostic advance during the year is a new technique for visualizing the coronary arteries by injecting a contrast substance into the aorta during induced arrest and blockage of the ascending aorta. The method, proven safe and effective in animals, is being used clinically. At Mount Sinai Hospital in New York, animals studies have shown that X-rays applied to the heart in successive, small doses raise sur- vival rates following experimental coronary occlusion, and suggest that cardiac irradiation may increase the supply of blood to the heart. A new technique for experimental production of inborn cardiac defects was reported by a grantee at Northwestern University Medi- cal School. Congenital heart malformations were produced in rats by exposing their mothers to an atmosphere of increased carbon dioxide concentration during an early stage of pregnancy. The find- ings suggest that altered blood gas levels in pregnancy may lead to similar defects in humans. 92 Department of Health, Education, and Welfare, 1959 Institute of Mental Health The past year witnessed a sizable expansion of the Institute’s sup- port of mental health research and training. Broad programs of re- search were supported in a number of critical areas. Over $4 million was expended for support of 180 projects in the field of psychopharma- cology. A total of 93 mental health project grants, amounting to over $234 million, supported pilot studies and demonstrations designed to develop new methods of care, treatment, and rehabilitation of the mentally ill. There was a substantial increase in the number of in- vestigations on problems of schizophrenia, alcoholism, and mental retardation. A large number of studies continued to be concerned with such basic problems as the biology and biochemistry of mental illness, the role of psychological and social factors in normal and abnormal be- havior, child development, the epidemiology of mental illness, juve- nile delinquency, aging, and mental retardation. Investigations were supported in almost all the biological, psychological, and social sci- ences relevant to mental illness. Among the more noteworthy advances during the past year has been the emergence of new pharmacological agents potentially useful in the treatment of depression and the discovery of new psychosis- producing drugs which should prove valuable in biochemical research on the function of the brain. BASIC RESEARCH In the Institute’s basic research program, scientists in several major disciplines have been working on key problems, ranging from mecha- nisms which regulate hormone production, genetic transfer, and energy release, to the effect of community organization and attitudes on mental health and disease. Research on the limbic system (the so-called primitive forebrain) has aided in identifying brain loci responsible for activity vital to preservation of the species and of the individual. A series of experi- ments on poisons affecting different regions of the brain has led to knowledge with implications in brain damage associated with chronic alcoholism. The Addiction Research Center has been studying bio- chemical factors in drug addiction, and has been evaluating drugs that modify mental processes and behavior. The Institute’s multidisciplinary program of research on biological factors in schizophrenia moved into full operation during fiscal year 1959. ‘This program has been characterized by careful attention to scientific design and to sources of false-positive errors common to such research. Many of the concepts underlying these controlled studies are becoming widely accepted by other institutions. | Public Health Service 93 CLINICAL INVESTIGATIONS The opening of the Clinical Neuropharmacology Research Center, a collaborative research program with Saint Elizabeths Hospital, marked the beginning of a broad series of studies on the impact of drugs on mental illness. It augments a major interdisciplinary pro- gram of studies on the biological aspects of behavior. Another area of intensive interest involved studies of the psycho- logical and social forces which influence behavior and personality de- velopment. These include expanded activities in the field of normal child development; the inception of a program designed to elucidate the psychological basis for successful adaptation and creativity; and studies of the dynamics of family relationships. ‘The program for the study of hyperageressive children progressed to the point where it was possible to discharge the patients to treatment in a school setting. COMMUNITY SERVICES Probably the most far-reaching development in community mental health during the past few years has been the enactment of State legis- lation providing for continuing State grants-in-aid to localities. There has been rapid and extensive expansion of local services. All States now provide mental health consultation to nonpsychiatric agencies and groups. Several localities have established experimental programs to handle psychiatric emergencies more effectively and to develop facilities which will obviate the need for long-term hospitali- zation. ‘The number of general hospitals accepting psychiatric patients rose from 43 in 1939 to almost 1,000 in 1958. Demonstrations and studies designed to improve the care, treatment and rehabilitation of the mentally ill increased considerably during the past year. By the end of the year, 102 of these projects had been approved and were being supported. More attention was given to consultation activities in such impor- tant mental health areas as school mental health, alcoholism, and mental retardation. Greater use was made of Technical Assistance Projects, through which States and localities are assisted in develop- ing new approaches to mental health problems. TRAINING Substantially increased funds for mental health training enabled the Institute to expand and inaugurate several programs. Support was extended for training biological and social scientists who wish to prepare for research careers in mental health, and increases were made in the programs designed to train personnel for research in psychiatry, psychology, and social work. A new program of support in the basic sciences of human behavior at the undergraduate medical school level, announced in August 1958, acquaints the future physi- 94. | Department of Health, Education, and Welfare, 1959 cian with knowledge about the interrelations among social, psycho- logical, and biological factors in health and disease. The general practitioner training program, initiated with a special Congressional allocation of $1,300,000, is expanding the Nation’s psy- chiatric resources in two ways, It supports psychiatric residency training for practicing physicians who wish to become psychiatrists, and it enables medical schools, hospitals, clinics, and professional societies to offer postgraduate courses and seminars in psychiatry for physicians who are not specializing in this field. BIOMETRICS Important research studies on the epidemiology of mental illness were completed, including one on admissions to 11 State mental hos- pital systems. The first national summary of characteristics of out- patient clinic patients was completed, and historical material showing trends in mental hospitalization for the period 1939 to 1955 was compiled from extensive data. Several field studies on clinic and hospital populations in Maryland were initiated, and the Model Re- porting Area was expanded so that it now includes 21 States. Institute of Neurological Diseases and Blindness Neurological research at the present time appears to offer outstand- ing opportunities at the extremes of the life cycle—infancy and old age. Among the disorders of infancy and childhood are cerebral palsy, mental retardation, congenital malformations, muscular dys- trophy, and epilepsy. In later life, Parkinson’s disease and cerebro- vascular diseases occur, Disorders of sight, speech, and hearing are pronounced both in childhood and old age. During the past year, artificial induction of seizures in epileptic patients has made it possible to locate more accurately the area of the brain involved. This has increased the accuracy of surgical re- moval of epileptic foci from which the seizures originate. In the chemical control of seizures, it has become clear that hormonal fac- tors may play a part in influencing seizure threshold and susceptibility to convulsions. Investigators are encouraged by research findings relating to the biochemistry of multiple sclerosis. Synthesis of sphingosine, previ- ously reported, has been followed by discovery of a biological mech- anism that yields a precursor of sphingosine. More has been learned about butylcholinesterase, an enzyme related to demyelinization. In- hibitors of this enzyme are reported to cause loss of myelin in fowl. Among the most difficult neurological problems have been the dis- orders of muscle. It is known that in dystrophic muscle the protein content 1s abnormal. The distribution of this protein is being studied | | | Public Health Service 95 by means of fluorescent-labelled elements, radioactive tracers, and the development of specific antibodies which carry a dye directly to the protein molecules under investigation. Through such studies, it will be possible to distinguish the actual abnormal molecules in the diseased muscle, and perhaps to find ways to modify them. Major advances have gradually been made in knowledge of the basic structure of the ear and of the pathways over which sound is conducted to the central nervous system. Through electrophysiolog- ical techniques, the passage of a sound impulse can be traced from the eardrum to the nerve receptor organs in the internal ear, and then to the area of the brain where the sound is received and interpreted. A new approach employs animals trained to respond to a sound with a highly organized pattern—one designed to test the animal’s ability to recognize pitch, loudness, quality, or location of the source. In these animals, the deficit resulting from surgical removal of specific areas of the brain can be determined. The most common causes of blindness are cataract and glaucoma, and the incidence of these disorders is increasing with the longevity of the population. At present, there is no medical means of treating cataracts. Surgical removal of the lens, however, has been greatly improved. The most recent advance has been the discovery that the supporting ligaments of the lens can be weakened or dissolved by an enzyme, alpha-chymotrypsin. Thus the lens can be removed without tearing the connecting tissues. A new method of sealing retinal breaks has been devised, utilizing an intense light which produces a burn at its point of focus. Thus the retina can be sufficiently scarred to seal it to the underlying choroid. GRANT-SUPPORTED RESEARCH The most recent development in the Institute’s total program has been the creation of the collaborative research area, designed to co- ordinate studies that would be difficult to carry on within a single insti- tution. The largest such program is the collaborative project for the study of perinatal pathology, officially begun in January. This project is of fundamental importance in relation to cerebral palsy, mental retardation, and congenital forms of vision and hearing loss. It is also concerned with the normal processes of conception, preg- nancy, delivery, and growth of the newborn child. Many of the methods were carefully pretested during the year, and collection of data in accordance with this protocol is now under way. Cooperative projects continue in cerebrovascular diseases. Several institutions are studying aneurysms—the dangerous ballooning of blood vessel walls—and their correction by surgery before fatal hemorrhage. Another project explores the effects of anticoagulant 96 Department of Health, Education, and Welfare, 1959 drugs on several hundred patients. A clinical study of the narrow- ing of brain arteries of various sizes was completed. Bureau of Medical Services The Bureau of Medical Services operates hospitals and outpatient clinics, foreign quarantine activities, and the health program for American Indians and Alaska Natives. It 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, epi- demiology and treatment of tuberculosis and other infectious diseases common 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, regional, and State studies are made of the 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, and in many other aspects of modern medical practice. They are among the Nation’s primary resources for the training of physicians, nurses and other health personnel. Hospitals and Outpatient Facilities The Division of Hospitals operates the medical care program for legal beneficiaries of the Public Health Service. Besides American seamen, these patients include officers and enlisted men of the Coast Guard, officers and crew members of the Coast and Geodetic Survey, commissioned officers of the Public Health Service, civil service em- 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 1959, 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, such as Boston, New York, Baltimore, New Orleans, Chicago, Detroit, San Francisco, and Seattle. In certain other places, depending upon the concentration of beneficiaries, outpatient clinics and outpatient offices have been established. The clinics, staffed by full-time personnel, provide comprehensive medical, dental, and allied health services. Public Health Service 97 Local physicians conduct the outpatient offices in their private facili- ties on a part-time basis, as needed. VOLUME OF SERVICES Inpatient admissions in all of the Public Health Service hospitals during 1959 totaled 49,786—a 1.9 percent increase over 1958. In addition, 720 babies were born in these hospitals in 1959, as compared with 650 the year before. ‘The average daily census was 5,140, a de- crease of 2.7 percent. Meanwhile, the number of outpatient visits to hospitals and clinics rose 1.7 percent—to 1,108,751. General hospitals —The general hospitals admitted 45,072 patients in 1959, a 38 percent increase over the 43,760 admissions in 1958. The average daily patient load at 2,703 was off 1.5 percent. Days per admission at the general hospitals in 1959 averaged 21.9 as compared with 22.9 in 1958. Tuberculosis—The Division’s tuberculosis hospital at Manhattan Beach, Brooklyn, N.Y., admitted 309 patients in 1959, a decrease of 18 percent. The average daily census dropped 14.8 percent. All the accepted new drugs in the treatment of pulmonary tubercu- losis are used at the hospital, and the staff keeps abreast of the status of experimental drugs and of therapeutic and surgical procedures for diseases of the chest. Leprosy.—The U.S. Public Health Service Hospital at Carville, La., is the only hospital in the continental United States devoted ex- clusively to the treatment and rehabilitation of patients with leprosy. Admissions at Carville totaled 62 in 1959 as compared with 73 the year before; the average daily census decreased from 296 to 277. Throughout the year, efforts were intensified toward realizing Car- ville’s potential as a principal center for training of personnel and investigation in the field of leprosy. An apportionment to the hospital earmarked for research permitted reorganization and expansion of the laboratory branch. The research effort was chiefly directed to- ward some of the still unknown characteristics of M. Leprae and the group of bacteria to which this organism belongs. Cooperative proj- ects with research workers elsewhere were continued. A 15-minute scientific film, “Recognition of Leprosy,” was completed. More than 8,000 visitors came to the hospital during the year. Many were physicians, nurses, and other health workers from all over the world who came to observe and learn the method of treatment. Narcotic addiction—The U.S. Public Health Service Hospitals at Lexington, Ky., and Fort Worth, Tex., have been in operation since 1935 and 1988, respectively, primarily for the treatment of narcotic addicts, as defined by Federal law. They also admit mentally ill patients entitled to care as beneficiaries of the Federal Government. 98 Department of Health, Education, and Welfare, 1959 In 1959, these hospitals admitted 4,343 patients, a 6.4 percent de- cline from 1958. Addict admissions fell from 4,317 to 3,979; “non- addict” admissions rose from 324 to 364. The average daily census of addict patients was off 2.9 percent from 1,367 to 1,828. Volun- tary patients accounted for 86 percent of the addict admissions. MEDICARE The Dependents’ Medical Care Act, which became effective Decem- ber 7, 1956, authorized Public Health Service hospitals and clinics to admit active duty and retired members of Federal Uniformed Services and their dependents, and the dependents of deceased mem- bers of these services. Patients eligible under this MEDICARE program made increased use of Service facilities during the past year. For example, admissions of Uniformed Service personnel and de- pendents to USPHS hospitals in June 1959 totaled 1,253, an 11.3 percent increase over June 1958; the 33,997 outpatient visits in June 1959 was 16.8 percent greater. The June 1959 average daily census of Department of Defense beneficiaries in USPHS hospitals totaled 242. Thenumber of dependents of PHS beneficiaries in Army, Navy, and Air Force hospitals averaged 115 during the same month. TRAINING MEDICAL CARE PERSONNEL Over 280 physicians, dentists, pharmacists and dietitians partici- pated in internship and residency training programs in U.S. Public Health Service hospitals during fiscal year 1959. Ten of the hospitals are approved for post-graduate medical training by the American Medical Association’s Council on Medical Education and Hospitals. Residency training is offered in a dozen medical specialties. Nine of the hospitals have approval by the American Dental Association to conduct dental internships. Approved dental residencies in oral surgery and prosthodontia were in progress at the Service hospitals at Staten Island and Seattle, respectively. Affiliations with colleges and technical schools afford practical experience and clinical instructions to more than 100 under- graduates in physical therapy, occupational therapy, vocational therapy, social service, and medical technology. During the year, an affiliation in dental hygienist training was initiated by the USPHS Hospital in San Francisco with the University of California School of Dentistry’s Division of Dental Hygiene. Similar programs were in progress at the USPHS Hospital in Seattle, cooperating with the University of Washington’s Oral Hygiene Department, and with the dental assistant training program of the Edison Technical School. The USPHS Hospital in Baltimore, Md., has an approved 1-year course in medical record library science, and the USPHS Hospital on Staten Island, N.Y., provides the clinical nursing portion of the hospital corpsmen training given by the Coast Guard. Public Health Service 99 Early in the year, the USPHS Hospital in Chicago, II1., received a Certificate of Merit signed by the Secretary of the Army and the Commanding General of the Fifth Army for “whole-hearted aid rendered to the 801st General Reserve Hospital in support of food handlers’ and X-ray technicians’ training * * *.” CLINICAL INVESTIGATIONS In 1959, the Division of Hospitals approved 59 clinical investiga- tion projects to be conducted at 10 of its hospitals. These investiga- tions include clinical trails and evaluations of newly developed drugs and procedures, further inquiries on heart, kidney and liver pathology, diagnosis and treatment of cancer, and studies of dental procedures. Dedication of the Seamen’s Memorial Research Laboratory at the U.S. Public Health Service Hospital in New Orleans, marked the first instance of a Service hospital allocating a structure exclusively for research purposes. Formerly used as quarters for employees, the renovated building contains laboratory space and equipment to facilitate the hospital’s performance of clinical investigative projects in basic sciences and in such fields as cancer, heart disease, and tropi- cal diseases. Initial research activities in progress represent co- operative effort among the hospital, local medical schools, and the Service’s National Institutes of Health. FEDERAL EMPLOYEE HEALTH PROGRAM The Federal Employee Health Program closely parallels the prac- tice of occupational health. Public Health Service medical and nurse officers in this program have responsibility for planning and conducting employee health activities designed to maintain op- timum health and well-being among Federal employees, including public health, preventive health, and emergency medical care. On a reimbursable basis, the Program operates 30 health units for Federal agencies that request this service. Located in Washington, D.C., Denver, Colo., New York, Kansas City, Boston and Waltham, Mass., and Belle Meade, N.J., these units are available to a population of over 50,000 Federal workers. During the year, several health units cooperated in tests and demon- strations for visual acuity, glaucoma, and diabetes. They also par- ticipated in vaccination projects against poliomyelitis and influenza. Twenty-six units which participated in the new Executive Health Maintenance Program gave 449 physical examinations to key em- ployees holding executive positions in Federal agencies. This pro- gram, begun in January 1958 in one health unit, was expanded to its present scope during fiscal 1959 by the addition of contract physicians, serving one or more clinic sessions per week, to most of the units which previously provided only nursing services. 100 Department of Health, Education, and Welfare, 1959 FREEDMEN’S HOSPITAL Outpatient visits at Freedmen’s Hospital in Washington, D.C., reached 97,298 in 1959, more than 2,000 above the previous year. In- patient admissions increased slightly, totaling 14,051. Freedmen’s serves as the clinical teaching resource for Junior and senior students of the Howard University College of Medicine. The hospital also offers approved internship and residency training as well as accredited educational programs in other professional cate- gories, such as nursing, X-ray technology, and medical social work. During 1959, a total of 46 residents received advanced training in 13 medical specialties. In addition, there were 16 medical interns, 2 dental interns, and 7 research fellows. The School of Nursing graduated 22 students on September 12, 1958, bringing its grand total of graduates to 1,374. ‘Three members of the class subsequently scored “cum laude” on State Board Examinations. Four X-ray technology students were graduated from the hospital’s recently approved course and all passed the qualifying examination conducted by the American Board of X-Ray Technology. Two phar- macists and ten dietitians also completed internships. The Social Service Department trained one student for field work practice in medical social work. Over 40 clinical research projects were under active study at the hospital during the year. Approximately 35 scientific articles by staff members were either already published or in press at year-end. Foreign Quarantine Protection of the United States against diseases that may be brought in from other parts of the world continues to be a major responsibility of the Public Health Service. In spite of the increasing danger caused by the increased speed and volume of international traffic, no quarantinable diseases were introduced into the United States in 1959. For the sixth consecutive year, the Nation was free from smallpox, despite outbreaks through- out the world. There was an outbreak of smallpox in Heidelberg and East Berlin, Germany, and a recurrence of the disease in Liverpool, England. Scattered cases of smallpox occurred near the Red Sea and the Persian Gulf, including the countries of Kuwait, Qatar, Iran, Iraq, and Egypt. These are areas of epidemiological importance because of commerce with the Middle East oil fields. In the Far East, smallpox remained endemic and epidemic. An outbreak occurred in Thailand where for 30 years there had been only scattered cases. The disease remained at a low endemic level Public Health Service 101 in most countries of Africa, but occurred in the port of Dakar, French West Africa, an important crossroad of international traffic. In South America, there was an outbreak of smallpox in Brazil which might have been a threat to the United States except for protection given by the staff of the Division of Foreign Quarantine. Smallpox is a potential danger to the United States because of the wide distribution of the disease, the constant increase in number of Americans traveling to remote areas of the world, and the continued reduction in travel time between countries by air transportation. It is a disease which can be controlled by maintaining a vaccinated population, including the moving population of persons in interna- tional traffic. Cholera continued to be confined to the Far East. It reappeared in Thailand in 1958 and remains at an endemic level there. An epidemic of cholera was reported in Nepal. Yellow fever was reported during the year in a forest area of Trini- dad—its second occurrence there in the past 5 years. Because of a vigorous vaccination program and other control measures, it did not spread to other areas. Sixteen additional yellow fever vaccination centers were desig- nated in the United States, making a total of 138 in Public Health Service facilities and in medical facilities of health departments and private organizations. The majority of these centers offer service to the general public. | The Division’s program to control the yellow fever mosquito was extended to cover international traffic areas of Puerto Rico and the Virgin Islands where the index of the Aedes aegypti mosquito was high. Thus the aegypti population in many international airports and docks was greatly reduced. Breeding of this mosquito was also reduced in international traffic areas of the yellow fever receptive zone across the Southern States. Aircraft, ships, and land conveyances arriving in international traffic channels were examined for presence of arthropods that can carry disease, and insecticides were applied in many cases. A case of vivax malaria in a crew member of an alien ship was de- tected by quarantine personnel at Tampa, Fla., and treatment was begun. This action prevented recurrence of the disease in an area where malaria has been successfully eradicated. VOLUME OF INTERNATIONAL TRAFFIC Inspections of aircraft for quarantine or immigration-medical pur- poses increased again, from 68,703 in 1958 to 70,607 in 1959. Inspec- tions of ships decreased slightly, from 34,120 in 1958 to 33,271 in 1959. Travelers arriving in the United States from abroad, including the interior of Mexico, who are subject to quarantine examination in- 102 Department of Health, Education, and Welfare, 1959 creased from 5,217,627 to 5,264,354. Largely because of the occurrence of smallpox in Germany and England, 607 persons were detained in isolation at ports of entry, compared with 124 in 1958. The number of incoming travelers who were allowed to continue on to their destina- tions in the United States, but were subject to medical observation for a time, was 117,310 as compared with 58,083 in 1958. MEDICAL EXAMINATIONS General program.—The number of aliens examined abroad by medi- cal officers continued to decrease, from 190,526 in 1958 to 155,068 in 1959; those examined were mostly immigrants. Aliensexamined upon arrival at United States ports increased from 2,503,740 to 2,669,768 ; these included tourists, business men, and students. Of the aliens examined abroad, 2,776 were found to have diseases or conditions excludable under the immigration law. Among those examined at ports in this country, 2,695 were found to have excludable diseases or defects; many had been so diagnosed abroad, but were admitted under special provisions of the immigration law. Immigration of aliens with tuberculosis —The immigration of cer- tain aliens who have tuberculosis continued for the second year under a provision of Public Law 85-316 which allows this privilege to those who are close relatives of American citizens or resident aliens. If the disease is in the communicable stage, they remain in isolation while aboard ship and while traveling to hospitals where care has been ar- ranged forthem. Under this law, quarantine officers abroad examined 1,073 aliens with confirmed or suspected tuberculosis during the year, and officers at U.S. ports examined 1,445. Migratory farm labor—Under an agreement with the Department of Labor, the Division is responsible for medical examinations of Mexican migratory farm laborers who cross the border to work on farms and ranches in the United States. Preliminary examination and vaccinations are given at three migratory centers in Mexico. Further medical examination, including X-raying and serologic testing for syphilis, is given at five reception centers along the Mexican border in the United States. In 1959, the eighth year of this program, 437,920 laborers were examined, with 8,870 rejections, at the three centers in Mexico; 489,477 examinations were made, and 5,215 laborers were rejected, at the reception centers on the border. Use of the plasma reagin test developed by the Public Health Serv- ice’s Communicable Disease Center for the rapid testing for syphilis was extended to all five reception centers; 339,064 serologic tests were performed and 20,6938 positive reactors were identified. With few ex- ceptions, laborers showing positive reactions were treated with penicillin. ee, ee pe ee Public Health Service 103 OTHER QUARANTINE ACTIVITIES A new office was opened in Montreal, Canada, to handle quarantine activities for traffic in the St. Lawrence Seaway. ‘The visa medical examination program for Eastern Canada was reorganized, and super- vision was placed under the Toronto office. Rat control in port areas and on vessels in international commerce was continued, with good results, as part of the sanitation program. This program was broadened to include measures to improve food sanitation on vessels from foreign ports. In response to a request made through the International Coopera- tion Administration, the Government of Iran received technical ad- vice from the Public Health Service in surveying, reorganizing, and modernizing its quarantine program. Health Services for Indians In November 1958, eyesight was restored to a 16-year-old Eskimo girl in the Public Health Service Hospital at Anchorage, Alaska, which serves beneficiaries of the Indian health program. This was the result of the first corneal transplant ever performed in Alaska. The successful conclusion of this complicated operation holds deep significance for the Indian and Alaska Native people. It is an ex- ample of the steady progress being made in the improvement of their health services, a symbol of the joint effort of public health, modern medicine, and the people to raise the levels of Indian health. Health officials classify such an operation as “elective surgery”— medical service provided to improve the value of human life as dis- tinguished from that essential to the actual preservation of life. While elective surgery is not wholly new in the Public Health Serv- ice’s Division of Indian Health, there has been little opportunity to provide this type of service in the past. The hospitals serving Indians and Alaska Natives were for years so overburdened with efforts to save lives that they were in no position to undertake costly and diffi- cult procedures to bring a better life to many who could be benefited. Shortages still exist, but throughout the program, with its hundreds of health facilities that reach from above the Arctic Circle to the Mexican Border, the major emphasis in 1959 has been.on improvement in the quality of health services. A larger health staff, improved facilities, more funds for contract patient care and specialist services, and wider opportunities for staff training are key factors that make possible the increases in elective surgery, more effective protection of the Indian and Alaska Native populations from disease, and better treatment for illness of all types. About 345,000 Indians and 87,500 Alaska Natives depend to vary- 104 Department of Health, Education, and Welfare, 1959 ing degrees for their essential health services on the Indian health program. Many of them know no other source for these services. To meet their needs for both preventive services and medical care, the Division of Indian Health conducts the largest and most compre- hensive civilian health program within the Federal Government. Services of this program are provided through its 53 hospitals and its system of field health clinics and other facilities at about 300 locations. In addition, beneficiaries of the program are served ex- tensively through contractual arrangements with non-Federal hos- pitals, private physicians and dentists, and other health agencies. The 1959 appropriation for Indian health activities amounted to $49,327,000. An additional sum of $6,010,000 was appropriated for construction of new health facilities, staff housing and hospital improvements. NEW AND IMPROVED HEALTH FACILITIES A new regional hospital and medical center is now being built at Gallup, N. Mex. Participants in the ground-breaking on May 20, 1959, included representatives of the Indians whose health needs will be better served by the new facility, planners, administrators of Indian health and Indian affairs, physicians who may be called upon as specialists, and residents of the non-Indian community. In this setting, construction started on the largest and most am- bitious of many projects under way to provide better facilities for Indian health. Nearly a hundred miles to the north, at Shiprock, N. Mex., another Indian hospital is approaching completion. This 75- bed hospital will be ready for use by December 1959. On January 30, 1959, a contract was awarded for construction of the new 50-bed hospital being built at Kotzebue, Alaska. Replacing an old, unsafe, and inadequate hospital at the same location, this facility is one of the Nation’s only two hospitals located above the Arctic Circle. Just before the close of the fiscal year, a contract was awarded for construction of a new 50-bed hospital at Sells, Ariz. During the year, engineers of the Division of Indian Health and the Geological Survey of the Department of Interior succeeded in finding beneath the rocky crust of the Sonoran Desert—in which Sells is located—a suitable water source for the hospital. The lack of a source of water had long delayed the construction of the sorely needed hospital for the Papago Indians. All 4 major hospital modernization projects authorized were under- way at the year’s end. Contracts were let for five additional moderni- zations. Of five major hospital alteration projects, one had been completed prior to the beginning of the year, and four were underway at the close of fiscal 1959. In addition, 14 new health centers and 0 ee Public Health Service 105 field health clinics were completed; and contracts were awarded for 21 new staff housing units. Under the terms of Public Law 85-151, enacted in 1957, 77 new beds for use by beneficiaries of the Indian health program are being provided in community hospitals now under construction for joint use by Indians and non-Indians. This law authorizes the Public Health Service to participate financially in the construction of such joint use facilities. The new beds for Indian use are in 10 hospitals located in California, Minnesota, Montana, North Dakota, and Wyoming. TRENDS IN THE PROGRAM Closer coordination of Federal, State, and local health services for Indians is resulting in better use of community health resources. Largely as a result of grants under the Hill-Burton program, many smaller communities in Indian Agency States now have excellent community hospitals which are close to Indian reservations and settle- ments. To an increasing degree, modern health services provided by these facilities are being utilized to augment the services provided through the 53 hospitals operated directly by the Indian health pro- gram. At the close of the year, contracts or arrangements for reimbursement for treatment of Indians were in effect with approxi- mately 225 non-Federal hospitals. Hospital services were discontinued at the small, uneconomical hos- pital in Nespelem, Wash., and at the one in Juneau, Alaska. In- patient care for beneficiaries at these locations was shifted wholly to up-to-date community hospitals under contract. The Nespelem hos- pital was converted into an Indian health center providing both pre- ventive and therapeutic services for outpatients. Upon closure of the hospital at Juneau, an outpatient health center for beneficiaries in that community was established at the St. Ann’s Hospital. Approximately $8 million was spent in 1959 on patient care pro- vided through contracts with community hospitals and by individual physicians and dentists. Increasing sums were spent for specialist services which otherwise would have been unavailable. Reflecting the dramatic successes achieved in efforts to cut tubercu- losis incidence and death rates, arrangements were made to terminate operation of the 330-bed Indian tuberculosis sanatorium at ‘Tacoma, Wash. The smaller numbers of tuberculosis patients needing hospital treatment in this area now receive care in contract facilities closer to their homes. HEALTH PROBLEMS OF THE INDIANS Most of the beneficiary populations live in relative isolation, with- out the health resources and services available to most of our popula- tion. Tens of thousands of Indians and Alaska Natives have had little 530344—60—_8 106 Department of Health, Education, and Welfare, 1959 or no opportunity to learn the essentials of individual or community health protection. Nor have they the means for adhering to recom- mended health practices, even where these are understood. ‘The ma- jority do not even have access to toilets or sanitary privies. Too often, their foods are insufficient in kind or amount to permit nutritionally adequate diets. In many cases, their food is contaminated. Overcrowded and inadequate housing is commonplace. Domestic water supplies used by Indians and Alaska Natives generally are grossly inadequate. Many thousands of these people must haul water a mile or more, often from polluted sources. It is not surprising, then, that many of them die of diseases which pose no serious problems in most well-protected American commu- nities. Their deaths from such preventable diseases as influenza, pneumonia, tuberculosis, and gastroenteritis are 3 to 9 times higher than in the general population. Average age at death among the Indians is 22 years earlier than the national average of 62. One- fourth of all Indian deaths occur among infants, compared with only 7 percent among the infants of the Nation as a whole. SERVICES PROVIDED Partly as a result of the declining tuberculosis patient load and the increasing volume of services to outpatients, hospital admissions showed a relatively small gain in 1959. Nevertheless the total num- ber of admissions—more than 73,000—established an all-time record. Of these, 18,700—primarily general patients—were to contract hos- pitals, representing an increase of 12.5 percent over last year. Throughout 1959, disease prevention continued to receive heavy emphasis. The outpatient departments of the Service-operated hos- pitals recorded 605,000 visits for treatment and preventive services, an increase of 5 percent over 1958. Indian health centers and field health clinics are providing a steadily increasing volume of preventive and therapeutic services in response to rising demands. Dental examinations were provided for more than 67,000 patients. More than 164,000 patients were given dental treatments, including 9,500 treated by contract dentists. In addition, nearly 10,000 children received topical fluoride treatments to inhibit tooth decay. The vast majority of program beneficiaries need dental care. However, limitations in the program make it impossible to serve more than about 20 percent of this population, with major attention being provided for children. Of those who do receive treatment, less than one-half of their dental needs can be met. Qualitative improvements in services are not in all cases revealed in operating statistics. Today, for example, it is possible for a bene- ficiary to obtain the skilled help of a medical social worker in dealing with problems which, if unsolved, impede recovery or even stand in ee ee ee ee nal ee _ Public Health Service 107 _ the way of discharge from the hospital. Nutrition services are making headway against dietary problems which affect large segments of the _ beneficiary population. Health education, now including the produc- _ tion of modern teaching aids aimed specifically at tribal groups, 1s _ making a greater impact. Public health nursing, special services for _ mothers and children, and medical record and referral services were strengthened during the year. ENVIRONMENTAL SANITATION Of the major factors contributing to high disease and death rates among Indians and Alaska Natives, none is more significant than the unfavorable environment in which most of them live. This en- vironment has been subjected to careful study in the field, and the extent of environmental health hazards is well defined. Field surveys confirm the general use of unsafe water, dangerous disposal of human and other wastes near living quarters, contamina- tion of food, infestations of rodent and insect pests, and grossly over- crowded and substandard housing. These factors are major causes of the high infant death rate, and the excessive death rates among all age groups resulting from infectious diseases such as tuberculosis and gastroenteritis. Intensive efforts, directed by the program’s sanitary engineers and carried out with the help of many Indian and Alaska Native sani- tarian aides trained by the Public Health Service, are helping the beneficiaries to overcome their unfavorable environmental conditions. With this guidance and their limited resources, the Indians and Alaska Natives are developing new and safe water sources and are building sanitary waste and refuse disposal facilities. On July 31, 1959, Congress enacted Public Law 86-121, which au- thorized the Service to provide sanitary facilities for beneficiaries of the Indian health program. Included are domestic and community water supplies and facilities, drainage facilities, and facilities for sewage and waste disposal. The law permits the Service to make joint arrangements for participating in such projects with tribal groups, local authorities, and other public and nonprofit agencies, both in construction costs and in subsequent operation and maintenance. The Service also is authorized to acquire necessary lands, accept con- tributions, and transfer completed facilities to State or local authori- ties or to the tribal groups concerned for continued operation and maintenance. Hospital and Medical Facilities The dollar volume of hospital and health facility construction started in the United States, both with and without Federal aid, 108 Department of Health, Education, and Welfare, 1959 reached new peaks in fiscal 1959. However, there was little change in the total numbers of hospital beds and health facilities currently needed. Over the past decade substantial progress has been made in meeting needs for general and community hospitals, but progress in constructing other kinds of health facilities has been less rapid. Rising building costs, population growth, and the obsolescence and abandonment of old facilities are among the factors affecting the general rate of progress. In addition to administering the Federal share of the construction program, the Division of Hospital and Medical Facilities conducted research and planning projects to bring about better use of hospital resources and services. To develop working principles for planning the hospitals and medical facilities of the future, four regional conferences were held in cooperation with the American Hospital Association. An agreement was made with the Office of Civil and Defense Mo- bilization to develop plans for hospitals illustrating methods of pro- tecting patients, personnel, and facilities from blast and fallout. The Baptist Memorial Hospital in Oklahoma City was the first facility to benefit from the legislation of 1958 authorizing the making of construction loans in lieu of grants. The Baptist General Con- vention of Oklahoma, sponsor of the $4,533,855 project, received a loan of $507,568. The hospital was opened on April 15, 1959. CHANGING NEEDS AND EMPHASES Inventories from the States showed that 77 percent of the need for general hospitals was met in 1959, as compared with 75 percent in the previous year and 59 percent in 1948 when State inventory records first became available. The Nation’s greatest need in health facilities continues to be additional chronic disease hospitals and nursing homes; the need met is only 15 percent and 35 percent, respectively. There has been little change in the need for mental] hospitals. There still are fewer beds in proportion to requirements than were reported in 1948—52 percent as compared with 55 percent. For all types of hospitals, the Nation still needs 867,000 additional beds according to State plans on record January 1, 1959. In addi- tion, 252,000 additional nursing home beds are needed for skilled nursing care, or 65 percent of the total requirements in this field. RESEARCH—HOSPITAL ADMINISTRATION Studies in “progressive patient care’—the better organization of hospital services around the medical and nursing needs of the pa- tient—continued to take the spotlight, with special research designed to analyze hospital staffing patterns, bed allocations, and costs. ee | Public Health Service 109 _ Su Seah? See 3, 986, 362. 00 Cancer contegl Wisse OfUTi Orel teins BU Be Sle eee 2, 171, 242. 00 Heart>-disease Gontroelcenwe- acc baud eudpebt OT ae 2, 075, 219. 00 Construction of community facilities in detaae impact areas 25, 000. 00 Hospital and medical facilities construction___________-___ 1385, 183, 829. 78 Waste treatment works construction____________-_____-__- 36, 429, 071. 08 Water pollution Controle Sf fot See eee SS ee * 2, 847, 867. 00 1Includes $575,444.27 in supplies and services furnished in lieu of cash. 2 Includes $256,876.00 paid to interstate agencies. Other funds used to help strengthen State and local health programs were: $1,972,848.13 for traineeships for professional public health workers; $199,936.79 for training and demonstration projects in air pollution control; and $442,300 for grants to schools of public health for the provision of public health training. Additionally, Alaska was paid $638,000 in grant funds for disease and sanitation investigation and control activities and $1 million for its mental health program. Upon Alaska’s formal admission to state- hood in January 1959, an arrangement of annual transitional grants was made to facilitate an orderly assumption of certain responsibili- ties previously performed by the Federal Government. The Territory of Guam received grants-in-aid for the second year for public health programs and obligated $97,333 of Federal grant funds for hospital construction. ARCTIC. HEALTH RESEARCH CENTER The Arctic Health Research Center in Anchorage, Alaska, investi- gates problems associated with life in low temperature areas and cooperates with the Alaska Department of Health and other agencies concerned with the improvement of Alaska’s public health and med- ical services. The Center’s research projects span a wide range of arctic and sub- Public Health Service 119 arctic health problems, including: a study of human burcellosis among Alaska Natives which indicates that reindeer and caribou may be potential reservoirs of this disease; a pilot study of corneal scarring; and various studies dealing with the ecology of enteric viruses, ambulatory chemotherapy for tuberculosis patients, physi- ological adaption to cold, and sero-immunology of Asian influenza in Alaska Natives. Sanitation studies continue to be productive in improving water supply systems, waste disposal systems, and experimental housing and in adapting ideas and materials to meet the singular environ- mental conditions of Alaska. NATIONAL OFFICE OF VITAL STATISTICS The two-volume publication, Vital Statistics of the United States, 1957, and 17 National Summary reports of 1957 data were issued. Current data were regularly published in the Weekly Morbidity and Mortality Report and the Monthly Vital Statistics Report. In the Selected Studies series, reports were issued on birthweight and the survival of newborn infants; child-spacing; birth rate trends; and death rates from selected causes. Also completed were: a release of current data on illegitimacy and a projection of illegitimate births to the year 1970; a classification and listing of institutions in which births and deaths occur; and, in cooperation with Canada, England, and Wales, a study of the comparability of cause-of-death classifi- cation, The following sampling survey studies were conducted in coopera- tion with the specified agencies: lung cancer (National Cancer Insti- tute); bone sarcoma (Atomic Energy Commission) ; cystic fibrosis (Children’s Bureau) ; and poliomyelitis vaccination (Communicable Disease Center). The Marriage Registration Area, inaugurated by the National Office of Vital Statistics 2 years ago, now includes 36 States, with the admission of Kentucky during the year. Two States, Maryland and Kansas, were admitted to the Divorce Registration Area, started in January 1958 by NOVS; the total now includes 19 States. Comprehensive surveys of registration and statistical programs were conducted in four States, and cause-of-death coding training was given in three States. Through an Interagency Committee, the NOVS cooperated with other Federal agencies and the States in de- veloping procedures for registering births occurring outside the civil jurisdiction of the United States. PROGRAM DEVELOPMENT The Program Development Branch of the Division of General Health Services helps to stimulate research in public health practice 120 Department of Health, Education, and Welfare, 1959 by State and local health departments, voluntary health agencies, and schools of public health. It is also the focal point within the Service for work on school health, rural health, and the health of agricultural migrant workers. TRAINING In 1959, the third year of the traineeship program under Title I of the Health Amendments Act, 654 persons received advanced train- ing in public health—bringing the total for the 3-year period to 1,682. A National Conference on Public Health Training, called by the Surgeon General in July 1958 to evaluate the program and make recommendations to the Congress, endorsed the extension of the traineeship program to increase the supply of trained professional workers. PUBLIC HEALTH EDUCATION Through consultation, research, and training, the Public Health Education Branch assisted States and local health departments, units of the Public Health Service, educational institutions, and other or- ganizations in developing health education programs designed to en- courage desirable health habits. Consultants in health education are now stationed in 6 of the 8 regional offices of the Department. The Branch also conducted or assisted in a number of behavioral science studies. During the year six studies were completed on a cooperative study of the effects of the Asian influenza epidemic on community life in five cities. Another study considered why people fail to seek vaccination for poliomyelitis. Current research includes studies on: (1) construction of a psychological instrument to measure people’s health concerns; (2) factors affecting decisions to accept or reject free testing for cervical cancer; and (8) why people use or fail to use available free dental services. Public Health Nursing The Division of Public Health Nursing was established in August 1958, replacing the Public Health Nursing Branch of the Division of General Health Services. Promotion of public health nursing services with special emphasis on expansion into the newer programs, such as chronic disease, was carried on through field consultation, teaching, and committee work. Information on the distribution of visiting nurse associations in cities of 25,000 population and over was obtained as a basis for planning, with State and local health departments, for expansion of services to include nursing care of the sick. A study to identify methods of documenting the results of public health nursing service to patients was initiated in one health depart- Public Health Service 121 ment in February 1959. Criteria were developed for evaluating nursing services in maternal and child health, and tuberculosis con- trol programs; other programs will be included during 1960. The Division also plays a major role in career development of public health nurses. It assisted in the assignment of 21 nurses, 6 of whom were new recruits. Special Health Services The Division of Special Health Services is the unit of the Service which works with State health agencies and other groups in develop- ing programs related to personal health maintenance. The Division administers special programs in accident prevention, medical aspects of air pollution, occupational health, and control of cancer, heart disease, tuberculosis, and other chronic diseases. CANCER CONTROL The Cancer Control Program, created in the Division of Special Health Services a year ago, completed its organizational and staffing pattern during the year. Working with public health authorities and private physicians, the Cancer Control Program staff explored the potentialities for cancer control activities throughout the country. Formal conferences in six regional areas of the Department were at- tended by 217 physicians in private practice, public health, and volun- tary agencies. Minimum standards were also developed for community services In cancer control work. During the year, the Washington Cytology Unit—a demonstration and training unit in screening for cervical cancer—was transferred from the National Cancer Institute to the Cancer Control Program. In addition to screening Federal beneficiaries, the Program studied methods of increasing the number of medical technologists in this field and of improving laboratory techniques in the processing of slides. HEART DISEASE CONTROL The Heart Disease Control Program during 1959 contributed to the advances being made throughout the country against cardiovascu- lar disease by: (1) helping apply current knowledge concerning heart disease, and (2) conducting community studies designed to learn more about the epidemiology and control of cardiovascular disease. Responding to mounting requests from States for professional assistance in this field, the Program assigned 23 medical and nurse officers to 21 State and local health departments to stimulate and extend work in heart disease control. Primary prevention of rheumatic fever—one of the most serious 530344—60—_9 122 Department of Health, Education, and Welfare, 1959 and crippling diseases of childhood—may be a step closer through use of the fluorescent antibody technique in diagnosis. Validation tests of the new method, first. step in the application of this research finding, were initiated by the Program in Colorado, North Dakota, and Montgomery County, Md. To combat stroke, one of the major cardiovascular diseases of the older years, the Program promoted new and expanded stroke rehabili- tation activities in various parts of the country, including demonstrations, clinics, outpatient and home care measures. In an attempt to learn more about the contributing factors and causes of cardiovascular disease, States are conducting epidemiological studies with Program support. Cardiac-in-industry surveys, mobile cardiac diagnostic clinics for children, new case-finding techniques, and continued expansion of community studies in atherosclerosis are other examples of heart program activities. CHRONIC DISEASE CONTROL The number of State and Territorial health departments with ac- tive public health programs to prevent the occurrence of the disabling effects of chronic disease reached a new high durig fiscal year 1959. Thirty-six health departments now have organized units responsible for diabetes casefinding and glaucoma detection, as well as commu- nity services and nursing care programs for the chronically ill and aging. Five years ago there were only 27 such units in the Nation. Early detection of diabetes and glaucoma through individual and multiple screening methods which are now feasible continues to be emphasized by the Chronic Disease Program. A small, hand-operat- ed diabetes blood-testing device was developed which enables small health departments to carry out a diabetes detection program. Strike Back At Stroke, a booklet produced by the Chronic Disease Program as a guide to physicians in prescribing effective restorative treatment for stroke patients, received national acceptance. A num- ber of programs are now under way to promote early mobilization of stroke patients, and medical schools are using the booklet for student instruction. The first program undertaken by Federal, State, and local official and nonofficial agencies to bring needed restorative services to resi- dents of rural communities was started in North Carolina. Dental care for homebound chronically ill and disabled people was started by a New York City hospital as part of the Public Health Service’s evaluation of a portable dental equipment kit enabling a dentist to give complete treatment at the bedside. TUBERCULOSIS CONTROL In fiscal year 1959, $4 million was appropriated by Congress for tuberculosis grants to the States. In addition, the Tuberculosis Pro- Public Health Service 123 gram, by collecting, analyzing, and disseminating a wide variety of information, by assigning personnel to trouble spots, and by offering specialized consultation, aided the States in putting their resources against tuberculosis to good use. Today tuberculosis patients spend less time in the hospital than they used to. Current recommendations are usually for six to eight months of hospitalization followed by several years of drug therapy; some patients receive all their treatment outside the hospital. The health department, therefore, now carries a major share of the re- sponsibilities for the medical care of tuberculosis patients. Many health agencies, however, do not have adequate resources to provide the new services required. The provision of medical care for patients outside the hospital is the most pressing current problem in tubercu- losis control, and much of the Tuberculosis Program’s staff time is spent in helping State and local health agencies to improve their services to these patients. Another difficulty in the changing situation is casefinding. As the number of people with tuberculosis declines, unknown cases are increasingly difficult to locate, and health departments must carefully select not only the populations to be screened but the screening techniques themselves. The Tuberculosis Program aided health de- partments in establishing priorities for their casefinding activities and in training nurses in tuberculin testing techniques. The program is also actively promoting the use of dual reading of screening films to increase yield and reduce radiation. Casefinding has been further complicated by the discovery of the so-called “atypical” mycobacteria which cause cross reactions to tuber- culin. The Program played a major role in investigating these organisms and in conducting research on their epidemiology. Other operational research conducted by the Program is concerned with the evaluation of various drug regimens in tuberculosis therapy and with the evaluation of the prophylactic effects of isoniazid. OCCUPATIONAL HEALTH To help safeguard the health of American workers, the Occupa- tional Health Program carries out field studies, laboratory research, technical assistance, and training. A major study in the Federal Prison Industries seeks to develop standards for the control of noise. Recent findings show that work- ers with less than 6 months’ noise exposure almost completely re- covered their hearing acuity, following temporary removal from the noise. Recovery was less complete in workers having over one year of noise exposure. The medical phase of the continuing, joint Public Health Service- U.S. Bureau of Mines study in metal mines completed its first year, 124 Department of Health, Education, and Welfare, 1959 with examinations of 3,000 workers in 8 Western mines. Preliminary findings reveal a surprising occurrence of pneumonoconiosis in men with relatively short periods of exposure to silica dust, despite the general availability of control measures. The study will yield valu- able clues as to why silicosis persists as the leading occupational disease, in terms of disability and compensation cost. A long-term study points to a possible occupational factor in deaths of uranium miners. Of approximately 80 deaths, 6 were caused by lung cancer. To assist in the detection of occupational diseases, work is under way to develop more rapid and efficient analytic procedures. As the result of a need demonstrated by a study of the phosphate industry, a rapid, simple procedure was developed for the separation of fluoride from fresh urine samples by an ion exchange method. The new procedure will permit a tenfold increase in the number of analyses performed within a unit of time. It can be readily performed in an industrial plant laboratory. Emergency and special consultative services included studies ranging from toxic and allergenic properties of Haitian voodoo dolls to outbreaks of illness among dock workers handling castor bean pomace used in fertilizer. To help meet personnel training needs of public health agencies, 18 training courses and 6 technical seminars were presented, attended by 665 persons. AIR POLLUTION MEDICAL PROGRAM During the year, the Air Pollution Medical Program was reorganized to deal with the growing problems arising from air pollu- tion. New sections were created to conduct laboratory investigations and community studies in this field. Laboratory studies are under way on the biochemical effects of air pollution, the physiological effects of air pollution upon animals, and the effects of long-term exposures of plants, animals, and human beings to irradiated auto exhaust components. Community studies include the physiological effects of air pollution upon man, the possible causation or aggravation of chronic disease, and the possible relationship between air pollution and other environmental influences. The National Conference on Air Pollution, conducted in cooperation with the Air Pollution Engineering Program in November, 1958, was attended by more than 1,000 representatives of industry, State and local governmental agencies, universities and research organizations. In addition to focusing public attention on air pollution problems, the Conference adopted resolutions which outline necessary research and control objectives for the immediate future. Increased emphasis on automobile exhaust studies and improved application of presently known control methods were among the Conference recommendations. Public Health Service , | 125 ACCIDENT PREVENTION During the year, the Accident Prevention Program continued to develop plans and techniques designed to help State and local health agencies reduce accidental injuries and deaths. Emphasis was given to traffic safety and the prevention of home accidents. The Program also conducted epidemiological studies of accidental fires and ex- plosions and of accidents among children and older persons. The number of local poison control centers continued to grow. There are now 289 such centers throughout the country, compared to 158 a year ago. These centers help control accidental poisoning by providing, primarily to physicians, a quick source of up-to-date infor- mation on the ingredients, toxicity, and recommended treatment of poisoning by potentially hazardous products. Through the National Clearinghouse for Poison Control Centers, maintained by the Public Health Service to coordinate this effort, information about new poisons encountered by any of the local centers is made available to all other centers. There was widespread concern during the year about the increase in alleged accidental suffocations among children caused by plastic garment bags. Since January 1, 1959, 49 such incidents were reported to the Accident Prevention Program. Investigation revealed that most of the deaths were associated with the use of the plastic bags as bedding for small infants. A few suffocations were also caused by use of the bags as toys and playthings. An intensive edu- cational campaign directed toward parents was launched by the plastic bag and dry cleaning industries, in cooperation with the Public Health Service and professional organizations, to prevent these needless fatalities. A study by Cornell University has shown that the use of seat belts in automobiles substantially reduces the risk of accidenta] death and the severity of injury from crashes. During the year, the Accident Prevention Program launched, in cooperation with the National Safety Council and the American Medical Association, a national campaign to encourage widespread use of automobile seat belts. Radiological Health The Division of Radiological Health, now in its second year of operation, grew in response to the increasing importance of radiation as a public health problem. In fiscal year 1959, the Division operated on a budget of $634,000 compared to $393,000 a year ago. ‘There was a, corresponding expansion in program activities. The Division helps State and local health departments to start and maintain radiological health programs and develops public health 126 Department of Health, Education, and Welfare, 1959 measures to reduce exposure from radiation-producing devices in medicine, industry, and other sources, It conducts research, including the accumulating epidemiological data on long-term effects of radia- tion on human beings. In addition, the Division monitors weapons testing; maintains surveillance of radiation levels in air, water, milk; and conducts training for health personnel in various aspects of radio- logical health. In April 1959, the Surgeon General called a radiological health conference to review current developments in radiological health with the State and Territorial Health Officers, representatives of the Food and Drug Administration, the Children’s Bureau, the Atomic Energy Commission, and members of the National Advisory Committee on Radiation. Discussions centered on emerging problems and trends in this field. The group considered Federal-State relationships in radiological health, medical X-ray protection, radiological training and research, standards relating to environmental contamination with radioactive materials, and legislative and regulatory aspects of radio- logical health. Finally, there was an evaluation of the needs of the States in developing and implementing radiological health programs. During the year, the Division completed an inventory of the radio- logical health programs in 32 States. At the request of the Florida State Health Department, a team of PHS scientists assisted in setting up a project to survey diagnostic medical X-ray sources in Dade County, Fla. It was hoped that this project would also serve as a demonstration of the techniques of measuring radiation that may be applicable to other areas in the United States. Under an agreement with Joint Task Force 7 and the Atomic En- ergy Commission, the Service continued to carry out its radiological off-site monitoring activities during weapons testing (Operation HARDTACK, Phase I and II) at the Pacific Proving Grounds and at the AEC Nevada Test Site, respectively. Cooperation in radiological health and safety activities was con- tinued with the Maritime Administration on its nuclear powered merchant ship program and with the Navy on its Nuclear Propulsion Program, In each case, a Public Health Service team is assigned to the agency to assist in developing radiological safety practices. The Public Health Service, in cooperation with the Atomic Energy Commission, initiated a joint study of radiological protection and surveillance programs appropriate to the various types of reactors under development at the National Reactor Test Site (NRTS) at Idaho Falls, Idaho. The Service initiated a study of biological samples collected in the vicinity of the Nevada Test Site to determine body burdens of radio- activity and to obtain related radio-epidemiological data. Radio- Public Health Service 127 chemical analyses of samples are made by the radiological health re- search staff at the Robert A. Taft Sanitary Engineering Center. During fiscal year 1959, 15 training courses in radiological health were presented at the Sanitary Engineering Center. About 450 peo- ple attended these courses, including representatives of State and local health departments, industry, and Federal agencies. Engineering Services The Division of Engineering Services works with State and local health departments, industry, and other groups on health problems associated with the modern environment. Division programs include the engineering aspects of air pollution, milk and food sanitation, the sanitation of interstate carriers, and advanced professional training in sanitary engineering. ROBERT A. TAFT SANITARY ENGINEERING CENTER The Robert A. Taft Sanitary Engineering Center, Cincinnati, Ohio, is the Nation’s primary facility for research, technical assistance, and training in the following fields: air pollution, water supply and pollution, milk and food sanitation, and radiological health. Research is conducted through the staff operations at the Center. The training program offers a wide variety of resident and field training courses for scientific and administrative personnel engaged in sanitary en- gineering work. ENGINEERING RESOURCES The Division works to increase the supply, improve the utilization and develop the professional status of sanitary engineers and related personnel. This is done through inservice training, traineeships, research fellowships and research grants, and through close liaison with universities and professional and technical organizations. In cooperation with the National Science Foundation and the Confer- ence of State Sanitary Engineers, work continued on a roster of sanitary engineering manpower in the United States. GENERAL ENGINEERING Special citations were awarded to 19 vessel companies and 8 rail- roads for meeting Public Health Service criteria on all operating units. Increased attention was given to sanitation problems created by the introduction of jet aircraft on commercial airlines. Major modification and expansion of servicing facilities are involved. Some 162 of 168 aircraft constructed were given Certificates of Sanitary Construction. Vessel construction continued at a high level, with 41 of 55 new or reconstructed vessels qualifying for such certificates. Surveillance was maintained on interstate railroads and_ buses. 128 Department of Health, Education, and Welfare, 1959 One major outbreak of food poisoning aboard a carrier was investigated. The Division worked with the American Public Works Association in the preparation of a textbook on Refuse Collection Practice. Also under preparation is a companion text on disposal practice. During the year, the Division compiled material for a manual designed to evaluate environmental health problems in urban and metropolitan areas. Cooperative projects were begun with several national organizations interested in metropolitan area planning. MILK AND FOOD SANITATION A recommended sanitation ordinance and code which establishes standards for Grade A dry milk used in the commercial preparation of fluid milk products was issued. The Public Health Service makes monthly analyses of milk samples from 12 milksheds of the Nation for the presence of radioactivity. The yearly averages for radioisotopes in the samples collected remained below the permissible concentrations published by the National Com- mittee on Radiation Protection and Measurement. Participation in the Cooperative State-PHS Program for Certi- fication of Interstate Milk Shippers continued to increase for the ninth consecutive year. Studies were initiated at SEC to determine ecological factors in the prevention of foodborne disease. Model ordinance provisions on inspection of poultry were dis- tributed to the States, and a related manual was published jointly with the Food and Drug Administration. The Service continued to participate with the States, the shellfish industry, and the Government of Canada in the voluntary program for the certification of interstate shippers of fresh or frozen oysters, clams and mussels. The Public Health Service Shellfish Sanitation Laboratory was moved from Florida to the State of Washington where a long-range study of the bacteriological properties of West Coast shellfish will be undertaken in cooperation with the Washington State Department of Health. AIR POLLUTION ENGINEERING PROGRAM Established after the National Conference on Air Pollution, at the request of the Secretary of Health, Education, and Welfare, an ad hoc Committee on National Goals for Air Pollution Research is cur- rently completing a report which will recommend desirable levels of support for air pollution research by government, industry, universi- ties and other groups. Major emphasis in research centered on the auto exhaust problem. A joint Engineering-Medical auto exhaust study unit, established at Public Health Service 129 the Sanitary Engineering Center, will permit more precise research in this area than has heretofore been possible. Significant projects completed included improvements in instru- ments for air pollution sampling and analysis, including the develop- ment of a portable particle counter and size analyzer for field use. Full-scale field operations were carried out during a detailed study of community air pollution in Nashville, Tennessee. Progress has been realized on work concerning chemical and phy- sical methods for air pollution analysis. Multiple gas samplers, de- veloped by the Program to fill an important gap in knowledge of air pollution, have been put into limited field use for evaluation. A new time-saving method has been developed for the analysis of polycyclic hydrocarbons which will greatly facilitate study of the carcinogenicity of air pollutants. In cooperation with the National Cancer Institute and the Uni- versity of Southern California Medical School, a special air sampling program for carcinogens was continued. Water Supply and Pollution Control A separate Division of Water Supply and Pollution Control was created on April 1, 1959, reflecting intensified efforts in these environ- mental health fields. An agreement between the Department of the Army and the De- partment of Health, Education, and Welfare calls for assistance to the Army Engineers in determining supply, demand and economic value of municipal and industrial water supplies from reservoirs au- thorized by the Water Supply Act of 1958. | ee 2 2io 2215 Sanitary engineering activities___.._______ 12, 789 441 1,166 (22ers 14, 396 14, 207 Foreign quarantine activities___-________- AP O48. |C hens so 278 (2.2 eee 4, 626 4, 616 Construction, mental health facilities, Merritoryeor Alaska .2 55:02 soy Bears i ts Oy 500) | Aes 52. JCS Soe 2 ee 62500". Berek ee Equipment, communicable disease center_ 1,700" pac Bie aa ek oe =| 1, 700 908 Hospitals and medical care__-.._----.----- GO;a 74 este tee tse 4,009))222.. See 55, 383 55, 286 Dependents’ medical care_.._____-_------- 884) ou. sett ce ee | 384 382 Salaries and expenses, hospital construc- GION: SCIVICOS to Re See Senet eh 1, 600 5 ae eee 1, 635 1, 626 Indian health activities._......._....____- 42°169 |2f1ee ee 727 1 510 43, 406 42, 359 Construction of Indian health facilities (1959-60) Terri re reer sree. Exige ee Ae D4 SLES eT | ee 4,124 2,018 Construction of Indian health facilities (4.958-50) Sore PARED ELT See oe EU A CEE tee eee Ce Eke 2, 490 2, 490 Zook Construction of Indian health facilities (MO year) tis: wrasse ore a VISSO" | Ss a2. eel ke ae 7, 637 9, 523 8, 422 Grants forhospital construction.(1959-60)_|. 186,200 Jl---.2 2. ele 2 |e ee 186, 200 90, 472 Grants for hospital construction (1958-59) _|....__-.-_]_--------_]_----.-__ 76, 337 76, 337 75, 562 General research and services, National Institutes‘of Healthesici tis eben PTE BAe esc fomige Be |b 4 eae |B ee 28, 974 28, 957 National'Cancer Institute... -..-22----- =5_ 05208 4) sieeeere ee dn Ol ee 75, 279 69, 409 Mental health activities.......-.--___-___ 2, GION See Fel 42) cy ee 52, 461 49, 931 National Heart Institute 2-220 SO OVS ae cle ee eee, | ee 45, 613 45, 468 Dental health activities___._.....___...__-- Ci OA bags ae ee 1 cha oe 7, 421 7, 406 Bulldingesandaacilitiess ©incimnatl, Oise lone ee ee jl 11 6 Arthritis and metabolic disease activities._| 31,215 |___._____- 358; | Jue 31, 573 31, 484 Allergy and infectious disease activities___| 24,071 |_---_---__ 0) |e eee 24, 076 24, 044 Neurology and blindness activities________ 294030 saws Weer 2 einai t a eae 29, 403 29, 033 Operations, National Library of Medicine_ 1, 415 lll 11 pee 1, 5387 1, 583 Construction of library facilities__.-.._____ 6;,075y(|2 feo) 3234 |e_ dys eee ee 6, 975 4, 734 Grants for waste treatment works con- striction (1959-60) bse... 5S ee 45, 000 (24 teuct clog sous eeh hee pee 45, 000 36, 558 Grants for waste treatment works con- struction (1957-60).<224.--2s22. 4... )5_.-2 Obit coisa tote eee 9, 670 10, 327 9, 670 1 Liquidation of contract authorization obligated in 1958 fiscal year. Public Health Service 137 Table 1.—Statement of appropriations, authorizations, and obligations, fiscal year 1959—Continued [In thousands] Funds available for obligation Total Appropriations Appro- Net Repay- Prior funds | Amounts priations | transfers | ments year available | obligated and between for unobli- authori- | appro- | services gated zations | priations balances Construction of Biologics Standards Lab- OUAEOLVmENTMOeeriene sos. totes tee eee a ek $598 $598 $544 Construction of surgical facilities_____.___- ps Rees a oe 1, 548 1, 883 1, 575 Construction of Dental Research Building- Su COU: aera ene cee Apes ee ee 3, 700 2, 507 Grants for construction of health research SACU Smwepeere on ae ee SOHOOO) [eee aL ee ae ce alee Te ieee 8 30, 000 29, 960 Consuuchonoranimal quarters... 2222.2 .|7 0 eye ee 154 OAD emer eee General Otice building. =. 2. ....=.... OROS8 (a |. Be ee | oe ee TS 9, 687 135 Cons ruction of research facilities. :.2-£2. |... .3.5_.|..L J. 2s. 2222 105 105 1 Retired pay of commissioned officers______ 1, 627 ra Ul |e eee ne A ee | ee 1, 576 1, 576 Salaries and expenses_-__._..-.-.-..-_--_-- 5, 260 406 lily kPa os PY PAL 5, 703 National Institutes of Health manage- TEOGTOR RLU VG | 5 pk? ES ga Ee es ee ee (ee DMN OSe a=. eet ee 22, 153 22, 109 Appropriations, special project funds mageavalaole py other agencies: _|_..-. 2 fc Jue te fee 2 7, 567 6, 529 Salaries and expenses, Bureau of Prisons ila CmCOnerE Veer Elis eee aaa sel he eee A ie ee a ae 1, 921 1, 920 American Sections, International Com- missions, State (transfer to HEW, lias) een Dee ti see ee ee We AS Se ee la eB 70 69 Salaries and expenses, Office of Civil and Defense Mobilization (transfer to HEW, TEE Sipe tet an Oe) a A RS OR | eh arr ae 9 (et eA) (ARC PU (Een (Nee RR oP 170 170 Research and development, Office of Civil and Defense Mobilization (transfer to LEDS. TRIBUS) oo Se oe SIRE 0 See hi (ee, * See Ol (LL Ue ON (ene Oa 356 120 Farm labor supply revolving fund, Bureau of Employment Security (transfer to Teco hy, TRIES i ag’ ie 5 San A es Bee a age (ee (en BR a 651 616 General administrative expenses, section 411, Mutual Security Act, executive CEPQTOR 2Ee THO) TELID se aay aa BO eae seg ne Le (ces Sen ee | 51 49 Special assistance in joint control areas in BIMoOpey executive (transter to HURW,) 2-\= 22222 |. 2 | Xe |2 2 2 3 3 Technical cooperation, general executive iEatisierscOminPnh) a(annial et ocsee. (2 el eee sles ee eee Ba 2, 132 1, 956 Technical cooperation, general executive (GranstervonlebByW) (NO-year) 2222-22 252-|oseccccuas|lesccctec_lecccscseecleeseee cee 1, 734 1, 166 Defense support, general executive (trans- Cope WG LOD NAYS oe 3g SO Ss a) ea ae a a (-T | t| e 312 298 Special assistance, general, executive (COSEYGSTSIP (ig) 15 CBI NAVY SSeS I a, SER 5 Oe (oa ee (Pe a 153 148 Salaries and expenses, Office of Civil and Defense Mobilization (transfer to HEW, CUEEIGS, GLE SELES A IE oa a Pe 14 1 Gift funds donated for general and Speemie purposes: f=... 22-2. GDI Ie Sie Set oe |e eel 148. 4 296. 3 122.4 Patients’ benefit fund, Public Health Netvicewlospitaise.£...6-0 2 owe kos eek STB geek eran aE See ae 15s8 52.6 o2n! 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The criticisms of former years gradually were, for the most part, taking a more constructive turn, with frank appraisal and action resulting. American educators, school administrators, and informed laymen, knowing their schools were not perfect, were seeking without employing crash programs or overemphasis, to strengthen the broad foundation of public educa- tion so that every child could develop his potentialities to the fullest. What were the influences which brought about this determination and the resultant achievements? For a number of years, critics—laymen and professionals, informed and uninformed—had pointed out what they thought were weak spots in American education. Some of the criticisms were justified; others were not. During this period many bills designed to aid or support education were considered by the Congress and other legislative bodies. Out of this criticism and from the debate on educational legisla- tion, there came a sharper public and professional awareness of some of the basic deficiencies in the Nation’s schools, which required con- certed action to correct. 1The U.S. Office of Education was established by Congress in 1867 for the purpose of collecting and disseminating statistics and facts, and promoting the cause of education. The Office had approximately 920 employees at the end of fiscal year 1959. Its budget for salaries and expenses was $6,927,500. Federally appropriated amounts were administered by the Office for the following Federal programs: Vocational education, $40,888,412 ; land- grant colleges, $5,051,500; school assistance to federally affected areas, $225,400,000 ; cooperative research, $2,700,000; library services, $6,000,000; and defense education ac- tivities, $115,300,000. 143 144. Department of Health, Education, and Welfare, 1959 While ways to remedy deficiencies in key areas were being sought, the American people would not forget the broad basis upon which their educational system is built. Results of the White House Conference on Education were fresh in the minds of schoolmen and laymen as they worked to improve all aspects of the educational program. Fresher still were the recommendations of the President’s Commit- tee on Education Beyond the High School and the proposals of a task force on higher education appointed in 1957. These studies formed the basis for administration proposals which were introduced in both branches of Congress in January 1958. The legislation that emerged as the “National Defense Education Act of 1958” was a compromise, incorporating features of several bills. NATIONAL DEFENSE EDUCATION ACT FILLS A CRITICAL NEED The Act was signed into law by President Eisenhower on Septem- ber 2, 1958. In it the needs of both education and national defense are served in the recognition “that in a free society the individual is the first line of defense.” What were the needs which the provisions of this Act sought to alleviate? A look at the following statistics reveals a few of the conditions which existed in the fall of 1958. Some of these indicate healthy growth; others indicate deplorable lags, shortages, and omis- sions. But they all reveal basic needs which, in part, the programs of the Act sought to meet. First, some desirable increases: @® The 1958-59 school and college enrollment totaled 44,540,000, or about 26 percent of the Nation’s population, an alltime peak and an increase of 2,096,000 over 1957-58. Of the total United States population of persons between 6 and 17 years old in October 1958, 96.4 percent were enrolled in school. @® Public and nonpublic elementary schools—kindergarten through grade 8— enrolled 32,010,000 children, an increase of 1,340,000 over the previous year; secondary schools—grades 9 through 12—enrolled 8,940,000, an increase of 516,000; institutions of higher education, 3,590,000, an increase of 210,000. En- rollment increase over the previous year in the secondary grades was 6.1 percent and in the elementary grades, 4.4 percent. @ At the beginning of the 1958-59 school year there was an estimated increase over the previous year of 8,900 new qualified elementary and secondary teachers. ® Degree granting institutions of higher education conferred a total of 440,304 degrees in 1957-58, 7.1 percent more than in 1956-57. But, unfortunately there were many undesirable conditions in some of the schools of the Nation: ® During the 1956-57 school year, only about one-third of the high school students in the grades where the courses are usually offered took chemistry or intermediate algebra; about one-fourth took physics. @® It is estimated that approximately 10 million public elementary and second- ary school pupils attended overcrowded or double-session classes during the past year because of the need for 182,000 additional ep teachers and more than 140,000 classrooms. ® Only eight State departments of education had full-time consultants in science; only three in mathematics; and only three in foreign languages. : | | , | | : | Office of Education 145 | @ Only six States required their schools to maintain cumulative records of _ their pupils. | @ The estimated current shortage of high school counselors was 15,000. More | than 50 percent of all high school counselors were located in only seven states serving about one-third of the nation’s secondary students, and an estimated two-thirds of these counselors did not meet minimum certification requirements. | @ Few, if any, schools and colleges in the United States taught the languages spoken by more than three-fourths of the earth’s population. | @ In spite of an estimated need last year for a minimum of 30,000 new college teachers, only about 13,400 were recruited. Fewer than one-half of the ap- | proximate 9,000 persons who earned doctoral degrees, chose college teaching as a profession, and less than 2,000 entered college teaching for the first time. | @ In the fields of mathematics and engineering, less than one-fourth of the | new college teachers were Ph. D.’s. Into such a flood of needs the National Defense Education Act was | launched in the fall of 1958. The administration of the National Defense Education Act, which | was committed to the Office of Education with the exception of title | IX, required an unusual amount of planning and action. Further- | more, it was urgent to implement the provisions of the Act with all _ possible haste as the school year was already beginning when this law was signed by the President. Activities relating to the National Defense Education Act, therefore, occupied a priority position among | Office activities during the year. | CONTINUING OFFICE ACTIVITIES Large as were the responsibilities inherent in administering the | National Defense Education Act during the fiscal year, these activities | were carried on in addition to the basic and continuing responsibilities of the Office of Education. In fulfilling these responsibilities, Office staff members prepared | scores of articles for the Office of Education periodicals School Life and Higher Education and for the professional journals of many edu- cational organizations. Specialists from all branches of the Office | cooperated with Federal agencies and other national organizations | In projects of mutual concern to education. Consultative services were _ provided to State and local agencies on problems such as the improve- ment of personnel administrative practices, detailed procedures of recording and reporting educational data, current school and chil- _ dren’s library problems, and educational legislative measures. Con- _ sultative services were also provided to private educational] institutions. Through its regular program of gathering, interpreting, and dis- seminating basic data, through its surveys of educational programs at all levels, and through research in organization and administration problems, the Office of Education endeavored to meet the needs for information and assistance. In performing these services, the Office 146 Department of Health, Education, and Welfare, 1959 © sought to focus attention on educational problems whose solution ap- | peared to be essential to the national welfare. The National Defense Education Act of 1958 In the National Defense Education Act of 1958 (Public Law 85- — 864) the Congress recognized that the defense and the security of the Nation are inseparably bound with education. The Act was — another landmark in the history of Federal concern for education. ~ It followed such historical educational legislation as The Ordinance of 1785, the Morrill Land-Grant Acts of 1862 and 1890, the Smith- ~ Hughes Vocational Education Act of 1917, the Bankhead-Jones Act — of 1933, the George-Barden Act of 1946, and Public Laws 815 and © 874 of 1950. The National Defense Education Act authorized the appropriation of over a billion dollars during its 4-year life. The programs which — these funds inaugurate were wisely designed by the Congress to affect the entire system of education from the elementary grades through the graduate school. The prompt and effective implementation of © these programs constitutes an impressive testimony to the untiring and dedicated efforts, not only of the staffs of the State departments of education and of the institutions for higher learning, but also the staff of the Office of Education. ORGANIZATION AND PLANNING Upon approval of the legislation, the Commissioner solicited the eS ee active cooperation of the chief State school officers and the presidents | of colleges and universities, and advised with other leading educa- tional officials and consultants, including personnel from State agencies and heads of national organizations, for the developing of guidelines and policies to implement the National Defense Education Act. More than 500 educators cooperated in this work. Within the first few months, a detailed explanation of the Act was made to approximately — 4,000 key administrators in higher education. The Commissioner designated four divisions of the Office of Edu- cation to assist with the administration of the measure. The Divisions assigned primary responsibility are as follows: 1. Dwision of Higher Education: Title II.—Student Loans; Title [IV.—National Defense Fellowships; Title V, part B.— Guidance Institutes; Title VI—Language Development. 2. Division of State and Local School Systems: Title III.—Fi- nancial Assistance for Strengthening Instruction in Science, Mathematics, and Modern Foreign Languages; Title V, part A.—Grants to States for Guidance, Counseling, and Testing Programs; Title X.—Grants to States for Statistical Services. : l i \ | | Office of Education 147 3. Division of Statistics and Research Services: 'Title VII.—More Effective Utilization of Communications Media. 4, Dwision of Vocational Education: Title VIII.—Area Voca- tional Programs. In order to accommodate and centralize the activities growing out _ of some of the titles of the Act, sections of the Office were shifted and _ combined, and new branches were created. Twelve of the chief career / administrators of the Office of Education were transferred to leader- _ ship positions in NDEA programs and about 30 experts recruited. During the year numerous regional meetings were held under the | sponsorship of the Office of Education. Great interest and enthusiasm | were shown by State and local agencies, representatives of institutions of higher education, and by leaders in educational, scientific, and re- | lated organizations. The meetings encompassing State programs were arranged in coop- _ eration with State supervisory personnel. Asa result of these sessions, | mutually helpful channels for working relations between the U.S. | Office of Education personnel and State and local supervisors were opened, misunderstandings were clarified, further interpretations were provided for, opportunities were given for State supervisors | to explore common problems with Office personnel, and needed serv- ices which the Office of Education can provide were determined. Similarly, regional meetings encompassing higher education pro- grams were held in the fall of 1958 with representatives of higher educational organizations and institutions. Office specialists supplied information on the provisions of the various titles of the Act and on details for implementing the provisions. Consequently, these pro- grams were in operation much sooner than would otherwise have been possible. Broad plans for launching programs for more effective educational use of mass communications media were discussed at a major con- ference called by the Office of Education in October 1958, and held in - Washington, D.C. At a second conference in January 1959, repre- sentatives of several major professional educational organizations and associations met to discuss ways and means of implementing the programs. Throughout the year Office staff participated in the meet- ings of national professional organizations to explain the provisions of title VII. Regional conferences are planned for 1960. The National Defense Education Act is not to be regarded as a single specific program, nor as a string of isolated provisions. It is, rather, a mighty complex, in which each part reinforces the other, and all parts join to strengthen education across the board. In this report, however, an account of accomplishments under each title of the Act administered by the Office of Education will be given. es 148 Department of Health, Education, and Welfare, 1959 — NATIONAL DEFENSE EDUCATION ACT IN FISCAL 1959 Trrin II.—Loans To STUDENTS IN INSTITUTIONS OF HigHER EDUCATION Funds authorized for fiscal 1959: $47.5 million. Appropriation for fiscal 1959: $31 million. Basis: Institutions must provide $1 for each $9 in Federal funds. This program is designed to help public and nonprofit private colleges and universities establish or increase student loan funds so that more able students can complete their higher education. Accomplishments @ By the end of June 1959, the Office of Education had obligated $30,882,663 million to 1,197 institutions of higher education for student loans. With the institutions’ own contributions to the loan funds, more than $34 million in Federal and institutional funds were made available to worthy students in fiscal 1959. @ A new set of guidelines was formulated for the evaluation of all 1959-60 student-loan applications by a special consultant panel composed of 12 distin- guished college administrators. The new formula allowed the institutions more latitude in establishing their requests for funds, while at the same time it safeguarded the use of the funds in line with the statutory responsibility of the Commissioner of Education. @ Twelve regional workshop conferences on the student-loan program were held. These were instrumental in clarifying the provisions of the title, espe- cially in identifying the degree of financial need of institutions. @® Regional representatives reported enthusiastic reception of the student-loan program in all parts of the country. Administrators in institutions of higher education were eager to talk with them. A rising tide of interest in the program was registered throughout the year by an ever-increasing number of inquiries that came to the offices of administrative heads, regional representatives, and to the Office of Education itself. These reports from the field indicated that institutions manifested a commendable ingenuity in the use of loan-program information and funds to attract talented students, to stretch institutional scholarship funds, and otherwise to make it possible for many students without funds to continue their education. Tirtp JII.—FinancraL Assistance For STRENGTHENING SCIENCE, MarTHEMATICS, AND Mopern Foreign LAncauace Instruction Funds authorized for fiscal 1959: $75 million. Appropriation for fiscal 1959 : $57.35 million. Basis: Fifty-fifty matching required for equipment purchases and minor remodeling ; no matching for State supervisory and related services in fiscal 1959 (fifty-fifty matching is required in the following years). This program provides financial assistance through (1) grants to States for local elementary and secondary schools for the purchase of laboratory or other special equipment in the areas of science, mathe- matics, and modern foreign languages and for minor remodeling of laboratories; (2) loans to nonprofit private schools on the same level and for the same purposes; and (3) grants to States for expansion or improvement of supervisory or related services in public elementary 0 a a ee | Office of Education 149 or secondary schools in the same subject areas, and for administra- tion of the State programs. | Accomplishments | @ State plans outlining programs under which funds would be expended for | equipment and minor remodeling, were submitted for approval by 50 States and outlying parts of the United States, and 49 were approved by the end of the fiscal year. From an appropriation of $49,280,000, a total of $32,617,341 | was certified for payment to States for this purpose. @® Of 132 completed applications for loan funds submitted by nonprofit private | schools, 88 were approved by the close of the fiscal year. The sum of $6,720,000 | was appropriated for the year, and of this amount $1,104,919 was approved for | loans. The loans varied in amounts from less than $1,000 to more than $50,000. @® The States, upon being advised that their plans had been approved, aug- / mented their professional and administrative staffs in order to supervise the | programs. From an appropriation of $1,350,000, a total of $1,130,756 was certi- | fied for payment to the States for this purpose in fiscal 1959. The States estab- | lished procedures for local educational agencies to follow in submitting their | projects for approval, and standards for equipment to be purchased. They | held conferences with representatives of local school systems to explain the Act | and the requirements for participation. @ Under the leadership of the Council of Chief State School Officers and with | the cooperating assistance of the Bureau of Standards and the Office of Educa- tion, a valuable book entitled Purchase Guide was published, and 44,000 copies were distributed free to schools. The Guide contains valuable aid to local school systems in making application to State educational agencies for assistance in purchasing items of equipment in the fields of science and mathematics and on new methods and materials for teaching modern foreign languages. TirteE LV.—NATIONAL DEFENSE FELLOWSHIPS Funds authorized for fiscal 1959: Sums sufficient for 1,000 fellowships. Appropriation for fiscal 1959: $5.3 million. Basis: No matching required. This program is designed to assist in the expansion and improve- ment of facilities for graduate education and to increase the supply of well-trained college and university teachers. Accomplishments @ The 1,000 fellowships authorized in 1959 were administered through 272 programs in 123 graduate schools. These programs were chosen from among 1,040 proposals submitted by 169 graduate schools, and called for 6,000 fellow- ships. Because of the time necessary to process these applications, it was im: possible for any fellows to begin study before summer, and the great majority began their work in September 1959. @ The total cost of the fellowships approved in fiscal 1959 was estimated at $5.3 million. Of this amount approximately half was for fellowship stipends and dependency allowances and half was for grants to participating institu- tions to provide the cost of educating the fellows. @® College and university heads were enthusiastic over the fellowship program. They encouraged teachers on their staffs with less than the doctor’s degree and promising young men who were just finishing their undergraduate work, to make application for graduate fellowships. 150 Department of Health, Education, and Welfare, 1959 Tirts V.—Guipancr, CouNnsELING, AND TESTING; COUNSELING AND GUIDANCE INSTITUTES Part A—STATE PROGRAMS FOR GUIDANCE, COUNSELING, AND TESTING Funds authorized for fiscal 1959: $15 million. Appropriation for fiscal 1959: $7.4 million. Basis: No matching for 1959. Fifty-fifty matching for the following years. This program provides for testing programs in secondary schools to identify students with outstanding abilities and a program of guid- ance and counseling in the public secondary schools. Accomplishments @ During the fiscal year, 47 of the States and outlying parts of the United States submitted plans involving total funds in the amount of $6,238,538, which were approved for payment to the States submitted in time for use in the spring of 1959. ® States participating in title V(A) spent an estimated 18 percent of the funds for State supervision and related services; 38 percent for testing; and the remaining 44 percent for local guidance and counseling programs. @ Under the provision whereby nonpublic schools may receive funds for testing their students, 728 applications involving 54,693 students were filed from 26 States and the District of Columbia. Funds for this purpose in the amount of $50,752 were withheld from State allotments, PART B—COUNSELING AND GUIDANCE INSTITUTES Funds authorized for fiscal 1959: $6.25 million, Appropriation for fiscal 1959: $3.4 million. Basis: No matching required. This program is designed to increase the supply of qualified guid- ance and counseling personnel and to improve the competence of those now working in the counseling field. Accomplishments @® Fifty counseling and guidance training institutes located in widespread geographic areas of the country were operated during the summer of 1959. These enrolled approximately 2,210 secondary school counselors. The estimated cost of operating the institutes was $2,248,319. @® Seven institutes were authorized to be held during regular sessions, begin- ning in the fall of 1959. It is estimated that in these institutes more than 300 persons with little or no previous training will receive instruction at a cost of more than $1.1 million. @® More than 300 institutions advised the Office of Education that they wanted to participate in this program. Approximately $5 million, available for the coming fiscal year, will make it possible to operate institutes in an estimated 98 of these institutions, @ In spite of the excellent geographical dispersion achieved in locating these institutes, teachers in many areas found it impossible to travel the distance to attend. It is hoped that the benefits of this title will soon be extended to those areas where few counseling programs exist. | Office of Education 151 Titte VI—Laneuace DEVELOPMENT Part A—LANGUAGE AND AREA CENTERS, FELLOWSHIPS, AND RESEARCH Funds authorized for fiscal 1959 : $8 million. Appropriation for fiscal 1959: $3,416,000. Basis: Fifty-fifty matching required for centers; not matching required for students receiving stipends. This program provides for centers for teaching foreign languages | rarely taught in this country; for modern foreign language fellow- | ships; and for research related to more effective and extensive meth- | ods of teaching languages and to the development of specialized teach- | ing materials. Accomplishments | ® Agreements for the establishment of 19 language and area centers were com- pleted with 14 institutions. These centers are providing instruction not only | in the languages themselves but also in the economic and cultural aspects of the countries or areas in which the languages are spoken. From the 1958-59 | appropriation, approximately $500,000 was obligated for this purpose. | @ From 354 applications the Commissioner awarded 171 foreign language fel- | lowships for advanced study and research in 25 institutions of higher education. These ‘are distributed as follows: 22 in Arabic, 32 in Chinese, 10 in Hindustani, 24 in Japanese, 14 in Portuguese, and 69 in Russian. @ Eleven of the awards were for summer-session 1959 studies; 25 were for studies beginning in the summer and continuing through the 1959-60 academic year; and the remaining 135 awards were for the 1959-60 year only. An estimated $500,000 has been allocated for these fellowships. @ Twenty research and development projects (Studies and surveys, 6; re- | search of more effective teaching, 6; and development of specialized materials, | 8) were under contract with institutions of higher education, organizations, and | individuals. These projects ranged in character from sending an American scholar to the Near East to make recordings of a critical but little-known Asian language to a massive 3-year program for developing instructional materials in 25 Ural-Altaic languages. A typical project was a 3-year survey of all aspects of modern language instruction in the United States. A total of $2,415,749 from 1958-59 funds was obligated for these studies. Part B—MopernN ForREIGN LANGUAGE INSTITUTES Funds authorized for fiscal 1959: $7.25 million. Appropriation for fiscal 1959 : $1,594,617. Basis: No matching required. This program provides for institutes to be established in institutions of higher education to improve the skills and effectiveness of ele- mentary and secondary school teachers of modern foreign languages. Accomplishments @® Twelve summer-session institutes were established from among 251 pro- posals submitted. At the first institute to get underway 1,500 language teachers applied, of which 100 were enrolled. Approximately 1,000 teachers attended 152 Department of Health, Education, and Welfare, 1959 — EEE a, these institutes which ranged from 6 to 8 weeks in length and provided instruc- — tion for elementary and secondary school teachers of French, German, Spanish, and Russian. @ Four academic-year institutes were planned for operation during the 1959— — 60 school year. At one, 20 secondary school teachers will study Russian; at a ~ second, 20 secondary school teachers of Spanish will further their studies; at a third, 20 secondary school teachers of French will study; and at a fourth, 35 elementary teachers of modern foreign languages will continue their studies. @ The total cost of the language institutes program for fiscal 1959 was about $1.5 million. Tirte VII.—REsSEARCH AND EXPERIMENTATION IN More EFF&crive UTILIZATION OF COMMUNICATIONS MeprIA Funds authorized for fiscal 1959: $3 million. Appropriation for fiscal 1959: $1.6 million. This program provides for research and experimentation in the educational uses of television, motion pictures, radio, and related media, and for the dissemination of information on these media to State and local educational organizations and to other educational institutions. Accomplishments @ After evaluating more than 350 proposals, the Advisory Committee approved 69 of these. The Office of Education gave grants amounting to $1,349,985 to 23 of the 69 successful applicants. Complete funding of all activated projects, requiring a total of more than $5,353,000, must wait availability of funds in the future. @ Of the 65 proposals which have been approved, and on which negotiations are complete, 19 are concerned with an investigation of the types of content suitable to teaching via the new media, 20 are investigating methods of using the media in teaching, 17 will examine the quality of education resulting from the use of the media, and 9 are making direct comparisons between the effective- ness of the media and of traditional methods of instruction. @ The Office of Education contracted 14 dissemination projects for a total expenditure of approximately $250,000. These dissemination projects were con- cerned with one or more of the following purposes: to provide information about research completed, in process, or projected; to provide more information about significant programs and teaching practices; to increase the accessibility and availability of the new media by bibliographic and direct means; to improve directly the educational use of the media and the training of teachers for such use; and to develop national goals, standards, and guidelines for improved edu- cational uses of the media. ® Total obligations under title VII were $1,599,935. Office of Education 153 Trttzm VIII.—Area VocationaL EpucATion ProGrRaMs Funds authorized for fiscal 1959: $15 million. Appropriation for fiscal 1959: $3.75 million. Basis: Fifty-fifty matching by State and/or local funds. This program is designed to fit young people and adults for useful employment as highly skilled technicians in recognized occupations requiring scientific knowledge, as determined by the State Board for each State, in fields necessary for the national defense. Accomplishments @® Forty-six States, Hawaii, Puerto Rico, and the District of Columbia partici- pated in programs under this title during fiscal 1959. @ Approximately 47,500 persons were enrolled in more than 660 title VIII programs and courses during the fiscal year. @® Offerings during the year provided training for highly skilled technician oc- cupations in fields such as electronics, drafting and design, tool and die design, instrumentation, industrial chemistry, business data processing, and computer programming. Since extensive day-school courses could not be established quickly, most of these vocational courses were of the extension type. type. TirLE X.—Sxrctrion 1009: IwprovEMENT OF STATISTICAL SERVICES OF Sratre EpucATIONAL AGENCIES Funds authorized for fiscal 1959: $2.75 million (not to exceed $50,000 for any one State). Appropriation for fiscal 1959 : $489,383. Basis: Fifty-fifty matching. This program is designed to help the States improve the accuracy, speed, and scope of their statistical services so that nationwide data on the condition and progress of education will be greatly improved. Accomplishments @® Plans from 42 States, the District of Columbia, Hawaii, and the Virgin Islands were approved. Twenty-nine of the States and outlying parts of the United States completed their applications in time to receive funds amounting to $365,927 during fiscal 1959. @® A variety of ways of improving statistical services were revealed in these plans. Forty-two States planned to add personnel; 41 to adopt standard termi- nology, definitions, and units of measure; 26 to improve their State agency statistical services organization ; 17 to speed the process of collecting, analyzing, and reporting by the installation of data processing machines; 18 to add data- processing machines to those already in use; 37 to issue manuals and handbooks for use of local school personnel who record and report statistics ; 43 to provide workshops and conferences in local communities for the inservice training of these local school personnel; 41 either to broaden their data collection systems or to close the gaps in their present ones. @ These plans will make it possible for the States to improve the adequacy and accuracy of data and to speed the collecting, processing, and reporting of educa- tional information. Many of the States will conduct conferences, workshops, 530344—60——11 154. Department of Health, Education, and Welfare, 1959 and other kinds of inservice training activities to increase the efficiency and competency of local and State personnel engaged in recording and reporting educational data. @® Furthermore, 43 of the States planned comprehensive and intensive evalua- tions of their entire statistical services in order to provide wisely for future needs. 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Aloe SES Adyvances.in. Prostheties . og. 22522 56 a hin ALOU Oli CLL BORER AericulturaleProictiss..0..cene5s owte wane Jul. ooo ee et Prejects:ing Mental: Healths... 2.0.22 2 Sen I Z Tate 223 Epileptics at Work_________- seus ig da cl bua 2u0° 224 Selected Demonstrations... ... 1.2 a ee Rehabilitation Research Fellowship Program... 1.1 .___3 2 224 STATE-FEDERAL RELATIONSHIPS UNDER New Law ProvipgE INCENTIVES FOR EXPANSION OF SERVICES TO DISABLED_____________=_---- 2222-2. 224 Expansion of Staffs and Services______- See een nee 225 State Planes 2754 see reine NERS eee RT es CO 225 State Program Development 02 {02 Soe Be oe eee 226 More state and Community Facilities... 4 oe P a ee eee 226 Expansion¥Grants 4.33.4 Pi Fis e ts 335 te ee tg Pee Extension and Improvement Grants A a SSC See RMS ee 226 State-Federal Expenditures for Facilities and Workshops_________.__._- 227 Aid Under Hospital Construction Legislation_______- es 5. 2S Professional. Organizations Among Centers........- 22 2__ 4“. S3 5 ee 228 Demand for Special Facilities. ______-_- bewow O8Gh2 So OL 228 TRAINING OF QUALIFIED PERSONNEL FOR ALL PHASES OF Progra Is EXPANDED IN NUMBERS AND OBJECTIVES MRE. eet meeps 229 Medical Students Indoctrinated ___ a a Praining in..Prosthetics.......< wei agri ee Se Lv Io eae 231 Tota oF FEDERAL GRANTS_2-_______= 6 SOA EE pat) Detailed Contents REHABILITATION OF THE AGING Is AIDED BY RESEARCH AND NEW SERVICES Ma ROPORTION IN POPULATION INCREASES. 2 ee States Emphasize Programs for Aging____________-_ ERS Citas Ne tert ceaireag Seth Reeromrnviow and OASI=-—---+--.<--5---2e22oe-=5 sete eee eM Rermetenee On Aging. =.=... 22-2222 ceeee ge ee i U8 IRI ee Ut ore te et ee Oe ee ee Pee en emctarded= 2/2 0.9 oo 8 ii 2g tbo fe Be Ge Sh ae a ais eases of Retardation Examined... -.2. 2... Le aIe Te) TENT) 6 oe a ee ee emer eae Lea sa ts ibe! irate. re eh Meese ie eh eatin oe en se en TasuLE 1.—Number of referrals and cases, by agency, fiscal year 1959______ TasBLeE 2.—Vocational rehabilitation grants, 1959, State divisions of Semmmenemer ence maiitatioi. 226 2 oe ee ee ce TaBLeE 3.—Vocational rehabilitation grants, 1959, State commissions or eS LSS CURLEES O10 01 ¢0 RES i ga a ne PP CHART 1.—Disabilities and major occupational groups________._______- SAINT ELIZABETHS HOSPITAL Meee ( LINTOAT, SERVICES... 24.2. 2222-24-l22 2220-5 n2u2ckL. Cii@icaoranches__.._. =... 2 ee ee tio eed ee Le emeerreocreurcical Branch. 2-00.22... koe eek Sk seed PR eH oe at I de ee DRE dye A WON cS. 2 ae oe DUR eR ee a Geen ot Pevenology Branch. __.__.. ety ies ee A eh ee ee OMe SER ae Ce Recreational Therapy Branch-__---_--_- Ls ee eae Se ER ae e: BME es CCCs TAO